Les patients atteints de schizophrénie présentent un risque de morbi-mortalité cardiovasculaire et métabolique plus élevé que la population générale en raison d’une mauvaise condition physique et en lien avec un mode de vie sédentaire. De plus, malgré des progrès thérapeutiques majeurs dans la prise en charge globale de ces patients, certaines dimensions symptomatiques de la maladie comme les symptômes négatifs et cognitifs restent résistants aux approches pharmacologiques usuelles. Les bénéfices de l’activité physique sur la santé physique et mentale sont désormais bien décrits dans la schizophrénie en tant que thérapeutique adjuvante et seraient sous-tendus par des mécanismes biologiques et cérébraux, lesquels restent à éclaircir. Dans cette revue, nous proposons de faire un état de la littérature et de présenter une mise à jour de l’intérêt de l’activité physique dans la prise en charge des patients atteints de schizophrénie. Nous reviendrons ensuite sur les bénéfices cliniques de l’activité physique sur les différentes dimensions symptomatiques de la maladie et son impact spécifique sur les déficits cognitifs. Nous aborderons également les différents mécanismes physiopathologiques sous-jacents, notamment sur le plan neurobiologique, cérébral et physiologique. Enfin, nous discuterons des obstacles, des facteurs facilitateurs et motivationnels à la pratique d’une activité physique afin d’améliorer les initiatives de promotion de cette approche thérapeutique novatrice mais également d’aider à optimiser les ressources lors de l’allocation des programmes d’activité physique en pratique clinique.

Schizophrenia is a severe chronic mental disorder that mainly manifests by positive symptoms, negative symptoms, disorganized behavior and thought and cognitive impairments. Taken together, these symptoms have substantial impact on quality of life, well-being and functional outcome. Patients with schizophrenia have dramatically higher levels of cardiovascular and metabolic morbidity than the general population due to poor physical fitness and to sedentary lifestyle. They have a reduced life expectancy, and an excess mortality being two or three times more than that in the general population. Moreover, despite major therapeutic advances in the overall management of these patients, some symptomatic dimensions, and more specifically the negative and cognitive ones, remain to be resistant to the usual pharmacological approaches. Moreover, antipsychotics can also reinforce the global cardiovascular risk due to side effects and low neurometabolic tolerance. The benefits of physical activity on health are now well described in the general population and in many medical diseases. More recently, physical activity has also found its place as an adjuvant therapy in severe mental illnesses, particularly in schizophrenia. In the literature physical activity programs, in addition to pharmacological treatments, appear to be feasible in patients and improve both physical and mental health as well as functional outcome. Clinical benefits of physical activity would be underpinned by biological and cerebral mechanisms, which remain unclear. In this review, we propose to present a state of the art and to present an update of the interests of physical activity in the management of patients with schizophrenia. We emphasize the clinical benefits of physical activity regarding the different symptomatic dimensions and its impact specifically on cognitive deficits. Finally, we describe the various underlying pathophysiological mechanisms in particular in the neurobiological, cerebral and physiological fields. We then discuss the barriers, facilitators and motivating factors towards physical activity to enhance health promotion initiatives, to optimize resource allocation when delivering physical activity programs in clinical practice, and to maximize physical activity participation. Physical activity appears to be an original and novel adjunctive therapeutic approach in the management of patients with schizophrenia and would both reduce schizophrenic symptoms and act like pro-cognitive therapy, improve quality of life and long-term functioning in daily life and reduce cardiovascular comorbidities. However, efforts are still needed to increase the motivating factors and adherence towards physical activity participation for people with schizophrenia.