Health Care Coverage for Exercise-Based Programs for People with Serious Mental Illness

The Society of Behavioral Medicine (SBM) and American College of Sports Medicine (ACSM) recently released a position statement calling for health plan coverage for exercise interventions for serious mental illness (Pratt et al., 2015).  The position statement states that, “The Society of Behavioral Medicine and the American College of Sports Medicine encourage legislation and policies for Medicare, Medicaid, and private insurers to reimburse exercise programming for people with serious mental illness treated in community mental health programs.”  Currently, exercise programs designed to treat mental illness are not reimbursable through Medicaid, Medicare, or private insurers.

Research indicates that exercise is related to improvements in both physical and mental health (Lobelo et al., 2014).  Specifically, lack of exercise is related to several health issues including increased risk of heart disease, hypertension, and stroke (AHA, 2015).  Regarding mental health, exercise is effective for treating depression (Cooney et al., 2013).  Furthermore, studies have found that exercise is just as effective as antidepressant medication for treating depression (Blumenthal et al., 2007).  Despite these benefits, only 20% of individuals with serious mental health illness exercise at the recommended levels to obtain these health benefits and over 80% are overweight or obese (Bartels & Desilets, 2012; NIH, 2013).  The recommendation is that healthy individuals engage in five or more day of moderate intensity physical activity for at least 30 minutes each session or three or more days of vigorous intensity physical activity for at least 20 minutes per session (Haskell et al., 2007).  Behavioral interventions are efficacious for increasing exercise among individuals with severe mental illness (Rosenbaum et al., 2014); however, these types of interventions are typically not reimbursed by health insurers.

The policy statement summarized several barriers to providing exercise interventions to individuals with serious mental health issues (Pratt et al., 2015).  For example, health care usually separates out mental health funding from physical health funding, which then prevents community mental health programs from financing exercise programming.  Additionally, training programs do not exist that train staff from community mental health programs to deliver exercise programs.  Finally, Medicare, Medicaid, and private insurers do not allow certain health professionals to receive reimbursement for exercise programming.  Even though the report focused on community mental health settings, much of this can be applicable to private clinical settings in that exercise interventions are not reimbursable.

The policy statement calls for “allied health professionals” to receive reimbursement for exercise counseling.  The policy statement does not specifically define “allied health professional” but as an example, could refer to an “ACSM Registered Clinical Exercise Physiologist (RCEP),” which is a practitioner with at least a master’s degree in exercise science and has experience delivering physical activity behavioral interventions to individuals with clinical conditions that can significantly benefit from exercise (ACSM, 2010).  Therefore, allied health professionals could potentially work with psychologists in providing a holistic program of care for individuals with severe mental illness.  Another option would be to train the practicing psychologist to deliver exercise interventions that could be part of an overall treatment plan for the patient.  For example, cognitive behavioral therapy can include “behavioral activation,” which can include exercise.  Further training regarding how to motivate individuals to exercise could be provided to practicing psychologists in order to encourage exercise by their patients.

In summary, research indicates that exercise can be an effective intervention for mental illness.  Legislators and policy makers should make changes to current policy in order to allow for reimbursement of physical activity behavioral interventions.  Exercise has the potential benefit of not only treating mental illness, but can also impact the long-term health of the patients receiving the intervention.  The full summary of the SBM/ACSM position statement can be found by clicking here.

Beth Lewis, Ph.D., L.P., is an Associate Professor in the School of Kinesiology at the University of Minnesota.  She researches the effect of exercise on preventing postpartum depression.


American College of Sports Medicine (2010).  ACSM registered clinical exercise physiologist® job task analysis.  Retrieved from

Bartels, S., & Desilets, R. (2012).  Health promotion programs for people with serious mental illness (Prepared by the Dartmouth Health Promotion Research Team). Washington, D.C. SAMHSA-HRSA Center for Integrated Health Solutions.

Blumenthal, J.A., Babyak, M.A., Doraiswamy, P.M., Watkins, L., Hoffman, B.M., Barbour, K.A., ….& Sherwood, A. (2007). Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosomatic Medicine, 69(7), 587-596.

Cooney, G., Dwan, K., Greig, C., Lawlor, D., Rimer, J., Waugh, F.,…& Mead, G. (2013). Exercise for depression.  Cochrane Database of Systematic Reviews, 2013(9).

Haskell, W. L., Lee, I. M., Pate, R. R., Powell, K. E., Blair, S. N., Franklin, B. A., … & Bauman, A. (2007). Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation, 116(9), 1081.

Lobelo, F., Stoutenberg, M., & Hutber, A. (2014).  The exercise is medicine global health initiative: A 2014 update. British Journal of Sports Medicine, 48(22), 1627-33.

National Institutes of Health (2013).  NIH study shows people with serious mental illnesses can lose weight. Retrieved from:

Pratt, S., Jerome, G., Schneider, K., Craft, L., Stouten­berg, M., Buman, M., ……& Goodrich, D. (2015).  Increase United States health plan coverage for exercise programming in community mental health programs for people with serious mental illness.  Retrieved from

Rosenbaum, S., Tiedemann, A., Sherrington, C., Curtis, J., & Ward, P. B. (2014). Physical activity interventions for people with mental illness: a systematic review and meta-analysis. The Journal of Clinical Psychiatry, 75(9), 964-974.
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