Exercise guide

Exercise for psychosis and schizophrenia: symptoms, weight, medicines and motivation

Exercise is part of the care the National Institute for Health and Care Excellence (NICE) recommends for psychosis and schizophrenia: people, especially those taking antipsychotic medicines, should be offered a healthy eating and physical activity programme. Alongside medicine and therapy, it can ease symptoms a little and builds fitness, which matters because heart disease and diabetes are common. It doesn't replace treatment, and you should never stop an antipsychotic without talking to your care team.

If you are thinking about suicide or can't keep yourself safe, call 999 or go to A&E. For urgent help, call Samaritans free on 116 123, any time, or in England call 111 and select the mental health option. In the US, call or text 988.

This guide covers what the trials show, how much to do, weight on antipsychotics, staying safe in the heat and on clozapine, and getting started when motivation is low, with moves on the 3D figure, workouts to follow and notes for carers.

If you need help now

Get help straight away

The NHS (the UK National Health Service) says a mental health emergency should be taken as seriously as a physical one, and that you will not be wasting anyone's time.

  • Call 999 or go to A&E if your life is at risk: for example, you have seriously harmed yourself or taken an overdose, or you feel you can't keep yourself safe.
  • For urgent help in England, call 111 and select the mental health option, or use 111 online.
  • Call Samaritans on 116 123. It is free, any time, day or night.
  • In the US, call or text 988, the 988 Suicide and Crisis Lifeline, any time.

Sources 1, 2, 3, 4

Use your crisis plan

Your care co-ordinator should give you and the people close to you contact details for a crisis, and if you become unwell again, your written care plan, advance statement or crisis plan should be followed. If you have one, use it, and contact your crisis team.

Sources 5, 6

If you're worried about someone else

Contact their GP, or their mental health worker if they have one. If their symptoms are severe enough to need urgent treatment and could be putting them at risk, the NHS says you can take them to the nearest A&E if they agree, call their GP or out-of-hours GP, or call 999 and ask for an ambulance.

Source 7

The short version

Part of your care, not instead of it

NICE says people with psychosis or schizophrenia, especially those taking antipsychotics, should be offered a combined healthy eating and physical activity programme. The NHS says your care plan should include one, with support to stop smoking. The treatments for the illness itself are medicine and talking therapies.

Sources 8, 5

Your heart is the clearest reason

People with schizophrenia live about 14 to 15 years less on average, and in England adults with severe mental illness are about 5 times more likely to die before 75, mostly from physical illnesses, many of which can be prevented.

Sources 9, 10, 11

A small lift for symptoms and thinking

Across 28 trials, exercise added to usual care eased symptoms by a small amount. Aerobic exercise may help memory and attention a little, though in the largest trial stretching, strength and balance training helped as much as cardio.

Sources 12, 13, 14

Weight: start support early

Weight gain is common with all antipsychotics. Exercise on its own rarely shifts weight, but eating and activity support that starts in the first weeks of a new medicine limits gain best. Never stop a medicine because of weight gain: talk to your team.

Sources 15, 16, 17

Medicines change how you exercise, not whether you can

Some antipsychotics make you overheat more easily or feel sleepy or dizzy, and clozapine has its own warning signs. Exercise in the cooler part of the day, stand up slowly, and know the signs in this guide.

Sources 18, 19, 20

Support beats willpower

Most people with severe mental illness want to be more active. Low mood, stress and lack of support are what get in the way, and fewer people drop out when trained staff run the sessions.

Sources 21, 22

Psychosis and schizophrenia

What psychosis is

The NHS: "Psychosis is when people lose some contact with reality." The 3 main symptoms are hallucinations (hearing voices is common), delusions (strong beliefs not shared by others) and confused thinking and speaking. Psychosis can come with schizophrenia, bipolar disorder or severe depression, and can also be triggered by trauma, stress, drugs, alcohol, some medicines, physical illness or childbirth.

Source 7

What schizophrenia is

The NHS: "Schizophrenia is a long-term mental health condition", often described as a type of psychosis. Positive symptoms include hallucinations and delusions. Negative symptoms include losing interest in everyday activities, wanting to avoid people and feeling disconnected from your feelings. "People with schizophrenia do not have a split personality", it does not usually cause violence, and many people recover, sometimes with periods when symptoms return.

Sources 23, 24

Low drive is a symptom, not laziness

The NHS says negative symptoms "can sometimes be mistaken for deliberate laziness or rudeness", and Rethink Mental Illness says they can make it hard to get motivated. That is the main reason exercise is hard to start, and why support matters more than willpower.

Sources 24, 15

How common it is

In England, about 1 in 200 adults (0.5%, pooling surveys from 2007 to 2023/4) had a psychotic disorder in the past year, about 190,000 people in private households. It was most common at ages 35 to 44 and in the poorest neighbourhoods. In the US, estimates range from 0.25% to 0.64%.

Sources 25, 26

TreatmentStrong evidence

Treatment is usually antipsychotic medicine with cognitive behavioural therapy (CBT) for psychosis and family intervention, through a community or early intervention team. NICE says there is "a high risk of relapse" if medicine is stopped in the first 1 to 2 years, and the NHS says: "Do not stop taking your antipsychotics without first consulting your care co-ordinator, psychiatrist or GP."

Sources 8, 5, 7

Things that can trigger an episode

The NHS lists severe stress, lack of sleep, low blood sugar, drugs such as cannabis, cocaine, amphetamine and ketamine, and stopping alcohol or drugs suddenly after long use. Anabolic steroid misuse can cause paranoia, hallucinations and delusions. Protect your sleep, and avoid steroids and stimulant pre-workouts (our suggestion).

Sources 27, 28, 6

Why physical health matters

Life expectancyStrong evidence

In 11 studies of up to 247,603 people, schizophrenia went with 14.5 years of life lost, and in 135 studies the risk of dying in a given period was about 2.5 times that of other people. Antipsychotics were linked with fewer deaths, not more. In England, adults with severe mental illness are about 5 times more likely to die before 75, and an estimated 2 in 3 of their deaths are from physical illnesses that can be prevented.

Sources 9, 29, 10, 11

Metabolic syndromeStrong evidence

About 1 in 3 people with schizophrenia (32.5% in 77 publications) have metabolic syndrome, a cluster of a large waist, high blood pressure, high blood sugar and abnormal blood fats that raises the risk of heart disease and diabetes. It was more common with clozapine and olanzapine and less common with aripiprazole. Heart and metabolic disease drive most of the gap in life expectancy.

Sources 30, 31, 17

SmokingStrong evidence

40.5% of adults with serious mental illness smoke, which the Office for Health Improvement and Disparities calls the largest contributor to the shorter lives of people with mental health conditions. NICE says help to stop should be offered even if earlier attempts failed. If you take an antipsychotic, talk to your doctor before you stop or restart smoking, because smoking changes the dose some medicines need.

Sources 32, 8, 6

Less active, less fitEmerging evidence

In 35 studies of 3,453 people, people with schizophrenia did less moderate and vigorous activity than others, though just over half met 150 minutes a week. People with severe mental illness sit for about 8 hours a day, and their aerobic fitness is much lower than other people's.

Sources 33, 34, 35

Antipsychotics and weightStrong evidence

Rethink Mental Illness: "weight gain is common with all antipsychotics", most with clozapine and olanzapine, followed by chlorpromazine, quetiapine and risperidone. In 100 trials of about 6 weeks, gain against a dummy pill ranged from none with haloperidol to about 3 kg with clozapine; with longer use, almost all antipsychotics cause some gain, most in people taking one for the first time. Gaining 3 to 4 kg in the first 4 weeks predicts more gain later.

Sources 15, 36, 37, 17

What the evidence says

Effect sizes put the different scales trials use onto one: about 0.2 is small, 0.5 moderate and 0.8 or more large. Most trials here are small.

Symptoms: a small benefit as an add-onEmerging evidence

In 28 randomised trials with 1,460 people, exercise added to usual care improved overall symptoms by a small amount (0.28), at moderate certainty. The benefit was clearer in people living in the community (0.43) and absent in hospital inpatients. An earlier review of 29 studies found effects on negative symptoms (0.49), low mood (0.71) and quality of life (0.55). Control groups in these trials didn't improve on their own, and a 2026 review of 17 trials found larger effects, but most trials are small; an older Cochrane review of 3 trials said larger ones were needed.

Sources 12, 38, 39, 40, 41

How much, and how hardEmerging evidence

Two reviews point to about 90 minutes a week: one found programmes with around 90 minutes of moderate to vigorous exercise a week reduced symptoms, and the other found thinking skills improved more with at least 90 minutes a week. In 40 trials with 2,111 people, moderate intensity did better than low intensity, and more sessions a week went with better everyday functioning.

Sources 42, 43, 44

Negative symptomsEmerging evidence

In 17 randomised trials with 954 people, aerobic exercise eased negative symptoms by a small amount, and the effect held in the better-run trials. A network of 32 trials found every type of exercise helped, with larger effects for yoga and strength training, but 23 of the trials were in Asia, effects were larger there, and certainty was low for most comparisons. Cochrane judged the yoga evidence "too weak" to show yoga beats standard care.

Sources 45, 46, 47

Memory, attention and thinkingEmerging evidence

Reviews found effects on overall thinking skills ranging from small (0.21 for aerobic exercise in 15 studies, and 0.33 in 10 trials) to moderate (0.73 for any exercise in 22 studies), larger when sessions were supervised, done in groups, and kept up for at least 12 weeks. Certainty is low, because the trials are small and differ, and one earlier review found no effect except for yoga on memory. Across 6 studies, aerobic exercise didn't clearly change the size of the hippocampus, a part of the brain involved in memory.

Sources 13, 43, 48, 38, 49

The largest trial: cardio was no betterEmerging evidence

In 180 people with stable schizophrenia, 6 months of supervised aerobic training did no better than flexibility, strength and balance training: both groups improved symptoms, functioning and thinking, and more frequent training helped memory further. Nearly 6 in 10 people dropped out of each group, and people who were managing better day to day were more likely to keep going.

Sources 14, 50

Everyday lifeEmerging evidence

In 18 studies with 734 people, exercise improved overall functioning by a moderate amount (0.40), with social functioning (0.54) and daily living skills (0.65) also improving, more with aerobic exercise of at least moderate intensity.

Sources 51, 38

YogaMixed evidence

In Cochrane's review of 8 short trials, single trials found benefits for mental state, social functioning and quality of life, but the reviewers called the evidence "too weak to indicate that yoga is superior to standard-care control". Another review of 5 trials found no short-term effect on symptoms. Network comparisons that rank yoga highly rest on small trials, and in one of them most trials were from Asia, where effects were larger. Choose the exercise you'll keep doing.

Sources 47, 52, 53

Weight and metabolic healthMixed evidence

Exercise improves fitness (0.33 in pooled trials) but on its own hasn't been shown to lower body mass index (BMI) or improve waist size, blood pressure, blood sugar or blood fats (10 trials, 773 people). One review of 9 small trials found a small to moderate fall in BMI with aerobic programmes lasting at least 20 weeks.

Sources 35, 42, 54, 55

Healthy eating and activity programmesMixed evidence

Programmes combining eating and activity support did better at preventing weight gain than at causing weight loss in 25 trials. A larger review of 41 trials found BMI fell by 0.63, which it called statistically significant but clinically insignificant, at low or very low certainty. England's STEPWISE trial (414 people) and Denmark's CHANGE trial (428 people) found no benefit, while the US ACHIEVE trial (291 people, 18 months of group and individual sessions with group exercise) led to 3.2 kg more weight loss.

Sources 56, 57, 58, 59, 60

Starting earlyEmerging evidence

In young people starting antipsychotics for a first episode, a lifestyle and life skills programme limited weight gain over 12 weeks to 1.8 kg, against 7.8 kg with standard care, in a small study that wasn't randomised (16 and 12 people). Weight gain is greatest in people taking an antipsychotic for the first time.

Sources 16, 37

A first episodeEmerging evidence

In 31 people in early intervention services, 10 weeks of individual training aiming for 90 minutes a week (they averaged 107) went with symptom scores falling and negative symptoms easing by a third, against a small comparison group. In two NHS early intervention services, live online group sessions twice a week for 8 weeks were safe, with no adverse events, and people became more active. Neither study was randomised.

Sources 61, 62

Can exercise prevent psychosis?Mixed evidence

In 4 long-term studies of 30,025 people, more active people were less likely to develop psychosis at first sight, but not once other factors were taken into account. It hasn't been shown to prevent psychosis.

Source 63

Where treatment carries the evidenceStrong evidence

Antipsychotic medicine, CBT for psychosis and family therapy are the treatments, and antipsychotics are linked with fewer deaths overall. Reviews across mental health conditions agree exercise helps symptoms as an add-on to treatment, not on its own.

Sources 8, 29, 64

What NICE and the NHS offer

A healthy eating and activity programmeStrong evidence

NICE recommends a combined healthy eating and physical activity programme from your mental health service, and NICE's quality standard measures how many people received one in the past 12 months. It asks staff to make services accessible to people with negative symptoms, and to be aware of "lack of access to affordable physical activity".

Sources 8, 65

Checks on your physical healthStrong evidence

When you start an antipsychotic, NICE says your weight should be checked weekly for 6 weeks, then at 12 weeks, at 1 year and every year, with waist, pulse, blood pressure, blood sugar and blood fats. Anyone aged 18 or over with schizophrenia, bipolar disorder or psychosis can have a free annual health check that includes advice on exercise. Rethink suggests asking to go on your surgery's severe mental illness register so you're invited.

Sources 8, 66, 67

The targets your team may use

NHS England's Lester resource, a heart and metabolic health framework for psychosis, sets a target of at least 30 minutes of activity a day and at least 150 minutes of moderate activity a week, such as 30 minutes on 5 days, with less time sitting. For 14 to 17 year olds it is at least 60 minutes a day. If targets aren't met in 3 months, it suggests the team considers medicines alongside lifestyle support.

Source 17

How much, and when

The guideline amounts

At least 150 minutes a week of moderate activity, such as brisk walking, spread over the week, plus strength exercises on 2 days, and breaking up long spells of sitting. Moderate means you can still talk, but not sing.

Sources 68, 17

What the trial programmes used

A 2026 review summarises the European Psychiatric Association's dose as 2 to 3 supervised sessions a week of 45 to 60 minutes at least at moderate intensity (60% to 70% of maximum heart rate), for 12 to 24 weeks. Two reviews found benefits from about 90 minutes a week of moderate to vigorous exercise. We read the association's own statement as a summary only.

Sources 69, 70, 42, 43

Strength and flexibility count too

In the largest trial, flexibility, strength and balance training helped as much as cardio. Aim for strength exercises on 2 days a week, as the NHS advises for everyone.

Sources 14, 68

Supervision and company help

Fewer people dropped out when physiotherapists or exercise professionals ran the sessions, fitness improved more with supervision and at least 3 sessions a week, and thinking skills improved more when sessions were supervised.

Sources 22, 35, 13

During an acute episode or in hospital

Follow your care team. In trials with inpatients, exercise didn't change symptoms, so the aim is to keep moving and sleeping, with short walks, not to train (our suggestion).

Source 12

Starting or changing an antipsychotic

Expect your weight to be checked every week for 6 weeks; the Lester resource advises a review if you gain more than 5% (about 3 to 4 kg) in the first 4 weeks. Start the eating and activity support now, not later. Take care with sleepiness and dizziness at first: clozapine can cause tiredness, drowsiness and seizures, especially early on.

Sources 8, 17, 16, 20

When your early warning signs appear

The NHS says signs you're becoming unwell can include losing your appetite, feeling anxious or stressed, and disturbed sleep. Don't push your training then: follow your plan and contact your team (our suggestion).

Source 6

A first fortnight: our editorial starting point

Days 1 to 7: a 10-minute walk every day at the same time, or the 10-minute starter workout on days you can't get out; the NHS says even a brisk 10-minute walk can clear your mind. Days 8 to 14: 15 to 20 minutes of brisk walking on 5 days, plus one strength session. Then add about 5 minutes a session each week towards 150 minutes a week, with a second strength day.

Sources 71, 17, 68

Getting started when motivation is low

What people want, and what gets in the wayEmerging evidence

In 12 studies of 6,431 people with severe mental illness, 91% wanted to exercise to improve their health, 83% to lose weight and 81% to lift their mood. The commonest barriers were low mood and stress (61%) and lack of support (50%), and the reviewers suggest professional support to set and reach goals.

Source 21

Small, regular steps

Rethink suggests starting small, setting realistic goals and building a routine, such as a run every Wednesday and Saturday. Any exercise is better than none, and it should be something you enjoy.

Sources 72, 71

Help you can ask for

Ask your GP about an exercise or social prescription for free or cheaper sessions. If you're entitled to aftercare under section 117 of the Mental Health Act, a personal health budget agreed with your team might pay for a class, a gym membership, a bike or a support worker to go with you. Rehabilitation teams can include an exercise coach, parkrun is free, and walking groups meet in many areas.

Sources 72, 73, 65

Exercise with others

Supervised and group sessions keep more people going. A 2026 review recommends combining group and individual sessions, setting small goals and resetting them as you progress.

Sources 22, 69

For carers, partners and parents

Offer to go with them, keep it small and regular, and praise turning up rather than results; lack of support is one of the biggest barriers people describe. Don't nag about weight, and remember that low drive is a symptom. NICE asks services to support carers too (our suggestions, from these sources).

Sources 21, 24, 8

Medicines, heat and exercise

Your own team's advice comes first. None of this is a reason to stop or change a medicine.

HeatStrong evidence

The Medicines and Healthcare products Regulatory Agency (MHRA) says antipsychotics such as olanzapine or quetiapine "can increase your body temperature, making you overheat more easily", and that you shouldn't stop prescribed medicines in hot weather without advice. Rethink advises avoiding strenuous activity in the hottest part of the day, and the NHS says people with mental health problems are at higher risk in a heatwave. Exercise early or late, or indoors where it's cool, and drink regularly.

Sources 18, 74, 75, 76

Sleepiness and dizziness

The NHS says don't drive, cycle or use machinery if an antipsychotic makes you sleepy, and if you feel dizzy when you stand, get up slowly and hold on to something. Use a static bike or walk until you know how a medicine affects you, and stand up slowly after floor exercises (our suggestion).

Sources 19, 77, 78

Restlessness

Feeling like you need to move all the time can be a side effect (akathisia): the NHS aripiprazole page says call your doctor or 111. It isn't something to burn off with exercise: tell your team (our suggestion).

Sources 78, 8

Constipation

For constipation on olanzapine, risperidone or aripiprazole, the NHS suggests more fibre, more to drink, and regular exercise such as a daily walk or run. Clozapine is different: see the clozapine section.

Sources 19, 79, 78

Blood clots

Swelling, pain and redness in one leg needs your doctor or 111, and chest pain with difficulty breathing needs 999. The clozapine leaflet says tell your doctor if you can't walk around for a long time, because of the risk of a clot. Regular walking breaks up long spells of sitting (our suggestion).

Sources 19, 79, 20

Alcohol and drugs

Drinking too much or using drugs can trigger psychosis and make symptoms worse, and both "can also react badly with antipsychotic medicines". The clozapine leaflet says don't drink alcohol, and alcohol adds to the sleepiness olanzapine can cause. Our addiction recovery guide covers getting help.

Sources 6, 20, 19

Hot yoga and saunas

If you take an antipsychotic, ask your doctor before hot yoga or a sauna (our suggestion, because of the heat warning). Our hot yoga guide lists who else should avoid it.

Source 18

Clozapine and exercise

The first 2 monthsStrong evidence

Clozapine can rarely inflame the heart muscle (myocarditis), and the risk is greatest in the first 2 months. Build up gradually, keep to activity you're used to, and ask your team before starting hard training then (our suggestion). The warning signs are in the warning signs section below.

Sources 80, 20

A fast heartbeat and the talk test

The leaflet lists a fast heartbeat as a very common side effect to tell your doctor about before your next tablet, and a fast heartbeat at rest can be a sign of heart inflammation. So judge your effort by how easily you can talk, not by a heart rate target (our suggestion).

Source 20

Fever and sweating

A temporary fever above 38°C can happen, most often in the first 3 weeks, and is usually harmless, but it must be checked, because signs of infection need an urgent blood test. Changes in sweating and body temperature control are listed side effects, so take care in the heat.

Sources 80, 20

Constipation can be seriousStrong evidence

Clozapine slows the gut, and rarely this leads to a dangerous blockage. Report constipation straight away. An NHS prescribing sheet advises more fibre, more fluid and more exercise, aiming for 30 minutes five times a week.

Sources 81, 82

Smoking, vaping and caffeineStrong evidence

The leaflet says tell your doctor if you smoke and how much caffeine you have, because "sudden changes" in either can change clozapine's effects. Stopping smoking or switching to vaping can raise clozapine levels, by up to 72% in one NHS sheet, with toxicity possible within a week. Don't add pre-workouts, energy drinks or lots of coffee without asking your team (our suggestion).

Sources 20, 80, 82, 8, 17

Walk, cycle, row

Build towards 150 minutes a week, such as 30 minutes on 5 days, at a talk-but-not-sing effort (NHS and Lester guidance). Start with 10 minutes a day if that's what you can do (our editorial starting point). The static bike is a safer way to cycle while a medicine makes you sleepy.

Strength

2 days a week (NHS guidance): 2 sets of 8 to 12 at home, or 2 to 3 sets of 12 to 15 on gym machines, stopping a couple of reps short (our editorial starting point). The machines suit a supported gym session; stand up slowly after floor moves if your medicines make you dizzy.

Gentle yoga and slow breathing

Gentle yoga with normal breathing on the days between, near a wall if you feel unsteady. The slow breathing move page's dose is at least 5 minutes, done regularly, with no holds. Talk to your team before intensive breathing or meditation practices.

Workouts to follow

On low days the 10-minute starter is enough. The walk after meals suits medicines that raise blood sugar, the low-impact cardio workout suits hot days indoors, and the machine workout suits a supported gym session.

10-minute starter workout

A 10-minute session for low-energy days: marching, sit-to-stands, wall push-ups, step-ups and bridges, then a short walk. Doing a little counts.

10 minBeginner7 movesA bench or box, A wall

10-minute walk and move after meals

A 10-minute routine for straight after a meal: an easy walk, a few simple standing moves from blood sugar trials, then a short walk to finish.

10 minBeginner6 movesCardio machine, A bench or box

Easy cardio workout

A steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.

40 minBeginner3 movesCardio machine, A wall

Low-impact cardio workout (no jumping)

A 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.

25 minBeginner9 movesA bench or box, A step

Beginner home workout

A gentle 20-minute beginner home workout with a chair, a wall and a band: sit-to-stands, wall push-ups, band rows, step-ups and dead bugs.

20 minBeginner11 movesA bench or box, A wall

Full-body machine workout (gym)

A 45-minute full-body gym workout on machines: leg press, chest press, machine row, leg curl, shoulder press and arms, with sets, reps and rest.

45 minBeginner14 movesCardio machine, A band

Gentle yoga for beginners

A 25-minute gentle yoga class for complete beginners and over-50s: slow breathing, a warm-up, supported standing poses, floor poses and a closing rest.

25 minBeginner14 movesNo equipment

Follow a plan

The walking plan builds to 150 minutes a week over 8 weeks, the Lester resource's target. Couch to 5K pairs well with parkrun.

Warning signs and where to get help

Call 999 (911 in the US) or go to A&E now

Call 999 or go to A&E if:

  • Your life is at risk: for example, you have seriously harmed yourself or taken an overdose, or you can't keep yourself or someone else safe.
  • During exercise, you have chest pain that feels tight or like squeezing, or spreads to your arms, neck or jaw, or severe difficulty breathing, or someone passes out and isn't responding normally.
  • You have palpitations that don't go away, or that come with chest pain, shortness of breath or feeling faint.

Sources 1, 2, 83, 84

On an antipsychotic: call 999 or go to A&E

The NHS medicine pages list these between them, and other antipsychotics carry similar warnings:

  • A high temperature, muscle stiffness, sweating, anxiety or excess saliva: these can be signs of a disorder called neuroleptic malignant syndrome.
  • Chest pain or difficulty breathing.
  • Weakness on one side of your face or body, trouble speaking or thinking, or blurred eyesight: these can be signs of a stroke.
  • A seizure or fit.
  • Thoughts about harming yourself or ending your life: rarely, antipsychotics can trigger them.

Sources 19, 79, 78, 73

On clozapine: tell your doctor before your next tabletStrong evidence

The leaflet says tell your doctor immediately, before taking the next tablet, if you have:

  • Signs of a cold, fever, flu-like symptoms, a sore throat or any other infection: you'll need an urgent blood test.
  • A fast heartbeat, or a fast and irregular heartbeat even when you are at rest, palpitations, breathing problems, chest pain or unexplained tiredness.
  • Severe constipation, or constipation with tummy pain or tenderness, fever, bloating or bloody diarrhoea.
  • A sudden rise in body temperature with rigid muscles.
  • Crushing chest pain or chest tightness that may spread to the left arm, jaw, neck or upper tummy, with breathlessness, sweating or feeling sick: the leaflet says get emergency treatment, so call 999.

Source 20

On clozapine: go to A&E for signs of a blockage

An NHS prescribing sheet advises going to A&E for:

  • Medium to severe tummy pain or discomfort lasting over an hour.
  • A swollen tummy.
  • Watery poo leaking around a blockage (overflow diarrhoea).
  • Being sick, especially if it smells of poo.
  • Signs of sepsis: a high or low temperature, confusion or drowsiness.

Source 82

Heatstroke: call 999

  • Still unwell after 30 minutes of resting in a cool place, being cooled and drinking fluids.
  • A very high temperature, or hot skin that isn't sweating.
  • A fast heartbeat, or fast breathing or shortness of breath.
  • Confusion and lack of coordination, a seizure or fit, or loss of consciousness.

Source 85

Get urgent help today

  • In England, call 111 and select the mental health option, use 111 online, or ask for an urgent GP appointment.
  • Call Samaritans free on 116 123, any time, day or night. If you're under 19, you can also call Childline on 0800 1111.
  • Text SHOUT to 85258, any time.
  • Contact your care co-ordinator or crisis team, as your crisis plan says.
  • In the US, call or text 988, the 988 Suicide and Crisis Lifeline, any time.

Sources 1, 2, 3, 4, 5

Contact your doctor, care team or 111 soon

  • Swelling, pain and redness in one leg, which can be a blood clot.
  • Feeling thirsty, needing to pee a lot, feeling tired and losing weight, which can be signs of high blood sugar.
  • Feeling you need to move all the time, or stiff or jerky movements.
  • Gaining more than about 3 to 4 kg (5% of your weight) in the first 4 weeks of a new antipsychotic.
  • Before you stop or start smoking, start vaping or change how much caffeine you have, especially on clozapine.
  • Your early warning signs, such as losing your appetite, feeling anxious or stressed, or disturbed sleep.

Sources 19, 78, 17, 20, 6

Support lines (not for emergencies)

Rethink Mental Illness's advice line, freephone 0808 801 0525, is normally open 9.30am to 4pm, Monday to Friday, for practical advice, not crisis support. The NHS also lists Mind, SANE and the Hearing Voices Network.

Sources 86, 6

Myths

"Exercise can replace antipsychotics"Strong evidence

Exercise eases symptoms by a small amount as an add-on. Antipsychotics are linked with fewer deaths, and NICE says stopping them in the first 1 to 2 years carries a high risk of relapse. The NHS says don't stop without first talking to your care co-ordinator, psychiatrist or GP.

Sources 12, 29, 8, 5

"If you exercise enough, you won't put on weight"Strong evidence

Exercise alone hasn't been shown to lower BMI or improve metabolic health in psychosis, and even combined programmes have small effects. Weight gain is common with all antipsychotics. Exercise is still worth it, because it improves fitness; ask your team about eating support and other options.

Sources 35, 54, 57, 58, 15

"People with schizophrenia don't want to exercise"Emerging evidence

91% of people with severe mental illness in one review wanted to exercise for their health. Low mood, stress and lack of support get in the way, and negative symptoms can be mistaken for laziness. Supported programmes keep more people going.

Sources 21, 24, 22

"Only cardio counts"Emerging evidence

In the largest trial, flexibility, strength and balance training helped symptoms, functioning and thinking as much as aerobic training, and strength training did well for negative symptoms in one network of trials. Cardio does most for fitness, so a mix works.

Sources 14, 46, 35

"Yoga is the best exercise for schizophrenia"Mixed evidence

Some reviews rank yoga highly, but most of the trials were small and from one region, and Cochrane called the evidence "too weak" to show yoga beats standard care. Gentle yoga is a fine choice if you enjoy it.

Sources 47, 52, 46

"Exercise is risky for people with psychosis"Emerging evidence

The online NHS group programme for a first episode reported no adverse events. The risks that matter are specific and manageable: heat on some antipsychotics, sleepiness and dizziness, and the clozapine warning signs in this guide.

Sources 62, 18, 19, 80

Questions people ask

Does exercise help schizophrenia?

Yes, as an add-on to medicine and therapy. In trials, exercise eased symptoms by a small amount, more in people living in the community, and it improves fitness and everyday functioning. It isn't a replacement for treatment.

What is the best exercise for schizophrenia or psychosis?

The one you'll keep doing. Brisk walking, cycling and other aerobic exercise have the most evidence, but in the largest trial stretching, strength and balance training helped as much. Aim for at least a moderate effort, where you can talk but not sing.

How much exercise should I do with schizophrenia?

Work towards 150 minutes a week of moderate activity, such as 30 minutes on 5 days, plus strength exercises on 2 days, and break up long spells of sitting. Two reviews linked about 90 minutes a week of moderate to vigorous exercise with benefits. Start with 10 minutes a day if that's what you can do.

Can exercise replace my medication?

No. Exercise helps alongside antipsychotics and therapy, but its effect on symptoms is small, and stopping medicine carries a high risk of relapse. Never stop an antipsychotic without first talking to your care co-ordinator, psychiatrist or GP.

How can I lose weight on olanzapine or quetiapine?

Exercise on its own rarely shifts weight on antipsychotics, but healthy eating and activity support together helps, especially if it starts in the first weeks of a new medicine. NICE says you should be offered a programme, and the NHS says regular exercise helps keep your weight stable on olanzapine. If you gain weight quickly, tell your team, who have other options; never stop the medicine yourself.

Is it safe to exercise on clozapine?

Yes, and an NHS prescribing sheet advises more exercise, with more fibre and fluids, to help prevent clozapine's constipation. Build up gradually, especially in the first 2 months. Tell your doctor before your next tablet if you have a fast or irregular heartbeat at rest, chest pain, breathing problems, unexplained tiredness, a fever or flu-like symptoms.

Do antipsychotics make you overheat?

Some can: the MHRA says antipsychotics such as olanzapine or quetiapine can raise your body temperature and make you overheat more easily. In hot weather, exercise early or late, or indoors where it's cool, drink regularly and avoid strenuous activity in the hottest part of the day. Don't stop your medicine because of the heat.

Does walking help schizophrenia?

Brisk walking counts as moderate exercise, and it's the easiest way to build towards 150 minutes a week. Walking groups, parkrun and an exercise prescription from your GP can help you keep going.

Does yoga help schizophrenia?

It may. Some trials found gentle yoga helped symptoms and quality of life, but Cochrane judged the evidence too weak to say it beats standard care. If you've had psychosis, talk to your team before intensive breathing or meditation practices.

Can exercise cause or prevent psychosis?

We found no evidence that ordinary exercise causes psychosis; lack of sleep, severe stress, drugs and steroids are known triggers. More active people were less likely to develop psychosis in some long-term studies, but not once other factors were taken into account, so it hasn't been shown to prevent it.

How can I help someone with schizophrenia to exercise?

Offer to go with them, keep it small and regular, and praise turning up rather than results. Lack of support is one of the biggest barriers people describe, and low drive is a symptom, not laziness. Ask their care team about the NICE activity programme, a support worker or an exercise prescription.

Does exercise help memory and concentration in schizophrenia?

Probably a little. Aerobic exercise improved thinking skills by a small to moderate amount in reviews, more when sessions were supervised and kept up for 12 weeks or more, though certainty is low. In the largest trial, flexibility, strength and balance training helped as much.

Sources

  1. NHS · Where to get urgent help for mental health ("call 111 and select the mental health option"; review was due April 2026)
  2. NHS · Help for suicidal thoughts
  3. Samaritans · Contact a Samaritan: 116 123, free, any time
  4. SAMHSA (US Substance Abuse and Mental Health Services Administration) · 988 Suicide and Crisis Lifeline: support for mental health and substance use
  5. NHS · Schizophrenia: treatment (review was due April 2026)
  6. NHS · Living with schizophrenia (review was due April 2026)
  7. NHS · Psychosis: overview (review was due September 2026)
  8. NICE CG178 · Psychosis and schizophrenia in adults: prevention and management (recommendations, updated September 2026)
  9. Hjorthøj 2017 · Years of life lost and life expectancy in schizophrenia: 11 studies (systematic review and meta-analysis, Lancet Psychiatry)
  10. OHID (Office for Health Improvement and Disparities) · Premature mortality in adults with severe mental illness
  11. Public Health England · Severe mental illness and physical health inequalities: briefing (2018)
  12. Gallardo-Gómez 2023 · Exercise for symptoms of schizophrenia: 28 randomised trials (systematic review and meta-analysis, Eur Psychiatry)
  13. Firth 2017 · Aerobic exercise and thinking skills in schizophrenia: 10 trials (systematic review and meta-analysis, Schizophr Bull)
  14. Maurus 2023 · Aerobic training compared with flexibility, strength and balance training in 180 people with schizophrenia (randomised trial, Psychiatry Res)
  15. Rethink Mental Illness · Antipsychotics and physical activity (update was due May 2025)
  16. Curtis 2016 · A lifestyle programme to prevent antipsychotic weight gain in first-episode psychosis (controlled study, Early Interv Psychiatry)
  17. Perry 2023 · Positive Cardiometabolic Health Resource, the Lester UK adaptation for psychosis and schizophrenia, with a 2025 adolescent supplement (NHS England and the Royal College of Psychiatrists)
  18. MHRA (Medicines and Healthcare products Regulatory Agency) · Don't let this heatwave affect your medicines (June 2026)
  19. NHS · Side effects of olanzapine
  20. Viatris · Clozaril 25 mg and 100 mg tablets: patient information leaflet (revised February 2026)
  21. Firth 2016 · Why people with severe mental illness exercise, and what stops them: 12 studies (systematic review and meta-analysis, Psychol Med)
  22. Vancampfort 2016 · Dropout from exercise programmes in schizophrenia: 19 studies (meta-analysis, Gen Hosp Psychiatry)
  23. NHS · Schizophrenia: overview (review was due April 2026)
  24. NHS · Schizophrenia: symptoms (review was due April 2026)
  25. NHS England · Adult Psychiatric Morbidity Survey 2023/4, chapter 12: psychotic disorder (2025)
  26. NIMH (US National Institute of Mental Health) · Schizophrenia statistics
  27. NHS · Psychosis: causes (review was due September 2026)
  28. NHS · Anabolic steroid misuse
  29. Correll 2022 · Deaths in people with schizophrenia: 135 studies (systematic review and meta-analysis, World Psychiatry)
  30. Mitchell 2013 · Metabolic syndrome in schizophrenia: 77 publications (systematic review and meta-analysis, Schizophr Bull)
  31. Vancampfort 2015 · Metabolic syndrome in severe mental illness and the medicines involved (systematic review and meta-analysis, World Psychiatry)
  32. OHID · Smoking and tobacco: applying All Our Health
  33. Stubbs 2016 · How active people with schizophrenia are: 35 studies (systematic review and meta-analysis, Schizophr Res)
  34. Vancampfort 2017 · Sitting and activity in schizophrenia, bipolar disorder and depression (global meta-analysis, World Psychiatry)
  35. Vancampfort 2017 · Aerobic fitness in severe mental illness: 23 studies (systematic review and meta-analysis, Sports Med)
  36. Pillinger 2020 · Metabolic effects of 18 antipsychotics: 100 trials (network meta-analysis, Lancet Psychiatry)
  37. Bak 2014 · Almost all antipsychotics cause weight gain (meta-analysis, PLoS One)
  38. Dauwan 2016 · Exercise for symptoms, quality of life and functioning in schizophrenia: 29 studies (systematic review and meta-analysis, Schizophr Bull)
  39. Stubbs 2015 · No control group response in exercise trials in schizophrenia (meta-analysis, Psychiatry Res)
  40. Greca 2026 · Structured exercise in schizophrenia spectrum disorders: 17 trials (systematic review and meta-analysis, Psychiatry Res)
  41. Gorczynski 2010 · Exercise therapy for schizophrenia: 3 trials (Cochrane review)
  42. Firth 2015 · Exercise for schizophrenia: 20 studies (systematic review and meta-analysis, Psychol Med)
  43. Shimada 2022 · Aerobic exercise and thinking skills in schizophrenia: 15 studies (updated meta-analysis, Psychiatry Res)
  44. Rißmayer 2024 · Exercise intensity and other moderators in psychotic disorders: 40 randomised trials (meta-analysis, Schizophr Bull)
  45. Sabe 2020 · Exercise for negative symptoms of schizophrenia: 17 randomised trials (meta-analysis, Gen Hosp Psychiatry)
  46. Wang 2025 · Types of exercise for negative symptoms: 32 randomised trials (network meta-analysis, Psychiatry Res)
  47. Broderick 2015 · Yoga compared with standard care for schizophrenia: 8 trials (Cochrane review)
  48. Lak 2024 · Exercise and thinking skills in schizophrenia: 22 studies (meta-analysis, Schizophr Res)
  49. Roell 2024 · Aerobic exercise and hippocampus volume in schizophrenia: 6 studies (meta-analysis, Psychol Med)
  50. Schwaiger 2024 · What predicts sticking with exercise in schizophrenia (trial analysis, Eur Arch Psychiatry Clin Neurosci)
  51. Korman 2023 · Exercise and everyday functioning in schizophrenia: 18 studies (meta-analysis, Schizophr Res)
  52. Cramer 2013 · Yoga for schizophrenia: 5 randomised trials (systematic review and meta-analysis, BMC Psychiatry)
  53. Yang 2024 · Exercise type and dose for schizophrenia symptoms: 47 studies (network meta-analysis, Neurosci Biobehav Rev)
  54. Ancín-Osés 2025 · Exercise and metabolic syndrome in psychotic disorders: 10 randomised trials (meta-analysis, Eur Psychiatry)
  55. Liu 2026 · Exercise and body mass index in schizophrenia: 9 trials (meta-analysis, Schizophr Res)
  56. Bruins 2014 · Lifestyle programmes for weight in psychotic disorders: 25 randomised trials (meta-analysis, PLoS One)
  57. Speyer 2019 · Lifestyle programmes for weight in serious mental illness: 41 randomised trials (meta-analysis, Psychother Psychosom)
  58. Holt 2019 · STEPWISE: group lifestyle education for 414 people with schizophrenia in England (randomised trial, Br J Psychiatry)
  59. Speyer 2016 · CHANGE: lifestyle coaching for 428 people with schizophrenia in Denmark (randomised trial, World Psychiatry)
  60. Daumit 2013 · ACHIEVE: an 18-month weight loss programme for 291 people with serious mental illness (randomised trial, N Engl J Med)
  61. Firth 2018 · Exercise in first-episode psychosis: 31 people over 10 weeks (feasibility study, Early Interv Psychiatry)
  62. French 2026 · Online group exercise in two NHS early intervention services (feasibility study, Schizophr Res)
  63. Brokmeier 2020 · Physical activity and the risk of psychosis: 4 cohorts (meta-analysis, Psychiatry Res)
  64. Ashdown-Franks 2020 · Exercise for mental health and substance use disorders: 27 reviews (meta-review, Sports Med)
  65. NICE QS80 · Psychosis and schizophrenia in adults: quality statement 7, healthy eating, physical activity and stopping smoking
  66. NHS · Annual health check for people with severe mental health conditions
  67. Rethink Mental Illness · Physical health checks for severe mental illness
  68. NHS · Physical activity guidelines for adults aged 19 to 64
  69. Ventura 2026 · Aerobic exercise for thinking and functioning in schizophrenia: evidence and practical recommendations (review, Schizophr Bull Open)
  70. Stubbs 2018 · European Psychiatric Association guidance on physical activity for severe mental illness (meta-review and position statement, Eur Psychiatry)
  71. NHS · Exercise for depression
  72. Rethink Mental Illness · Physical activity and mental health: benefits, barriers and practical tips
  73. NHS · Psychosis: treatment (review was due September 2026)
  74. MHRA · Taking medication this summer: sun and heat exposure (August 2026)
  75. Rethink Mental Illness · Mental health medication and hot weather
  76. NHS · Heatwave: how to cope in hot weather
  77. NHS · Quetiapine
  78. NHS · Side effects of aripiprazole (review was due April 2026)
  79. NHS · Side effects of risperidone
  80. Viatris · Clozaril 25 mg tablets: summary of product characteristics (revised February 2026)
  81. MHRA Drug Safety Update · Clozapine: reminder of the risk of intestinal obstruction (October 2017)
  82. Nottinghamshire Area Prescribing Committee · Clozapine information sheet for primary care (version 5.0, 2024)
  83. NHS · Heart attack
  84. NHS · Heart palpitations
  85. NHS · Heat exhaustion and heatstroke
  86. Rethink Mental Illness · Contacting the advice service: 0808 801 0525

Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.