Effects of physical exercise on metabolic syndrome in psychotic disorders: a systematic review with meta-analysis of randomized controlled trials

Background. Physical exercise improves mental and physical health of individuals with severe mental illness (SMI); however, its impact on metabolic syndrome remains unclear. Aims. To evaluate the effects of exercise interventions on metabolic syndrome components in individuals with SMI and explore interactions between exercise and antipsychotic medications on metabolic outcomes. Methods. Following PRISMA guidelines, we systematically searched PubMed, CINAHL, Web of Science, and APA PsycINFO through October 10, 2023, for randomized controlled trials (RCTs) assessing the effects of exercise on waist circumference, blood pressure, glucose, triglycerides, and HDL cholesterol in SMI. Risk of bias was evaluated using the Cochrane RoB-2 tool. Data were pooled using random-effects models in Comprehensive Meta-Analysis and JASP. Results. Ten RCTs (N = 773; mean age 39.9 ± 7.36 years; 38.7% female; 71.5% schizophrenia spectrum disorders) met inclusion criteria. Pooled analyses revealed no significant effects of exercise on waist circumference (SMD = 0.206, 95% CI [-0.118, 0.530], p = 0.171), systolic blood pressure (SMD = 0.194, 95% CI [-0.115, 0.504], p = 0.219), diastolic blood pressure (SMD = -0.21, 95% CI [-0.854, 0.434], p = 0.522), HDL (SMD = 0.157, 95% CI [-0.36, 0.674], p = 0.551), triglycerides (SMD = -0.041, 95% CI [-0.461, 0.38], p = 0.849), or glucose (SMD = -0.071, 95% CI [-0.213, 0.071], p = 0.326). Heterogeneity was moderate to high. Conclusions. Exercise interventions did not significantly improve metabolic syndrome components in SMI. Future trials must prioritize tailored regimens, adjunctive therapies, and rigorous control of medication effects.