The aim of this paper was to describe the effects of physical activity on management of schizophrenia. A critical review of literature was made and current state of knowledge presented. In line with contemporary research trends and based on available evidence, a panel of experts from the European Psychiatric Association issued a guidance on exercise interventions in the treatment of severe mental illness. Elevated premature mortality rates in schizophrenia patients are linked largely to the effect of antipsychotic treatment, low physical activity, and/or increased somatic comorbidity, mainly of cardiometabolic origin. Physical exercise combined with psychological and dietary interventions are reported to improve parameters of the metabolic syndrome, cardiovascular fitness and cognitive performance. Moderate and high intensity training are deemed attractive forms of adjunctive therapy of schizophrenia, adjustable to patients’ age, performance and preferences. Future research and high-quality clinical trials investigating the effects of exercise on early presentation of the disease, its pragmatic efficacy, potential adverse events, financial burden and neurobiological underpinnings could help create specific recommendations for training programs of optimal format, dose and duration.