How much physical activity do people with schizophrenia engage in? A systematic review, comparative meta-analysis and meta-regression.
Physical activity (PA) improves health outcomes in people with schizophrenia. It is unclear how much PA people with schizophrenia undertake and what influences PA participation. We conducted a meta-analysis to investigate PA levels and predictors in people with schizophrenia.



Major databases were searched from inception till 02/2016 for articles measuring PA (self-report questionnaire (SRQ) or objective measure (e.g. accelerometer)) in people with schizophrenia, including first episode psychosis (FEP). A random effects meta-analysis and meta-regression analysis were conducted.



35 studies representing 3453 individuals with schizophrenia (40.0years; 64.0% male) were included. Engagement in light PA was 80.44min (95% CI 68.32-92.52, n=2658), 47.1min moderate-vigorous PA (95% CI 31.5-62.8, n=559) and 1.05min (95% CI 0.48-1.62, n=2533) vigorous PA per day. People with schizophrenia engaged in significantly less moderate (hedges g=-0.45, 95% CI -0.79 to -0.1, p=0.01) and vigorous PA (g=-0.4, 95% CI -0.60 to -0.18) versus controls. Higher light to moderate, but lower vigorous PA levels were observed in outpatients and in studies utilizing objective measures versus SRQ. 56.6% (95% CI 45.8-66.8, studies=12) met the recommended 150min of moderate physical activity per week. Depressive symptoms and older age were associated with less vigorous PA in meta-regression analyses.



Our data confirm that people with schizophrenia engage in significantly less moderate and vigorous PA versus controls. Interventions aiming to increase PA, regardless of intensity are indicated for people with schizophrenia, while specifically increasing moderate-vigorous PA should be a priority given the established health benefits.
Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom. Electronic address: brendon.stubbs@kcl.ac.uk.
Brendon
B
Stubbs
Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom.
Joseph
J
Firth
Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom.
Alexandra
A
Berry
Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós Graduação em Ciências Médicas: Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Felipe B
FB
Schuch
Department of Exercise Physiology, School of Medical Sciences, University of New South Wales, Sydney, Australia.
Simon
S
Rosenbaum
The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.
Fiona
F
Gaughran
Department of Medicine, Geriatrics Section, University of Padova, Italy.
Nicola
N
Veronesse
Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom.
Julie
J
Williams
Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom.
Tom
T
Craig
Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom.
Alison R
AR
Yung
KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium.
Davy
D
Vancampfort
D015444:Exercise; D006801:Humans; D012044:Regression Analysis; D012559:Schizophrenia / Q000453:epidemiology*
Cardiovascular disease; Exercise; Lifestyle; Physical activity; Psychosis; Schizophrenia