World Psychiatry | Physical Activity as an Adjunctive Treatment for Mental Disorders: Efficacy, Mechanisms, and Implementation Strategies

This study systematically evaluates the efficacy of physical activity across multiple mental disorders, covering children, adolescents, adults, and older adults, providing high-quality meta-analysis evidence. It summarizes critical facilitators and barriers in implementation, offering essential references for clinical practice and research.

 

Literature Overview
This paper, titled 'The efficacy, mechanisms and implementation of physical activity as an adjunctive treatment in mental disorders: a meta-review of outcomes, neurobiology and key determinants', published in the journal *World Psychiatry*, reviews advancements in physical activity interventions for mental disorders over the past decade. The study analyzed 256 randomized controlled trials (RCTs) involving 12,233 participants, assessing the impact of lifestyle activities, aerobic exercise, and resistance training on ADHD, depression, anxiety, schizophrenia, and dementia. It also explores potential neurobiological mechanisms and implementation strategies. The study notes insufficient RCT data to support physical activity as a first-line treatment but highlights its significant adjunctive benefits, warranting further research and promotion.

Background Knowledge
Mental disorders are increasingly prominent in the global health burden. Traditional pharmacological and psychological treatments have limitations in improving overall health, particularly for patients with comorbid chronic physical conditions. Physical activity, as an intervention under the biopsychosocial model, has been extensively studied for its health benefits in the general population but requires further exploration in mental disorders. Aerobic exercise, resistance training, and lifestyle activities improve brain function through neurotransmitter regulation, inflammation reduction, and neurogenesis promotion. However, optimal protocols for different activity types, intensities, and durations remain unclear, compounded by low patient adherence and implementation barriers. This study systematically reviews efficacy, mechanisms, and implementation challenges of physical activity in mental disorders, providing directions for future clinical practice and research.

 

 

Research Methods and Experiments
Researchers conducted systematic searches in Medline/PubMed, PsycArticles, and EMBASE databases up to August 22, 2024. Inclusion criteria required high-quality meta-analyses with AMSTAR scores ≥8, encompassing RCTs evaluating physical activity as an adjunctive treatment for ADHD, depression, anxiety, schizophrenia, and dementia. The study also incorporated meta-analyses on potential mechanisms (neurobiological, psychosocial, behavioral) and systematic reviews addressing implementation facilitators and barriers.

Key Conclusions and Perspectives

• Physical activity demonstrates significant efficacy as an adjunctive treatment for mental disorders, including improved attention in children with ADHD (SMD=0.84), reduced depressive symptoms (SMD=−1.14), and decreased BMI in schizophrenia patients (SMD=−1.69).
• Aerobic and resistance training show moderate effects across age groups in improving anxiety, executive function, social functioning, quality of life, and cardiopulmonary health.
• Neurobiological mechanisms reveal acute exercise significantly increases atrial natriuretic peptide and growth hormone levels, while long-term exercise mildly elevates kynurenine, BDNF, and TNF-α levels, though evidence remains preliminary.
• Implementation strategies include improving accessibility to physical activity facilities, providing professional guidance, creating safe environments, personalizing interventions, enhancing autonomous motivation, and establishing stable social support networks.
• High-quality RCTs remain limited, with most studies having small sample sizes and lacking intention-to-treat analyses. Future large-scale, rigorous RCTs are needed to validate these findings.

Research Significance and Prospects
This study provides systematic evidence supporting physical activity as an effective adjunctive intervention for mental disorders. It highlights the need to explore its potential as a first-line treatment, particularly for autism and substance use disorders. Future research must clarify optimal dose-response relationships for specific activity types in different disorders and investigate behavioral and psychosocial mechanisms to improve adherence. Integrating 24-hour movement guidelines and real-world longitudinal assessments, alongside developing individualized exercise prescriptions, will advance precision medicine and holistic health promotion.

 

Conclusion
This study comprehensively demonstrates the efficacy of physical activity as an adjunctive treatment across multiple mental disorders, emphasizing its benefits for attention, depression, anxiety, social functioning, and quality of life. While insufficient evidence currently supports its use as a first-line treatment, existing RCTs show comparable effects to pharmacological treatments for depression and anxiety, with additional metabolic benefits. Neurobiological mechanisms, including kynurenine metabolism regulation, growth hormone release, and inflammatory responses, require further validation. Implementation strategies focus on accessibility, professional training, safe environments, personalized interventions, motivation enhancement, and social support networks, providing theoretical and practical foundations for future intervention design. Future research should prioritize optimal implementation protocols, integrate 24-hour movement assessments, and standardize physical activity interventions in mental health care.

 

Davy Vancampfort, Joseph Firth, Brendon Stubbs, Tine Van Damme, and André O Werneck. The efficacy, mechanisms and implementation of physical activity as an adjunctive treatment in mental disorders: a meta‐review of outcomes, neurobiology and key determinants. World Psychiatry.