Exercise and Schizophrenia: Why It Helps and How to Get Started

“Exercise is not a replacement for psychiatric medication for the treatment of schizophrenia. However, exercise is a low-risk, worthwhile adjunctive [add-on] intervention,” says Divya Hedgren, MD, a lifestyle medicine–certified psychiatrist based in Columbus, Ohio, and the secretary of the American College of Lifestyle Medicine (ACLM) Mental Health and Behavior Health Member Interest Group.

“What this means is that it’s harder for those with schizophrenia to get into the rhythm of an exercise routine,” says Rohini Pahwa, PhD, an associate professor and the director of the PhD program at the New York University Silver School of Social Work in New York City, who has studied interventions for improving health among people with schizophrenia.

Finding ways to get enough exercise can help lessen these risks. “It is well established that exercise maintains heart and lung fitness and strengthens bones and muscles,” Hedgren says.

Other potential benefits include:

• Exercise can help improve various aspects of cognitive functioning, including attention, working memory, and social cognition. These functions are usually impaired among people with schizophrenia.

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• Exercise can help improve symptoms of depression and relieve stress associated with antipsychotic side effects, which are common in those with the condition.

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• Exercise can help increase brain volume, notably in the hippocampus, a brain area essential for learning and memory. People with schizophrenia often have reduced brain volume compared with those without it, which contributes to cognitive symptoms.
• Exercise can promote brain plasticity, the brain's ability to change and adapt. This function is often impaired in people with schizophrenia.

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At first, it may feel challenging to get into a rhythm, says Dr. Pahwa. You don’t have to start with that amount all at once if it feels overwhelming. “A person with schizophrenia should focus on less intensity in the beginning and get into a routine gradually,” says Pahwa. This will make you more likely to stick to it in the long run.

One way to do this: “Remember that bite-size fitness movements add up, incrementally benefiting your overall health,” says Hedgren. (This could look like whole-body stretches after meals and a 10-minute walk at least once a day, for example.)

As mentioned, factors like antipsychotic side effects and symptoms like fatigue, lack of motivation, and social withdrawal can make it difficult to exercise regularly. To help combat these factors, Pahwa suggests the following:

• Set realistic goals. Remember: You don’t have to start with a ton of activity all at once. Small amounts of physical activity throughout the day add up, and you can gradually increase how much exercise you do over time.
• Choose specific days and times that work best for you. For example, if you struggle with fatigue but find you have the most energy in the morning, consider exercising in the morning.
• Make plans to work out with a friend or family member. This can help you stay accountable to your fitness goals and lessen symptoms like social isolation.
• Choose an activity you genuinely enjoy. If you have fun doing it, you’re more likely to stick to it in the long run.
• Be consistent. For optimal physical health benefits, consistency is key. As mentioned, even doing small amounts of exercise consistently can be very beneficial in the long run.

It’s also important to speak with your doctor before starting any exercise program to make sure it’s right for you, Hedgren says. If you’re having trouble starting, they could also help you create a plan that suits your needs.

1. Aerobic Exercise Aerobic exercise — aka “cardio” — is a rhythmic and repetitive form of exercise that involves using large muscle groups. Brisk walking, running or jogging, swimming, and cycling are all aerobic activities that can get your heart pumping and improve your mental and physical health over time.

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2. Strength and Resistance Exercise Strength and resistance exercise is a form of exercise geared toward strengthening your muscles, which can boost your metabolism and help prevent injury. Common types include lifting weights or using weight-bearing machines. If you don’t have this equipment at home, you can find it at a local gym.

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3. Mind-Body Exercise Mind-body exercise combines physical movement, controlled breathing, and mental focus. It has many health benefits, including increased flexibility, strength, and overall health. Activities like yoga and tai chi fall under mind-body exercise.

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• Research shows regular exercise can be very helpful for managing schizophrenia symptoms and boosting physical health when combined with standard treatments.
• To start a regular exercise routine, it can help to start small and set realistic goals for yourself. Small amounts of exercise add up, especially if you do it consistently.
• Talk to your doctor before starting a new exercise program to make sure it’s right for you.