REVIEW Exercise and physical activity in mental disorders Elisabeth Wolff • Katharina Gaudlitz • Brigitt-Leila von Lindenberger • Jens Plag • Andreas Heinz • Andreas Stro ¨hle Received: 21 June 2011 / Accepted: 17 August 2011 / Published online: 21 September 2011 Ó Springer-Verlag 2011 Abstract Exercise (EX) and physical activity (PA) have been shown to prevent or delay the onset of several mental disorders and to have therapeutic effects in different groups of psychiatric disorders. This review focuses on studies investigating EX as therapeutic intervention in anxiety disorders, affective disorders, eating disorders, schizophrenia, and substance use disorders. Despite EX being discussed as a potential therapy for several decades, adequately powered randomized, controlled trials are sparse in most disorder groups. Nevertheless, evidence points toward disorder-specific benefits that can be induced by EX/PA. Mechanisms of the therapeutic effects of EX/PA are summarized, including metabolic and physiological as well as psychological aspects. Finally, implications for research and therapeutic practice are illustrated. Keywords Exercise Á Physical activity Á Mental disorders Á Psychiatric disorders Á Therapy Á Review Introduction Physical activity (PA) and exercise (EX) have been investigated in the context of prevention and treatment of mental disorders over the past few decades. Epidemiolog- ical and population-based studies demonstrate significant negative relationships between PA levels and the onset of mental disorders in cross-sectional and prospective designs [1, 2]. Furthermore, a cross-sectional study [3] confirmed that psychiatric patients who regularly exercise perceive a higher quality of life (QoL). In patients suffering from mental disorders, PA and EX are proposed to be effective for several reasons (e.g., [4–6]): First, a wide range of biochemical and physiological changes and adaptations are related to acute bouts of EX and regular EX training. Some of these mechanisms affect mood (e.g., via serotonin, endorphins), and others have neuroprotective functions (e.g., normalization of brain- derived neurotrophic factor (BDNF) release), act as anx- iolytic (e.g., release of atrial natriuretic peptide (ANP)), or alter stress reactivity (hypothalamus–pituitary–adrenal (HPA) axis). On a psychological level, several mechanisms have been proposed, such as changes in body scheme and health attitudes/behaviors, learning and extinction, social reinforcement, experience of mastery, shift of external to more internal locus of control, or improved coping skills. In the following sections, evidence is summed up for the acute and chronic effects of EX and PA as a sole or combined treatment in different mental disorders. Anxiety disorders A recent meta-analysis concluded that both aerobic and anaerobic EX are similarly effective as cognitive/behav- ioral therapy concerning the acute and chronic decrease of anxiety, and more effective than most other anxiety- reducing activities [7]. E. Wolff (&) Á K. Gaudlitz Á B.-L. von Lindenberger Á J. Plag Á A. Heinz Á A. Stro ¨hle Klinik fu ¨r Psychiatrie und Psychotherapie, Charite ´—Universita ¨tsmedizin Berlin, Charite ´ Campus Mitte, Charite ´platz 1, 10117 Berlin, Germany e-mail: elisabeth.wolff@charite.de 123 Eur Arch Psychiatry Clin Neurosci (2011) 261 (Suppl 2):S186–S191 DOI 10.1007/s00406-011-0254-y