Aerobic exercise in mental disorders: from basic mechanisms to treatment recommendations

Excerpt

During the last years, several lines of evidence support the notion that aerobic exercise has the potential to improve symptoms and outcomes in severe mental disorders. Patients with schizophrenia (SZ) and major depression (MDD) have increased morbidity and mortality. For example, in a 12-year follow-up study, Speerfock et al. [1] found evidence for severity of MDD and bipolar disorder as important correlates of long-term changes of arterial hypertension and obesity. Increasing physical activity by aerobic exercise programs may improve metabolic syndrome and cardiovascular risk factors in patients with mental disorders, thus improving mortality [2]. A new meta-analysis [3] reveals that SZ patients have lower vigorous physical activity, and this variable correlates with disease-specific factors of social functioning such as withdrawal, low independence performance, employment and motivation/energy. For a long time, specific mechanisms of aerobic exercise-mediating effects on the pathophysiology of mental disorders were unknown. In a comprehensive review, Maurus et al. [4] summarize the effects of aerobic exercise on symptoms and cognition, global functioning and quality of life in SZ patients. Improvements in brain volumes and connectivity with special impact on those regions, which are affected in SZ, have been detected in previous studies. On the molecular level, the hypothalamus–pituitary–adrenal axis, growth factors, immune-related mechanisms, neurotransmitters and the endocannabinoid system may mediate the effects of aerobic exercise on brain plasticity. …