Researchers Probe Connections Between Physical Activity and ‘Severe Mental Illness’

How does physical activity affect people diagnosed with bipolar, schizophrenia and major depressive disorders?


Research finds that people diagnosed with bipolar, schizophrenia, and major depressive disorders have lower physical activity rates and higher sedentary rates than the general population. A new study also explores how these differences may vary across geographic regions.

A group of researchers led by Davy Vancampfort published a systematic review and meta-analysis exploring the relationship between sedentary behavior, physical activity, and ‘severe mental illness (SMI)’. In this study, SMI included people diagnosed with bipolar, schizophrenia and major depressive disorders. The results of the meta-analysis demonstrated that people diagnosed and treated for SMI were significantly more sedentary than age- and gender-matched healthy controls.

“Understanding sedentary behavior, physical activity levels, and their correlates among people with severe mental illness may aid in tailoring efforts to improve their long-term physical health outcomes,” the authors write.

Photo Credit: Carol VanHook, “Painted City Walk,” Flickr

Previous studies have demonstrated that people diagnosed with (SMI) have higher levels of premature mortality than the general population. and that these higher rates may primarily be accounted for by cardiovascular disease. Further, a recent study demonstrated a widening of the mortality gap between people with a diagnosis of bipolar or schizophrenia and the general population. Given that prolonged periods of sedentary behavior can increase the risk of cardiovascular disease, the authors of this meta-analysis aimed to:

  1. Determine time spent being sedentary or physically active per day
  2. Compare rates across clinical subgroups (schizophrenia, bipolar disorder, and major depressive disorder)
  3. Explore predictors of physical activity and sedentary behavior
  4. Compare physical activity and sedentary behavior among people diagnosed with SMI and healthy comparisons

Sixty-nine studies, totaling 35,682 individuals diagnosed with SMI and 2,933 controls were included. Physical activity was defined as “any activity that involved bodily movement produced by skeletal muscles and that required energy expenditure” and sedentary behavior was defined as “energy expenditure less than or equal to 1.5 metabolic equivalents of task (METs), while in a sitting or reclining posture during waking hours”. Studies utilized objective measures (n=23), objective and subjective measures (n=3), and self-report questionnaires (n=57) or physical activity.

Time spent being sedentary or physically active per day:

Sedentary behavior

People diagnosed with SMI were sedentary for 476 minutes per day during waking hours and were more sedentary than healthy controls. Interestingly, study results found that people in Europe were significantly less sedentary (413 min /day) than those in North America (586 min/day), South America (555 min/day), or Asia (579 min/day).

Physical Activity

Mean amount of physical activity in the SMI group was 38.4 min per day. Individuals with a SMI diagnosis had significantly lower rates of moderate physical activity and vigorous physical activity than healthy controls. Those in Europe had higher levels of moderate or vigorous physical activity (47.6 min/day) than those in North America (26 min/day), and Oceania (13. 1 min/day). People diagnosed with SMI were more likely to not meet the physical activity guidelines than healthy controls.

Compare rates across clinical subgroups (schizophrenia, bipolar disorder, and major depressive disorder):

Sedentary behavior

Those with a bipolar diagnosis were significantly more sedentary (615 min/day) than those with schizophrenia (493 min/day) or major depressive disorder (414 min/day).

Physical Activity

People with a bipolar diagnosis engaged in significantly more moderate or vigorous physical activity (84.2 min/day) than those with a schizophrenia diagnosis (37.5 min/day), and major depressive disorder (28.8 min/day).

Explore predictors of physical activity and sedentary behavior:

Lower physical activity levels were associated with male gender, being single, unemployment, fewer years of education, higher BMI, longer illness duration, antidepressant and antipsychotic medication use, lower cardiorespiratory fitness and having a diagnosis of schizophrenia.

The authors of this study conclude that physical activity and sedentary behavior present important and modifiable risk factors for premature mortality. Moreover, not meeting physical activity guidelines is associated with longer ‘illness’ duration, fewer years of education and antipsychotic prescription.

There are numerous potential benefits for increasing physical activity rates and/or decreasing rates of sedentary behavior. The significant differences between geographic regions highlights that although there exists an interest in promoting physical activity in treatment for people diagnosed with SMI, it has yet to be fully embraced by most parts of the world.



Vancampfort, D., Firth, J., Schuch, F. B., Rosenbaum, S., Mugisha, J., Hallgren, M., … & Carvalho, A. F. (2017). Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta‐analysis. World Psychiatry16(3), 308-315. (Link)

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Bernalyn Ruiz
MIA Research News Team: Bernalyn Ruiz-Yu is a Postdoctoral Fellow in the Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles. She completed her Ph.D. in Counseling Psychology from the University of Massachusetts Boston. Dr. Ruiz-Yu has diverse clinical expertise working with individuals, families, children, and groups with a special focus on youth at risk for psychosis. Her research focuses on adolescent serious mental illness, psychosis, stigma, and the use of sport and physical activity in our mental health treatments.


  1. Gosh, if you are SO concerned about the “sedentary behavior” of people with “SMI,” maybe you should stop giving them drugs that make it difficult to move and difficult to get motivated to do anything! And if you’re so concerned about heart disease, maybe you should stop giving them drugs that give people diabetes! Sheesh!

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    • The researchers – all twelve of them – considered the point that there was an association between drugs and sitting down and admitted that it may be due to “fatigue as a medication side effect”. But then they reassure themselves: “On the other hand, a psychotropic medication prescription might as well be a measure-of-proxy for illness severity.”
      The researchers said that people in hospital reported being more active than people out of hospital. How does that work? Do you have gyms, etc., in hospitals?

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      • Yes. Blame it on the illness/patient. How convenient!

        The amount of neuroleptics you take has more to do with who your shrink is than anything else.

        Just like whether you’re “bipolar” or “schizophrenic.” A crap shoot that varies from shrink to shrink. Imagine if doctors claimed to be able to transform leukemia into skin cancer with a few strokes of the pen. They can’t–but those are actual diseases.

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    • Agreed. Throughout the article I was thinking about what happened to me when I was put on “medication”…I virtually COULDN”T move! AND all I wanted to eat was sugar and fat.

      I had no energy or desire to move at all and my coordination was so compromised that if I walked on uneven ground in the park I fell over. I had been in the national ski team in my younger years and had continued with skiing, back country hiking, fly fishing, bike riding etc throughout my adult life…until I was forced to take “medication”.

      After having been off all “medication” for over 7 years, my coordination is better than it was, but it isn’t as good as it should be…I still have difficulty skiing (I started skiing at age 3 and so it had been virtually second nature to me) and steep, difficult hikes are out of the question.

      My desire to be active has never quite returned but I make sure I go to the gym a few times a week, walk 15,000 steps a day and am deliberately working to improve my co-ordination by walking on rough ground etc. but it is a bit of a battle. The “medication” totally switched off my energy, desire and ability, and flipping the switch back on is really, really hard.

      That “medication” only seemed to get a passing glance in the research astounds me.

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      • I met a guy when I was advocating for nursing home residents who was so drugged that he could barely open his eyes, and had bruises on his head from running into the doorframe, as he could not navigate through the door. I talked to the activity director, and she said they’d been hitting a volleyball back and forth in the courtyard only a week or so before. They put him on a neuroleptic for “aggressive behavior,” not for a “mental illness” diagnosis. Something tells me his sudden inability to play volleyball (or get out of his chair for that matter) was not because his “mental illness” was so severe.

        — Steve

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      • I agree with Steve. I knew for certain my psychiatrist was totally full of sh-t when he tried to get me to stop exercising. What kind of psychopathic doctor makes such an insane request? How absurd the “mental health professionals” are just now realizing regular moderate exercise is important for a healthy lifestyle.

        I also agree with the others above, it was next to impossible to maintain my hour a day of regular moderate exercise while on the antipsychotics. Plus the antipsychotics took me from sleeping 6-8 hours a night to about 14 hours a night, which is way too much.

        The antipsychotics are the problem, not the solution. They also create the negative symptoms of “schizophrenia” via neuroleptic induced deficit syndrome. And they create the positive symptoms of “schizophrenia,” like “psychosis,” via anticholinergic toxidrome.

        I will say once I was weaned off the drugs I did experience what felt to me like “Godspeed,” the doctors would call it “mania.” I had a tremendous amount of energy, I would get up and dance for a couple hours, then I’d go bike 10 miles; I gardened like a fiend, rehabbed my home, lost about 8 pounds, multiple others even mentioned they could feel the energy. Definitely, the antipsychotics are the problem, not a solution.

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      • I remember a smug creep who ran a “Clubhouse” and would mock us for being tired–laziness of course–and drinking a lot due to thirst–dipsomania and lack of self control. I still drank psychiatric kool-aid then, but I thought Paul was ignorant and cruel. He never was on the drugs we had to take and probably wasn’t even informed about the symptoms they create.

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  2. “…Has a Diagnosis of schizophrenia..” means what exactly? Does it mean a person suffers from “schizophrenia” ; or is it a “play on words” ?

    I stayed chronically disabled and suicidal while I took medication suitable for “SMI”; and I regained longterm functioning capacity once I stopped taking medication suitable for “SMI”.

    (On the subject of exercise I walked 4 miles over to a social gathering tonight and walked 4 miles back again).

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  3. I feel like the title of this article is somewhat misleading. A corrected title would read: Researchers Probe Connections Between Physical Inactivity and ‘Severe Mental Illness’.

    Another thing these researchers might be looking into are the connections between physical inactivity and psychiatric drug usage. I can guarantee you there is a correlation there as well.

    It also makes you wonder, when they are not making the second connection, whether or not this deficit is due in part to connections the researchers might have with big pharma.

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