The effects of exercise on obsessive-compulsive disorder and bipolar disorder: a systematic review and meta-analysis.

BACKGROUND

Exercise, as a non-pharmacological intervention, alleviates symptoms of obsessive-compulsive disorder (OCD) and bipolar disorder (BD). Nevertheless, the comparative efficacy of these conditions remains uncertain. This systematic review and meta-analysis examined the effects of exercise on OCD and BD.

METHODS

The Cochrane Library, PubMed, Embase and Web of Science were searched from inception to 31 July 2025 to identify randomised controlled trials (RCTs) and single-group pre-post studies on exercise for OCD/BD. Retrieved studies were evaluated via predefined inclusion/exclusion criteria. Methodological quality was assessed using the MINORS scale and Cochrane Risk of Bias tool. Meta-analyses were conducted with Stata 17.0 and Review Manager 5.4.1. Subgroup analyses explored exercise parameters; sensitivity analyses and publication bias assessments were not performed for OCD outcomes due to the limited number of included studies, but were conducted for BD outcomes to evaluate robustness.

RESULTS

Seven studies (n = 202 participants) were included. Meta-analysis of two OCD single-group pre-post studies revealed a significant reduction in OCD symptoms following exercise intervention (Mean Difference [MD] = 14.74, 95% confidence interval [CI] [12.12, 17.36], p < 0.001), but two randomized controlled trials showed no significant effect. Subgroup analysis based on combined data indicated efficacy with a weekly exercise frequency. The investigation revealed no statistically significant difference between the aerobic exercise and yoga/tai chi interventions (p = 0.19). Meta-analysis of three BD studies revealed no significant effect of exercise on depressive symptoms (Standardised Mean Difference [SMD] = 0.08, 95%CI [-0.4,0.55], p = 0.75). A potential, non-significant effect was observed for manic symptoms (SMD = -0.62, 95%CI [-1.30, 0.05], p = 0.07). Subgroup analyses, categorised according to exercise type, frequency, or duration, revealed no significant effects.

CONCLUSION

Exercise may benefit OCD symptoms; however, randomized controlled trials showed no significant effect, and single-group findings should be interpreted as supportive evidence. For bipolar disorder, no significant effect was found for depressive symptoms, while a potential effect on manic symptoms cannot be excluded. Larger randomized controlled trials are needed. These findings provide preliminary evidence for exercise-based adjunctive interventions.

CLINICAL TRIAL NUMBER: Not applicable.

SYSTEMATIC REVIEW TRAIL REGISTRATION: This study has been registered on PROSPERO(CRD420251114629).