Übungen bei schweren psychischen Erkrankungen — Antipsychotika-bewusst, metabolischer Schutz

Vancampfort 2017 + Stubbs 2018 established that aerobic + resistance exercise reduce psychiatric symptoms and counteract metabolic side effects in severe mental illness (SMI) — schizophrenia, schizoaffective disorder, bipolar disorder. Hjorthøj 2017 captured the underlying crisis: a 10-20 year premature mortality gap vs general population, driven mostly by cardiometabolic disease + smoking — NOT directly by psychiatric symptoms. Pillinger 2020 ranked antipsychotic weight gain risk: olanzapine + clozapine highest; risperidone + quetiapine + paliperidone moderate; aripiprazole + lurasidone + ziprasidone lower. Medication adherence is medical priority — non-adherence drives relapse + hospitalization + mortality. The exercise priorities are therefore: cardiometabolic protection via aerobic + resistance, posterior chain + posture against medication-associated weight gain, breath/parasympathetic anchors for symptom + sleep + adherence support, gentle progression respecting energy + cognition. AVOID stimulant pre-workouts (psychosis + mania trigger risk). AVOID restrictive diets without psychiatry team (food-mood cycles).

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain that supports rebuilding + weight management, wall-push-up for upper-body strength scaling, scapular-retraction for posture, cat-cow for spinal mobility, supine-knee-to-chest for low-back release, calf-raise-rehab for posterior-chain strength + cardiometabolic protection, ankle-pump for circulation, diaphragmatic-breathing for parasympathetic regulation + symptom + sleep + adherence support, standing-march for cardio. The AI coach also knows the nutrition side — Hjorthøj 2017 mortality gap is largely modifiable (cardiometabolic + smoking), Mediterranean / DASH pattern + protein-forward, protein 1.2-1.4 g/kg/day, antipsychotic-specific monitoring (clozapine + olanzapine T2D + dyslipidemia screening per APA — baseline + 12 wks + quarterly + annual), bipolar mood-stabilizer interactions (lithium needs CONSISTENT sodium + fluid — low-sodium diets can raise lithium to toxic; valproate weight + tremor + PCOS; lamotrigine fewer interactions), MAOI tyramine restriction (aged cheese, fermented foods, cured meats, draft beer — hypertensive crisis risk), caffeine moderate + AVOID late-day, alcohol AVOID excess (psychiatric med interactions + sleep + relapse risk), AVOID stimulant pre-workouts (psychosis + mania risk), AVOID restrictive diets without psychiatry team. CRITICAL: psychiatrist + community mental health + NAMI + APA + DBSA + ISBD + 988. Medication adherence is medical PRIORITY. Annual cardiometabolic screening per APA. This is NEVER a replacement for psychiatric care.