Physical Activity Matches Medication and Therapy for Depression Relief

Major Research Validates Exercise as Depression Treatment

A comprehensive new study has confirmed what many mental health professionals have long suspected: exercise works as well as medication and therapy for treating depression. The analysis was led by researchers at the University of Lancashire and drew on data from 73 randomized controlled trials involving nearly 5,000 adults diagnosed with depression. These studies examined how exercise compared with no treatment or control conditions, as well as with psychological therapies and antidepressant drugs.

When measured against psychological therapy, exercise produced similar improvements, based on moderate certainty evidence from ten trials. Comparisons with antidepressant medication also suggested comparable effects, but the supporting evidence was limited and considered low certainty. Depression remains a major global health challenge, affecting more than 280 million people worldwide and contributing significantly to disability.

The findings represent a significant milestone in depression treatment research. "This new Cochrane review reinforces the evidence that exercise is one of the most evidence-based tools for improving mood," says Dr. Stephen Mateka, medical director of psychiatry at Inspira Health.

How Exercise Rewires the Brain

The biological mechanisms behind exercise's antidepressant effects are becoming clearer. "Exercise can help improve neurotransmitter function, like serotonin as well as dopamine and endorphins. So there is certainly overlap between exercise and how antidepressants offer relief," Mateka explains.

Beyond neurotransmitters, exercise triggers another powerful change in the brain. Exercise can trigger the release of brain growth factors, explains Dr. Nicholas Fabiano of the University of Ottawa. He says depression can decrease neuroplasticity, making it harder for the brain to adapt and change. "The brain in depression is thought to be less plastic. So there's less what we call neurotrophic factors, or BDNF," Fabiano explains. He calls it the Miracle-Gro for the brain. "And we know that exercise can also boost it."

Reported side effects were uncommon. People in exercise programs occasionally experienced muscle or joint injuries, while those taking antidepressants reported typical medication-related issues such as fatigue and gastrointestinal problems.

Finding the Right Exercise Formula

You don't need to become a marathon runner to see benefits. The review found that light to moderate intensity activity may be more helpful than vigorous workouts. Greater improvements in depressive symptoms were linked to completing between 13 and 36 exercise sessions. Programs that combined different types of activity and resistance training appeared more effective than aerobic exercise alone.

"When it comes to exercise, it's about just finding the exercise that works for you, such as something like yoga or tai chi versus something like walking and jogging," says Mateka. Compared with active controls, moderate reductions in depression were found for walking or jogging, yoga, strength training, mixed aerobic exercises, and tai chi or qigong.

For some, group activity can add to the psychosocial benefits. , it's best to pick something you enjoy or go back to an activity or sport you liked as a child.

Overcoming Treatment Barriers

Despite the evidence, exercise remains underutilized as a depression treatment. "Exercise has been adopted as a first-line treatment in guidelines for depression globally with good acceptability and safety," yet it remains underappreciated and underutilized. "It's much easier for a primary care physician to prescribe medication to a patient. You just write it on a pad," Fabiano says. It's harder to prescribe exercise, which takes time and effort and can be difficult to start for people who are depressed.

Fabiano says exercise can work best as part of a combination of treatments. "We can start someone on an antidepressant — maybe that improves their mood, and they're able to engage in therapy. And from there, maybe now they're more interested in starting some of these lifestyle habits like exercise," Fabiano says.

Exercise stands out as a low cost and widely accessible option that also improves physical health, making it appealing to both patients and healthcare professionals. As research continues to validate exercise as a legitimate treatment option, healthcare systems may need to rethink how they integrate movement into comprehensive depression care plans.