Exercise to enhance antipsychotic effectiveness and mitigate metabolic harm: systematic review and meta-analysis.
Paula Etayo-Urtasun, Arantxa Ancín-Osés, Mikel Izquierdo et al.
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In 30 seconds
This systematic review and meta-analysis pooled randomised controlled trials of supervised exercise in adults receiving antipsychotic medication for psychotic disorders. Across 28 studies (n = 1119) and four additional analyses, exercise improved negative symptoms, general psychopathology and PANSS total scores, while effects on positive symptoms were not significant. It also reduced body weight, body fat percentage and waist circumference, but did not materially change BMI. No significant effects were found for blood pressure or fasting glucose, and lipid findings were largely null. The authors judged evidence moderate for selected symptom and adiposity outcomes, while noting that changes did not reach clinically meaningful thresholds.
Key findings
- Negative symptoms improved with exercise (MD -3·078, 95% CI -4·457 to -1·699; p < 0·001).
- PANSS total score decreased (MD -7·069, 95% CI -13·290 to -0·849; p = 0·030); positive-symptom effects were not significant.
- Exercise reduced body weight (MD -1·620, 95% CI -3·080 to -0·159; p = 0.034), body fat percentage and waist circumference, without material BMI change.
- No significant effects were observed for systolic or diastolic blood pressure or fasting glucose; lipid outcomes were largely null.
Why it matters
Antipsychotic treatment can be accompanied by cardiometabolic adverse effects, while psychotic symptoms may remain a treatment target. This synthesis suggests supervised exercise may offer adjunctive benefits for negative symptoms and measures of adiposity. However, the reported changes were not clinically meaningful, and evidence for several metabolic outcomes remains limited, so the findings do not establish broad metabolic protection.
What to keep in mind
The authors report low to very low certainty for most remaining outcomes and call for adequately powered, high-quality trials with comprehensive metabolic endpoints. Changes in adiposity did not reach clinically meaningful thresholds.