A genetic perspective on the association between exercise and mental health in the era of genome-wide association studies

Regular exercise is associated with mental health throughout the life course but the chain-of-causality underlying this association remains contested. I review results from genetically informative designs that examine causality, including the discordant monozygotic twin design, multivariate genetic models, Mendelian Randomization, and stratification on polygenic risk scores. Triangulation across the results from these and the standard designs for causal inference (RCT, prospective studies) in the extant literature supports the existence of causal effects of exercise on mental health as well as residual confounding by genetic factors that independently influence participation in regular exercise and mental health outcomes. I present an update of our earlier model for the genetic determinants of voluntary exercise behaviour. The model allows causal effects of regular exercise on mental health to co-exist with genetic pleiotropy through differences in the genetic sensitivity to the mental health benefits of exercise. The model encourages research on strategies that use genomic information to improve the success of interventions on regular exercise behaviour.