People living with serious mental health conditions often face a hidden health crisis that many people do not realize.
Studies have shown that individuals with illnesses such as schizophrenia, major depression, or bipolar disorder die much earlier than the general population. On average, their life expectancy is reduced by about 10 to 20 years.
Many people might assume that suicide or direct effects of mental illness are the main reasons for this shorter lifespan. However, research shows that the biggest causes of early death in people with severe mental illness are actually physical health problems.
In particular, cardiovascular diseases and metabolic disorders such as heart disease, stroke, obesity, and diabetes play a major role.
Scientists say that one of the key factors contributing to these health problems is a lack of physical activity.
An international group of researchers led by Professor Brendon Stubbs from the Medical University of Vienna has now called for exercise to be treated as a central part of psychiatric care. Their review, which analyzed hundreds of scientific studies, was published in the medical journal JAMA Psychiatry.
The researchers examined results from several hundred studies and large analyses that together included data from tens of thousands of patients. Some of these studies followed more than 10,000 participants. By reviewing such a large amount of evidence, the team was able to evaluate the overall impact of physical activity on mental health.
Their conclusion was clear: structured exercise programs can produce meaningful improvements in people with severe mental illness.
The researchers found that regular physical activity can reduce symptoms of depression and psychosis. It can also improve thinking ability, increase quality of life, and support better heart and metabolic health. In many cases, the improvements were moderate to large, meaning they were strong enough to make a noticeable difference in daily life.
Despite these benefits, exercise is still rarely included as a routine part of psychiatric treatment.
One major reason is that people with severe mental illness often struggle to stay physically active. For example, people with schizophrenia tend to spend very long periods sitting each day. Studies show that they may sit for nearly 10 hours daily, which is more than almost any other group of people.
In addition, fewer than 20 percent of individuals with schizophrenia meet the physical activity guidelines recommended by the World Health Organization. These guidelines suggest that adults should aim for at least 150 minutes of moderate exercise each week, or 75 minutes of more intense activity.
People with depression or bipolar disorder also face similar challenges. They are about 50 percent less likely to reach recommended levels of physical activity compared with people without these conditions.
Researchers emphasize that low activity levels are not simply a consequence of mental illness. Instead, they often become part of a harmful cycle that worsens health over time.
When people move less, their risk of heart disease, diabetes, and other metabolic problems increases. At the same time, physical inactivity can worsen mental health symptoms. This creates a vicious circle in which poor mental health leads to less activity, and less activity further damages both physical and mental well-being.
The review explains that several biological processes may be responsible for this connection.
For example, a lack of exercise can disrupt the body’s stress response system, known as the HPA axis. This system controls how the body releases stress hormones. When it becomes unbalanced, it may contribute to mood problems and mental health symptoms.
Physical inactivity also increases levels of inflammation in the body. Certain inflammatory substances in the blood, such as C-reactive protein and interleukin-6, become elevated. These inflammatory signals may affect the brain and interfere with how nerve cells communicate with one another.
Another important effect involves dopamine, a brain chemical linked to motivation, pleasure, and reward. When dopamine systems do not function properly, people may lose motivation and find it harder to take part in everyday activities.
In addition, inactivity lowers levels of a protein called brain-derived neurotrophic factor, or BDNF. This protein helps support brain health, learning, memory, and emotional balance.
Exercise can reverse many of these harmful processes. Physical activity helps regulate stress hormones, reduce inflammation, improve dopamine signaling, and increase BDNF levels. Together, these effects can support both mental and physical health.
To help doctors include exercise more easily in psychiatric treatment, the researchers recommend a simple framework known as the 5A model. This approach helps mental health professionals guide patients through behavior change.
The steps involve asking about physical activity, assessing a patient’s readiness to become more active, advising them with personalized recommendations, assisting them with goals and motivation, and arranging follow-up to track progress.
Importantly, this process can be incorporated into normal medical consultations without requiring major changes to the healthcare system.
Professor Stubbs argues that the large gap in life expectancy between people with severe mental illness and the general population represents a major inequality in modern medicine.
While exercise alone cannot solve every problem, it is a safe, affordable, and widely accessible treatment option. Unlike many medical therapies, physical activity requires little equipment and can be adapted to different abilities and environments.
When reviewing the findings of this research, it becomes clear that mental and physical health are deeply connected. Treating mental illness effectively requires attention not only to psychological symptoms but also to overall lifestyle and physical well-being.
The review strongly suggests that exercise should no longer be seen as an optional recommendation. Instead, it should become a standard part of mental health care, just like medication and psychotherapy.
If healthcare systems begin to integrate physical activity into psychiatric treatment programs, it could significantly improve both quality of life and life expectancy for millions of people living with severe mental illness.
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The study is published in JAMA Psychiatry.
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