Investigating the relationship between low physical activity and psychotic symptoms

August 25, 2016

Physical activity can help reduce cardiovascular disease and premature mortality in people with psychological problems. However, there is limited data on exercise in people with serious mental disorders, especially from low- and middle-income countries. This study explored whether complying with the World Health Organization recommendations of 150 minutes of moderate-vigorous exercise per week is related to psychotic symptoms or the diagnosis of a psychosis.

The results indicate, on a multinational level across low-and middle-income countries, that a diagnosis of psychosis is associated with physical inactivity, especially among males. The study also demonstrates, however, that psychotic-like symptoms without a diagnosis of diagnosis of serious mental disorders do not appear to be associated with physical inactivity.

Across the entire population, the prevalence of people getting less than 150 minutes of moderate-vigorous physical activity was 26.9%. Overall, the prevalence of low physical activity was 24.3% in people with psychotic-like symptoms and no diagnosis and 33.0% in people with a diagnosis of a serious mental disorder.

The prevalence of low physical activity in people without any psychological problems was 27.0%. Compared to those without a diagnosis of a psychological condition, patients with a diagnosis of psychosis were more likely to be physically inactive in the overall sample and in males while this was not observed in females.

Research has established that people with confirmed psychotic illnesses such as schizophrenia are at increased risk of cardio-metabolic disease. Cardiovascular and metabolic diseases are the leading causes of the 15 year mortality gap between those with psychotic illnesses and the general population. Though physical activity is effective for the prevention and management of diabetes and cardiovascular disease in the general population, people with psychotic disorders are among the most inactive clinical populations, spending on average almost 13 hours a day engaging in sedentary behavior.

This data from the World Health Survey was a cross-sectional survey carried out in 70 countries between 2002 and 2004. Using a mailed survey and interviews, participants were asked how many days over the past week, on average, they engaged in moderate and vigorous physical activity. Researchers also asked participants how much time they spent engaged in physical activity at a moderate and vigorous level.

The finding that a diagnosis but not psychotic-like experiences is associated with low physical activity may reflect aspects of illness such as low motivation, but may also reflect sedative or other side-effects of therapeutic drugs. Those with psychotic-like experiences but no diagnosis are unlikely to be taking antipsychotic medication.

This is also the first adequately powered data set to demonstrate the importance of sex on physical activity levels in psychosis. The reasons why inactivity affects males more than females with a diagnosed mental disorder is unclear. However, the higher levels of inactivity among males could be due to the typical earlier onset of illness in males, higher burden of negative symptoms which includes low motivation, substance use disorders, and worse remission and recovery rates. Moreover, males with psychosis are more likely to die prematurely due to cardiovascular disease also.

Dr. Brendon Stubbs from King's College London and the South London and Maudsley NHS Foundation Trust, said: "Our data provide the first multi-national evidence that people with psychosis are less likely to achieve the recommended physical activity guidelines. Importantly, our data also offer a novel insight into the potential factors which influence physical activity levels in males with psychosis, who were not only most likely not to achieve the recommended physical activity levels, but are also more likely to die early due to cardiovascular disease. We found that mobility limitations, pain, cognitive impairment and depression are potentially key barriers to physical activity. Understanding and overcoming these barriers could be an important strategy to help people with psychosis be more active, and potentially to reduce their risk of cardiovascular disease."
The paper "Physical activity levels and psychosis: A mediation analysis of factors influencing physical activity target achievement among 204,186 people across 46 low- and middle-income countries" is available at:

Direct correspondence to:

Brendon Stubbs, Head, Physiotherapy Department
South London and Maudsley NHS Foundation Trust
Denmark Hill, London, UK

To request a copy of the study, please contact:

Daniel Luzer- or 212-743-6113

Schizophrenia Bulletin reviews recent developments and empirically based hypotheses regarding the etiology and treatment of schizophrenia. The journal publishes new knowledge ranging from the molecular basis to social and cultural factors. It gives new emphasis to translational reports which simultaneously highlight basic neurobiological mechanisms and clinical manifestations. The Bulletin content consists of original reports, major reviews, and manuscripts organized as a theme by special guest editors.

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