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A new study published in the Journal of Affective Disorders looked at the effect of exercise on suicidal ideation and behaviors.

“Our study aimed to investigate the effect of exercise on suicidal behaviors (suicidal ideation, suicide attempts, and suicide deaths) in those with mental or physical illness,” study author Dr. Nicholas Fabiano told us. “Our secondary objective was to determine if those with mental or physical illness were able to adhere to exercise regimes as people with comorbidities are often perceived not to be adherent to exercise regimes due to the nature of their illness.”

The research team hoped to find which exercise modalities in specific populations were most effective at reducing suicidal behaviours to allow this to be incorporated into treatment plans.

"As exercise has shown to have similar efficacy to antidepressants and cognitive behavioural therapy in the treatment of depression,” Dr. Fabiano told us, “we believed that exercise would also reduce suicidal behaviours.”

Those with mental or physical illness are at an increased risk of suicide compared to the general population. Mental and physical health are inexorably intertwined. Those with chronic physical conditions are more prone to develop mental illness, while those with mental illness are more likely to suffer from a variety of other medical conditions.

“We often split up ‘mental health’ and ‘physical health’ in medicine, however I believe that the two are more on a continuum and a holistic term such as ‘health’ should be used instead. Therefore, when treating those with mental illness it is also imperative that we bolster one’s physical health through easily accessible activities such as exercise.”

A PRISMA 2020-compliant systematic review was conducted searching MEDLINE, EMBASE, Cochrane, and PsycINFO from inception to June 21, 2022. Randomized controlled trials (RCTs) investigating exercise and suicidal ideation in subjects with mental or physical conditions were included. Seventeen RCTs encompassing 1021 participants were included.

The research team found that exercise resulted in decreased suicide attempts. There was no significant difference in dropouts between those randomized to exercise compared to inactive controls. This finding demonstrates that those with mental or physical illness are able to adhere to exercise regimes. Exercise did not impact suicidal ideation or suicide deaths. However, these lack of associations were likely due to the limited number and sample size of existing studies.

"I was surprised by the lack of effect of exercise on suicidal ideation or suicide deaths, however it was expected due to the limited sample size,” Dr. Fabiano told us. “As more RCTs are conducted in this area, I expect that we will see decreases in both suicidal ideation and suicide deaths due to larger sample sizes. As suicide rates are on the rise, it is important that we find methods to counteract this.”

These findings demonstrate that exercise may be an effective way to reduce suicidal behaviours among those with mental or physical illness. However, future RCTs examining a breadth of physical and mental health conditions with larger sample sizes and direct measurements of suicide-related outcomes are necessary to validate or confute these preliminary findings.

“I can personally speak to the beneficial cognitive and physical aspects of regular exercise,” Dr. Fabiano told us. “No matter how busy residency is, I maintain a regular exercise routine which has improved my mood, decreased anxiety levels and significantly improved my academic performance.”