REVIEW OF: Ancín-Osés A et al, European Psychiatry 2025;68(1):e101

STUDY TYPE: Systematic review and meta-analysis of RCTs

Exercise is a good adjunct for just about everything in the DSM. It also has many physical benefits. Can it treat the metabolic side effects of antipsychotics?

This meta-analysis examined whether structured exercise improves metabolic syndrome in patients from 10 RCTs (n = 773) who were taking antipsychotics for psychotic disorders. They were randomized to exercise programs, or to usual care or non-exercise. Interventions lasted 8 weeks to 12 months. Outcomes included waist circumference, blood pressure, fasting glucose, triglycerides, and HDL cholesterol. Across pooled analyses, exercise did not meaningfully improve any metabolic parameter. Although some individual trials reported small benefits, these did not persist once results were combined.

Outcomes were not analyzed by specific antipsychotic. As a result, any metabolic benefit in patients on lower-risk agents may have been masked by lack of benefit in those taking higher-risk drugs, such as olanzapine or clozapine. Certainty of evidence was rated low to moderate.

CARLAT TAKE
Good news: Exercise remains beneficial for fitness, mood, and functioning in psychosis. But if your goal is to prevent or reverse metabolic syndrome, use antipsychotics with less propensity to add pounds (such as aripiprazole, cariprazine, lumateperone, or ziprasidone), use the lowest necessary doses, and make sure your treatment plans include metformin in addition to exercise.