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Physical activity and common mental disorders

  • Samuel B. Harvey (a1), Matthew Hotopf (a1), Simon Øverland (a2) and Arnstein Mykletun (a3)

Previous studies have suggested that physical activity may have antidepressant and/or anti-anxiety effects.


To examine the bidirectional relationship between physical activity and common mental disorders and establish the importance of context, type and intensity of activity undertaken.


A clinical examination of 40 401 residents of Norway was undertaken. Participants answered questions relating to the frequency and intensity of both leisure-time and workplace activity. Depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Biological and social data were also collected.


There was an inverse relationship between the amount of leisure-time physical activity and case-level symptoms of depression. This cross-sectional association was only present with leisure-time (as opposed to workplace) activity and was not dependent on the intensity of activities undertaken. Higher levels of social support and social engagement were important in explaining the relationship between leisure activity and depression. Biological changes such as alterations to parasympathetic vagal tone (resting pulse) and changes to metabolic markers had a less important role.


Individuals who engage in regular leisure-time activity of any intensity are less likely to have symptoms of depression. The context and social benefits of exercise are important in explaining this relationship.

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Corresponding author
Dr Samuel B. Harvey, Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK. Email:
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S.B.H. and M.H. are funded by the NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, and Institute of Psychiatry, King's College London. S.B.H. was also supported by a grant from the Institute of Social Psychiatry. A.M. and S.O. were funded by the Norwegian Research Council.

Declaration of interest


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Physical activity and common mental disorders

  • Samuel B. Harvey (a1), Matthew Hotopf (a1), Simon Øverland (a2) and Arnstein Mykletun (a3)
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Physical activity and common mental disorders

Manjeet S. Bhatia
08 March 2011

The study by Harvey et al, though an old one (from Aug 1995 to June 1997) is commendable as it covers a large population with high participation rate, measuring physical activity, using metabolic and autonomic nervous system markers and assessing depression, anxiety, social support and physical disorders. However, there are certain short comings limiting the total utility of the study. Firstly, body weight and history as well as type of exercise were not mentioned. The amount of workplace activity also depends on type of job but in the study, one thirdof patients were put in the unclassified social class category. Secondly, Hospital Anxiety and Depression Scale does not provide clinical diagnosis.Thirdly, metabolic markers were measured from non-fasting sample. Fourthly, no scale was used to measure social support. Lastly, the types of symptoms which improve with exercise were not mentioned.Inspite of shortcomings, this study is valuable as it opens the door for further research on effects of physical activity in different psychiatric disorders when used in combination with drug treatment. It will also be useful to study the role of physical activity in partially responding and resistant cases. ... More

Conflict of interest: None Declared

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Physical activity, telomerase, leptin and mental illness

Feargus F. O'Croinin, Psychiatrist
10 November 2010

In the article "Physical activity and common mental disorders" Harveyet al.(1) show that individuals who engage in regular leisure-time activity of any intensity are less likely to have symptoms of depression. The authors emphasize the importance of the social context of the exercise. Physical activity and its effects on mental illness and cognition deserve this renewed interest. One area of interest is the effect of exercise on telomerase activity.

Chromosomal telomeric length, a widely recognized biomarker of immunecell biological age, has been shown to be reduced in peripheral blood leukocytes from individuals with schizophrenia and mood disorders.(2) Accelerated telomere shortening and decreased telomerase activity have been reported in chronically stressed individuals.(2) However, a recent paper by Puterman et al showed that vigorous physical activity seemed to buffer the effects of stress on telomeric length.(3) Long term exercise has also been associated with a marked increase in telomerase activity in leukocytes of young and middle aged athletes.(4)

Given the reduced telomeric length noted in association with mental illness, it would make sense to incorporate regular exercise into the daily routines of individuals with mental illness, the effect of which could be determined by measuring telomerase activity.

Physical activity may also be of benefit with respect to the high levels of obesity seen in schizophrenia and depression. High circulating levels of leptin, an adipose-derived hormone, and leptin resistance in thehypothalamus are seen in obesity. Interestingly, it has been shown that exercise restored leptin sensitivity in animal studies (5), suggesting a possible additional benefit for exercise in humans.

A cognitive enhancing role has also been suggested for leptin, with leptin receptors being found in many brain regions.(6) An increased risk of cognitive decline is associated with obesity. Could it be that the leptin resistance seen in obesity is contributory also to the cognitive decline seen in schizophrenia? Further research into the role of leptin and its effect on cognition and mental illness would be of interest.

1 Harvey SB, Hotopf M, Overland S, Mykletun A. Physical activity and common mental disorders. Br J Psychiatry 2010; 197: 357-364.

2 Porton B, DeLisi LE, Bertisch HC, Ji F, Gordon D, Li P et al. Telomerase Levels in Schizophrenia: A Preliminary Study. Schizophr Res. 2008; 106(2-3): 242-247.

3 Puterman E, Lin J, Blackburn E, O'Donovan A, Adler N, Epel E. The Power of Exercise: Buffering the Effect of Chronic Stress on Telomere Length. PLoS ONE 2010; 5(5): e10837.

4 Werner C, Furster T, Widmann T,Poss J, Roggia C, Manhoun M et al. Physical Exercise Prevents Cellular Senescence in Circulating Leukocytes and in the Vessel Wall. J Am Heart Assoc. 2009; 120: 2438-2447.

5 Ropelle ER, Flores MB, Cintra DE, Rocha GZ, Pauli JR, Morari J et al. IL-6 and IL-10 Anti-Inflammatory Activity Links Exercise to Hypothalamic Insulin and Leptin Sensitivity through IKKB and ER Stress Inhibition. PLoS Biology 2010; 8(8): e1000465.

6 Harvey J, Shanley LJ, O'Malley D, Irving AJ. Leptin: a potential cognitive enhancer? Biochem Soc Trans 2005; 33(5): 1029-1032.

Feargus O'Croinin, MB, MMedSc, MRCPsych, DCH, DObst
... More

Conflict of interest: None Declared

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Million dollar question

Sisira Siribaddana, Senior Academic
10 November 2010

This paper reconfirms that people with depression have low level of exercise; not only leisure time but non exercise activity thermogenesis (NEAT). Resting pulse rate and pedometers would be two low cost methods tomonotor physical activity more objectively. However the million dollar question remains unanswered. Whether depression causes less activity or people who are less active have CMD? Will the twin or any genetically senitive study design will help finding an answer to this as cohorts seemsprohibitively expensive. ... More

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