Introduction

When we think of schizophrenia, the focus often centres on its profound impact on mental health. However, this complex condition also significantly affects physical health, often in ways that go unnoticed. 

People with schizophrenia are more likely to face physical health challenges than the general population, leading to reduced life expectancy, poorer quality of life, and an increased burden on healthcare systems. 

In this article, we’ll explore the physical health risks associated with schizophrenia and discuss how an integrated care approach can improve outcomes for individuals living with the condition.

Physical Health Challenges in Schizophrenia

The Scope of the Problem

People with schizophrenia live, on average, 10 to 20 years less than those without the condition¹. This striking statistic isn’t solely due to mental health struggles; physical illnesses are a major contributing factor. Research shows that over 75% of individuals with schizophrenia have at least one chronic physical condition, such as diabetes, cardiovascular disease, or respiratory disorders². 

These challenges often arise earlier in life compared to the general population. For example, individuals aged 25–44 with schizophrenia are five times more likely to experience heart problems than their peers³.

Common Physical Health Conditions

Obesity and Related Complications
Obesity is one of the most pressing health concerns for individuals with schizophrenia. Linked to poor diet, sedentary lifestyles, and the side effects of antipsychotic medications, weight gain often leads to other health problems like heart disease, diabetes, and certain cancers⁴.

Antipsychotics such as Olanzapine and Clozapine are known to cause significant weight gain, while newer medications like Aripiprazole and Asenapine have fewer effects on weight⁵. However, the issue isn’t solely medication-related; studies have shown that people with schizophrenia tend to consume diets higher in sugar and fat, with lower intake of fruits, vegetables, and fibre⁶.

Cardiovascular Disease

Heart disease and stroke are twice as common in individuals with schizophrenia as in the general population⁷. These conditions are exacerbated by smoking, poor diet, and inactivity, all of which are prevalent in this group.

Diabetes
Diabetes is more common among people with schizophrenia, with antipsychotic medications playing a potential role by altering the body’s use of insulin. Interestingly, outcomes for individuals in developing countries—where physical activity through farming or other labour is common—tend to be better, suggesting lifestyle factors like exercise may help mitigate risk⁸. Emerging research has also proposed a genetic link between schizophrenia and diabetes⁹.

Respiratory Disorders and Smoking

Approximately 70% of individuals with schizophrenia are smokers, compared to just 25% of the general population¹⁰. Smoking not only increases the risk of respiratory diseases but also interacts with medications, reducing their effectiveness and necessitating higher doses, which can worsen side effects like weight gain.

Bone Health
Conditions like osteoporosis are more prevalent in individuals with schizophrenia, linked to a sedentary lifestyle and, in some cases, elevated levels of the hormone prolactin caused by antipsychotics. High prolactin levels can weaken bones over time, making regular monitoring essential¹¹.

The Role of Exercise in Schizophrenia

Exercise and Physical Health

Regular exercise plays a pivotal role in reducing the risk of chronic illnesses associated with schizophrenia. For instance:

• Heart Disease and Diabetes: Exercise is one of the most effective ways to reduce the risk of heart disease and diabetes, particularly for individuals with schizophrenia who are already at an increased risk due to lifestyle factors, medication side effects, and higher rates of obesity¹². Regular physical activity helps the body regulate insulin levels, which is essential for controlling blood sugar and preventing type 2 diabetes. For people with schizophrenia, whose antipsychotic medications may alter the body’s ability to manage insulin effectively, this is especially important.

Moreover, exercise strengthens the heart muscle, improves blood circulation, and lowers levels of harmful cholesterol while increasing levels of “good” cholesterol. Even moderate aerobic activities such as brisk walking or cycling for 30 minutes a day, five days a week, can significantly reduce the likelihood of developing heart disease, regardless of weight loss¹².

The benefits extend to reducing inflammation, improving arterial flexibility, and maintaining healthy blood pressure—all crucial factors in preventing cardiovascular issues. For individuals unable to engage in high-intensity workouts, low-impact exercises like swimming or yoga can still provide significant cardiovascular benefits without undue strain.

• Bone Health: Osteoporosis, a condition characterised by weakened bones, is more common in individuals with schizophrenia, particularly due to sedentary lifestyles and medication side effects¹¹. Certain antipsychotics can elevate prolactin levels, a hormone that, when too high, can lead to reduced bone density over time. This risk, coupled with a lack of regular physical activity, creates a pressing need for targeted interventions to protect bone health.

Weight-bearing exercises, such as walking, dancing, and resistance training, are particularly effective in strengthening bones. These activities work by applying stress to the bones, which stimulates the bone-building cells and helps maintain or even increase bone density. Resistance training, such as using free weights or resistance bands, is especially beneficial as it combines muscle strengthening with joint stability, further reducing the risk of fractures.

• General Fitness: Regular physical activity is vital for improving overall fitness levels, which includes cardiovascular health, muscle strength, flexibility, and stamina¹². For individuals with schizophrenia, who may lead more sedentary lives due to the negative symptoms of the condition (such as apathy and low motivation), even small increments in physical activity can have profound effects on physical and mental health.

Aerobic activities such as jogging, swimming, or cycling enhance cardiovascular fitness by strengthening the heart and lungs, which improves oxygen delivery throughout the body. This leads to reduced blood pressure and a lower resting heart rate—both markers of improved cardiovascular health.

Resistance training, including bodyweight exercises or gym-based strength training, boosts muscular strength and endurance. Stronger muscles support joints, improve posture, and enhance overall mobility, making daily tasks easier and less physically taxing.

Flexibility exercises, such as yoga or stretching routines, can improve joint range of motion, reduce stiffness, and minimise the risk of injury. Additionally, these exercises often provide mental health benefits, such as stress reduction and improved relaxation, which are particularly helpful for individuals with schizophrenia.

Exercise and Mental Health

The benefits of exercise extend beyond physical health, offering improvements in mental and psychological well-being:

• Negative Symptoms: Exercise has shown promise in alleviating negative symptoms like apathy, lethargy, and social withdrawal¹³.
• Cognitive Benefits: Some studies suggest exercise can enhance memory and cognitive functioning, although further research is needed¹³.
• Auditory Hallucinations: Anecdotal evidence indicates that exercise may help reduce the distress caused by hallucinations, possibly through distraction and focus¹⁴.
• Psychological Well-Being: Exercise is linked to reduced stress, better sleep patterns, improved self-esteem, and a greater sense of relaxation¹⁵.

Improving Physical Health Care

Proactive Monitoring and Intervention

Care homes and healthcare providers play a crucial role in bridging the gap between mental and physical health care. Regular health checks focusing on blood pressure, blood sugar levels, and heart health are essential. Early intervention in these areas can drastically improve life expectancy and quality of life.

Promoting Healthy Lifestyles

Encouraging physical activity, improving diet, and offering smoking cessation support are critical components of integrated care. For example, studies show that even modest increases in physical activity can significantly reduce the risk of heart disease and diabetes, regardless of weight loss¹².

Tailored Medication Management

Where possible, prescribing antipsychotics with fewer metabolic side effects can help reduce weight gain and other associated health risks. Regular discussions with healthcare providers about side effects and medication adjustments are important⁵.

Holistic and Integrated Care Models

An integrated approach to care—bringing together mental health, physical health, and social services—ensures that individuals with schizophrenia receive comprehensive support. This includes not only managing health conditions but also addressing barriers to care, such as stigma and socio economic challenges¹⁶.

Conclusion

Schizophrenia profoundly affects both the mind and the body. By recognising and addressing the physical health risks associated with the disorder, care providers can help individuals live longer, healthier, and more fulfilling lives. At our care home, we are committed to supporting the whole person, ensuring that physical health is never overlooked.

If you’d like to learn more about how we approach integrated care for individuals with schizophrenia, please don’t hesitate to get in touch. Together, we can build a brighter future for those living with this challenging condition.

References

1. Healthcare Quality Improvement Partnership, 2014, Second National Audit of Schizophrenia: What You Need to Know.
2. Mitchell A, Malone D, 2006, Physical Health and Schizophrenia, published in Current Opinion in Psychiatry.
3. Penedo F, Dahn J, 2006, Exercise and Wellbeing: A Review of Mental and Physical Health Benefits Associated with Physical Activity, published in Current Opinion in Psychiatry.
4. Chesney E, Goodwin G, Fazel S, 2014, Risks of All-Cause and Suicide Mortality in Mental Disorders: A Meta-Review, published in World Psychiatry.
5. De Hert M, et al., 2011, Physical Illness in Patients with Severe Mental Disorders, published in World Psychiatry.
6. Peet M, 2004, Diet, Diabetes and Schizophrenia: Review and Hypothesis, published in The British Journal of Psychiatry.
7. Lancet, 19th February 2011.
8. Jurczyk A, et al., 2015, Beyond the Brain: Disrupted in Schizophrenia 1 Regulates Pancreatic β-cell Function via Glycogen Synthase Kinase-3β, published in The Journal of the Federation of American Societies for Experimental Biology.
9. Fuller Torrey E, 2013, Surviving Schizophrenia, Harper Perennial.
10. Faulkner G, Taylor A, 2005, Exercise, Health and Mental Health, Routledge.
11. Warner R, 2000, The Environment of Schizophrenia, Brunner Routledge.
12. Firth J, et al., 2015, A Systematic Review and Meta-Analysis of Exercise Interventions in Schizophrenia Patients, published in Psychological Medicine.
13. Kimhy D, et al., 2015, The Impact of Aerobic Exercise on Brain-Derived Neurotrophic Factor and Neurocognition in Individuals With Schizophrenia: A Single-Blind, Randomised Trial, published in Schizophrenia Bulletin.
14. Author’s personal experiences.
15. Burton N, 2012, Living with Schizophrenia, Acheron Press.
16. Eaton W, et al., 2006, Association of Schizophrenia and Autoimmune Diseases, published in The American Journal of Psychiatry.