Exercise is often recommended in clinical settings, but the advice can be too general to help patients act on it. In an opinion article published in Brain Health, researchers argue that physical activity should instead be prescribed as structured, individualised care for brain health.
The authors—Carl Zhou and Nicholas Fabiano of the University of Ottawa’s Department of Psychiatry, and Stanley Wong of the University of Toronto’s Department of Psychiatry—draw on clinical trials, meta-analyses and cohort studies. They define brain health as maintaining cognitive, emotional, behavioural and social functioning throughout life.
The article describes several ways exercise may affect the brain, including through vascular health, metabolism, inflammation and neuroplasticity. One proposed explanation is the “muscle-brain” pathway: contracting skeletal muscles release signalling molecules called myokines, which interact with processes linked to mood and cognition. The authors stress that this is only one model; sleep, vascular risk and psychological factors also matter.
Evidence is strongest for mental-health outcomes, according to the article’s review of randomised trials and meta-analyses. Physical-activity interventions can reduce symptoms of depression and anxiety, psychological distress and adverse outcomes related to suicide. A 2024 network meta-analysis found that walking, running, yoga and strength training reduced depressive symptoms, with effects generally greater at higher intensities.
Dose-response analyses also suggest that benefits may begin below public-health activity targets. The article gives roughly half the recommended weekly volume—about 75 minutes of moderate activity—as an example. For adults, the World Health Organization recommends 150 to 300 minutes of moderate aerobic activity, or 75 to 150 minutes of vigorous activity, each week, alongside muscle-strengthening exercise on at least two days.
The authors also discuss physical activity and ageing. Studies have linked it with lower risks of cognitive impairment, dementia and Alzheimer’s disease, and the WHO includes activity in its dementia-risk-reduction guidance. However, the researchers caution that much of this evidence is observational and cannot by itself establish cause and effect. They cite a 2011 randomised trial in older adults in which aerobic exercise increased the volume of the anterior hippocampus and improved memory, while noting that broader claims about cognition and slower brain ageing require careful interpretation.
For people with schizophrenia and other serious mental illnesses, exercise may be particularly relevant because of high rates of inactivity, cardiometabolic illness and premature death. Meta-analytic evidence suggests aerobic exercise could improve overall cognition in schizophrenia, including working memory, attention and social cognition. The authors say, however, that the findings rely on a limited number of small trials and need confirmation in adequately powered studies.
The proposed prescription should specify the type, frequency, intensity and duration of activity, as well as safety considerations and a follow-up plan. Frailty, unstable heart or respiratory symptoms, or recent falls may call for medical assessment, supervision or a temporary pause. For most patients, the authors favour gradual progress. Someone experiencing depression, for example, might begin with a five-minute walk, seated exercises, a supervised group or an activity already part of their routine.
The article also says clinicians could assess activity during routine appointments, coordinate with primary care and physiotherapy, and refer patients to community programmes. The authors warn that prescribing exercise without addressing access could worsen inequalities, and suggest funded community programmes, transport support and partnerships with recreational and community centres.
The article does not directly propose reimbursement for exercise. Treating it as a monitored therapeutic intervention could raise questions about funding, but the authors’ recommendations do not mean that a prescription would automatically be covered by public health systems or insurers. Such arrangements would require decisions about funding rules, eligible programmes and qualified supervision.
Sources: Pplware.