Why Your Shrink Should Prescribe Exercise

A recent viewpoint paper posits that our approach to physical activity has been misguided. While exercise has long been promoted as beneficial for the body, recent research indicates it also positively impacts our brains. A team of psychiatric researchers suggests that doctors should go beyond simply advising patients to exercise as part of a healthy lifestyle and instead prescribe it. This recommendation is based on several lines of evidence, including randomized trials, meta-analyses, and cohort studies.

The authors explain that the positive effects of exercise on the brain are due to myokines, signaling proteins released by our muscles during physical activity. These myokines influence the brain through various pathways, including metabolic, inflammatory, neuroendocrine, and neurotrophic systems, ultimately affecting our cognition and psychological state.

One of the primary benefits of exercise is its ability to improve mood. Studies show that it can alleviate depressive symptoms, reduce anxiety, and decrease psychological distress. Notably, the required amount of movement to reap these benefits is surprisingly low. While the World Health Organization recommends 150–300 minutes of moderate activity per week, even 75 minutes per week can enhance psychological wellbeing.

Study author Nicholas Fabiano emphasizes that the starting point for exercise does not need to be impressive; rather, it should be achievable. Small, consistent successes can build self-efficacy and establish habits that foster continued activity.

For individuals suffering from severe mental illnesses like schizophrenia, who often lead sedentary lifestyles, exercise can have profound benefits. Pharmaceutical treatments for schizophrenia often come with side effects, but research indicates that aerobic exercise can improve cognition, working memory, and attention. Moreover, exercise can simultaneously address psychiatric symptoms, cognition, and physical health in this population, which faces significant unmet needs across all three domains.

However, currently, exercise is often viewed as general lifestyle advice rather than a prescribed treatment. Study author Carl Zhou argues that the evidence supports a more deliberate approach, similar to how a medication would be prescribed. This would include specifying the type of activity, frequency, intensity, duration, safety considerations, and a plan for follow-up.

To implement this recommendation effectively, the authors suggest investing in public infrastructure, transportation, and community-based programs to ensure that exercise is accessible to all patients. In the future, psychiatrists might replace traditional mood-elevating medications with a referral to a local kickball league or other physical activity group.