Exercise as Medicine: The Science-Backed Guide to Using Physical Activity for Depression Treatment
If you've ever wondered whether exercise can truly help with depression, you're not alone. Recent research has transformed our understanding of physical activity as a legitimate, evidence-based treatment for mental health conditions. In this comprehensive guide, we'll explore the latest scientific findings on exercise and depression, helping you understand how movement can become a powerful tool in your mental health toolkit.
What the Research Really Shows
Meta-Analysis Findings: Large Effects Across Studies
Recent meta-analyses (studies that combine results from multiple research trials) have revealed impressive findings:
41 studies with over 2,000 participants showed large effect sizes for exercise interventions
When restricted to people with clinical depression, effect sizes increased to nearly 1.0
Supervised exercise interventions showed even greater benefits
The number needed to treat was just 2 - meaning for every 2 people who exercise, 1 will experience significant improvement
Comparing Exercise to Other Treatments
Multiple studies have directly compared exercise to standard treatments:
Exercise vs. Antidepressants:
A 2023 study found comparable remission rates between running therapy (43.3%) and antidepressants (44.8%)
Exercise showed superior benefits for physical health markers including weight, blood pressure, and heart rate variability
Antidepressants showed faster improvement in anxiety symptoms at 6 weeks
Exercise vs. Cognitive Behavioral Therapy (CBT):
Long-term studies (12 months) found similar effectiveness between exercise and internet-based CBT
Both treatments significantly outperformed usual care
Exercise groups showed sustained benefits over time
The Optimal Exercise "Dose"
Research has identified specific parameters for maximum mental health benefits:
Minimum Effective Dose:
320 metabolic equivalent minutes per week
Equivalent to about 245 minutes of walking weekly
Optimal Dose:
860 metabolic equivalent minutes per week
Achievable through:
245 minutes of walking per week, OR
140 minutes of moderate aerobic exercise, OR
250 minutes of yoga per week
Important Finding: The relationship follows a U-shaped curve - benefits increase rapidly with initial activity but level off at higher intensities. This means any amount of exercise is beneficial, and you don't need to be an athlete to see results.
Types of Exercise: What Works Best?
The encouraging news is that almost any type of exercise can help with depression:
Common & Effective Forms of exercise:
Aerobic Exercise (running, cycling, swimming)
Resistance Training (weightlifting, bodyweight exercises)
Yoga and Mind-Body Practices
Walking/Jogging
Mixed Aerobic and Resistance
Group vs. Individual Exercise:
Yoga shows better results when done in groups
Strength training and mixed aerobic exercise are equally effective individually or in groups
Group settings provide additional social support benefits
How Exercise Works: The Science Behind the Benefits
Neurobiological Mechanisms:
Increased BDNF (Brain-Derived Neurotrophic Factor): Exercise significantly boosts this "miracle grow" protein for brain cells
Neurotransmitter Enhancement: Improved serotonin, norepinephrine, and dopamine function
Reduced Inflammation: Exercise decreases systemic inflammation linked to depression
Myokine Release: Muscle contractions release beneficial proteins that communicate with the brain
Psychological Mechanisms:
Improved Motivation: Exercise may help break the cycle of decreased dopamine and motivation common in depression
Behavioral Activation: Physical activity provides structure and achievement experiences
Enhanced Self-Efficacy: Regular exercise builds confidence and sense of control
Addressing Common Concerns and Barriers
"I'm Too Depressed to Exercise"
This is perhaps the most valid concern. The research shows:
Studies primarily included people with mild to moderate depression
For severely depressed individuals, exercise should be part of a comprehensive treatment plan
Starting with just 10 minutes daily (the "Commit 10" approach) can be effective
Any movement is better than none
Adherence Challenges
Research consistently shows higher dropout rates for exercise compared to medication:
Exercise groups: ~50% completion rates in some studies
Medication groups: ~80% adherence rates
Key to success: Finding enjoyable activities and starting small
Practical Prescription Guidelines: The FITT Framework
Mental health professionals now use a structured approach to "prescribing" exercise:
Frequency
Start with 2-3 days per week
Build up to 4-5 days for optimal benefits
Intensity
Use the "talk test":
Light: Can sing while exercising
Moderate: Can talk but not sing
Vigorous: Difficult to speak in full sentences
Start with light to moderate intensity
Time
Begin with 10-15 minutes per session
Gradually increase to 30-45 minutes
Remember: some is better than none
Type
Choose activities you enjoy
Consider your current fitness level
Mix different types for variety and sustainability
Special Considerations for Mental Health
Exercise + Other Treatments
The most effective approach often combines exercise with other evidence-based treatments:
Exercise + Therapy: May enhance the neuroplasticity benefits of psychotherapy
Exercise + Medication: Can help mitigate side effects like weight gain and cardiovascular issues
Integrated Approach: Addresses both mental and physical health simultaneously
Personalizing Your Approach
Consider these factors when developing an exercise plan:
Past exercise experiences (positive or negative associations)
Current physical limitations
Time and resource constraints
Social preferences (group vs. individual activities)
Seasonal considerations
When to Seek Professional Help
While exercise can be highly effective for depression, it's important to recognize when additional support is needed:
Severe depression symptoms that interfere with daily functioning
Suicidal thoughts or self-harm behaviors
Inability to start or maintain any physical activity
No improvement after 6-8 weeks of consistent exercise
Coexisting mental health conditions requiring specialized treatment
The Bottom Line: Exercise as Essential Medicine
The evidence is clear: exercise is not just beneficial for depression—it's essential medicine that belongs in every mental health treatment plan. The key insights from current research include:
Exercise is as effective as traditional treatments for mild to moderate depression
Any amount of activity helps, with benefits increasing rapidly for inactive individuals
The best exercise is the one you'll actually do consistently
Combining exercise with other treatments often yields the best results
Physical and mental health benefits occur simultaneously
Moving Forward: Your Next Steps
If you're considering exercise as part of your mental health treatment:
Consult with your healthcare provider to ensure exercise is appropriate for your situation
Start small and build gradually to avoid burnout
Choose activities you genuinely enjoy or think you might enjoy
Consider working with a mental health professional who understands the role of exercise in treatment
Be patient with yourself - both mental health recovery and fitness improvements take time
If you're struggling with depression or other mental health concerns, the team at Psychiatry & Psychotherapy PLLC is here to help. We integrate evidence-based treatments, including lifestyle interventions like exercise, into comprehensive mental health care. Contact us today to learn more about our personalized approach to mental wellness.
References:
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.19 1
Bell, J. A., Kivimäki, M., Bullmore, E. T., Steptoe, A., MRC ImmunoPsychiatry Consortium, & Carvalho, L. A. (2017). Repeated exposure to systemic inflammation and risk of new depressive symptoms among older adults. Transl Psychiatry 7, e1208. https://doi.org/10.1038/tp.2017.155
Berk, M., Köhler-Forsberg, O., Turner, M., Penninx, B.W.J.H., Wrobel, A., Firth, J., Loughman, A., Reavley, N.J., McGrath, J.J., Momen, N.C., Plana-Ripoll, O., O'Neil, A., Siskind, D., Williams, L.J., Carvalho, A.F., Schmaal, L., Walker, A.J., Dean, O., Walder, K., Berk, L., Dodd, S., Yung, A.R., & Marx, W. (2023). Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management. World Psychiatry, 22: 366-387. https://doi.org/10.1002/wps.21110
Bettmann, J. E., Speelman, E., Blumenthal, E., Couch, S., & Schmalz, D. L. (2024). Nature Exposure, Even as Little as 10 Minutes, is Likely to Yield Short-Term Benefits for Adults with Mental Illness: A Meta Analysis. Ecopsychology. https://doi.org/10.1089/eco.2023.0063
Bernstein, C. M., Stockwell, M. S., Gallagher, M. P., Rosenthal, S. L., & Soren, K. (2013). Mental health issues in adolescents and young adults with type 1 diabetes: prevalence and impact on glycemic control. Clinical pediatrics, 52(1), 10–15. https://doi.org/10.1177/0009922812459950
Corathers, S. D., Kichler, J., Jones, N. H., Houchen, A., Jolly, M., Morwessel, N., Crawford, P., Dolan, L. M., & Hood, K. K. (2013). Improving depression screening for adolescents with type 1 diabetes. Pediatrics, 132(5), e1395–e1402. https://doi.org/10.1542/peds.2013-0681
Corey-Lisle, P. K., Nash, R., Stang, P., Swindle, R. (2004). Response, Partial Response, and Nonresponse in Primary Care Treatment of Depression. Arch Intern Med. 164(11):1197–1204. https://doi:10.1001/archinte.164.11.1197
Craft, L. L. (2005). Exercise and clinical depression: Examining two psychological mechanisms. Psychology of Sport and Exercise, 6(2), 151–171. https://doi.org/10.1016/j.psychsport.2003.11.003
Ecker, U. K. H., Lewandowsky, S., Chang, E. P., & Pillai, R. (2014). The effects of subtle misinformation in news headlines. Journal of Experimental Psychology: Applied, 20(4), 323–335. https://doi.org/10.1037/xap0000028
Fabiano, N., Puder, D., & Stubbs, B. (2024). The Evidence Is Clear, Exercise Is Not Better Than Antidepressants or Therapy: It Is Crucial to Communicate Science Honestly. Journal of Physical Activity and Health (published online ahead of print 2024). Retrieved Dec. 13, 2024, from https://doi.org/10.1123/jpah.2024-0743
Gourgouvelis, J., Yielder, P., Clarke, S. T., Behbahani, H., & Murphy, B. A. (2018). Exercise leads to better clinical outcomes in those receiving medication plus cognitive behavioral therapy for major depressive disorder. Frontiers in Psychiatry, 9. https://doi.org/10.3389/fpsyt.2018.00037
Hallgren, M., Helgadóttir, B., Herring, M. P., Zeebari, Z., Lindefors, N., Kaldo, V., Öjehagen, A., & Forsell, Y. (2016). Exercise and internet-based cognitive–behavioural therapy for depression: multicentre randomised controlled trial with 12-month follow-up. British Journal of Psychiatry, 209(5), 414–420. doi:10.1192/bjp.bp.115.177576
Harris, A. H., Cronkite, R., & Moos, R. (2006). Physical activity, exercise coping, and depression in a 10-year cohort study of depressed patients. Journal of affective disorders, 93(1-3), 79–85. https://doi.org/10.1016/j.jad.2006.02.013
Heissel, A., Teismann, T., Kahl, K. G., Puschmann, A. K., Sutter, L., Schuch, F. B., Stubbs, B., & Vancampfort, D. (2023). Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression. British Journal of Sports Medicine, 57(16), 1049–1057. https://doi.org/10.1136/bjsports-2022-106282
Hird, E.J., Slanina-Davies, A., Lewis, G. Hamer, M., & Rosier, J. P. (2024). From movement to motivation: a proposed framework to understand the antidepressant effect of exercise. Transl Psychiatry 14, 273. https://doi.org/10.1038/s41398-024-02922-y
Huang, Y., Li, L., Gan, Y., Wang, C., Jiang, H., Cao, S., & Lu, Z. (2020). Sedentary behaviors and risk of depression: a meta-analysis of prospective studies. Translational psychiatry, 10(1), 26. https://doi.org/10.1038/s41398-020-0715-z
Lam, R. W., Kennedy, S. H., Adams, C., Bahji, A., Beaulieu, S., Bhat, V., Blier, P., Blumberger, D. M., Brietzke, E., Chakrabarty, T., Do, A., Frey, B. N., Giacobbe, P., Gratzer, D., Grigoriadis, S., Habert, J., Ishrat Husain, M., Ismail, Z., McGirr, A., McIntyre, R. S., … Milev, R. V. (2024). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 69(9), 641–687. https://doi.org/10.1177/07067437241245384
Massengale J. (2005). Depression and the adolescent with type 1 diabetes: the covert comorbidity. Issues in mental health nursing, 26(2), 137–148. https://doi.org/10.1080/01612840590901590
Montesano, A., Feixas, G., Caspar, F., & Winter, D. (2017). Depression and identity: Are self-constructions negative or conflictual? Frontiers in Psychology, 8, 877. https://doi.org/10.3389/fpsyg.2017.00877
Noetel, M., Sanders, T., Gallardo-Gómez, D., Taylor, P., del Pozo Cruz, B., van den Hoek, D., Smith, J. J., Mahoney, J., Spathis, J., Moresi, M., Pagano, R., Pagano, L., Vasconcellos, R., Arnott, H., Varley, B., Parker, P., Biddle, S., & Lonsdale, C. (2024). Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials BMJ, 384:e075847. https://doi.org/10.1136/bmj-2023-075847
Oudbier, S. J., Goh, J., Looijaard, S. M. L. M., Reijnierse, E. M., Meskers, C. G. M., & Maier, A. B. (2022). Pathophysiological Mechanisms Explaining the Association Between Low Skeletal Muscle Mass and Cognitive Function. The journals of gerontology. Series A, Biological sciences and medical sciences, 77(10), 1959–1968. https://doi.org/10.1093/gerona/glac121
Puder, D. (Host). (2018, March 22). Sensorium Part 3: Exercise as a Prescription for Depression, Anxiety, Chronic Stress (like Diabetes) and Sensorium (No. 10) [Audio podcast episode]. In Psychiatry & Psychotherapy Podcast. Emotion Connection. https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/episode-10-sensorium-part-3-exercise-as-a-prescription-for-depression-anxiety-chronic-stress
Puder, D. (Host). (2018, April 16). Performance Enhancement with Dr. MaryEllen Eller (No. 12) [Audio podcast episode]. In Psychiatry & Psychotherapy Podcast. Emotion Connection. https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/performance-enhancement-breathing-maryellen-eller?rq=012
Puder, D. (Host). (2018, May 18). Prescribing Strength Training for Depression (No. 18) [Audio podcast episode]. In Psychiatry & Psychotherapy Podcast. Emotion Connection. https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/prescribing-strength-training-depression-treatment
Puder, D. (Host). (2020, Sept. 30). The Best Exercise Program For Depression (No. 96) [Audio podcast episode]. In Psychiatry & Psychotherapy Podcast. Emotion Connection. https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/the-best-exercise-program-for-depression
Puder, D. (Host). (2022, March 15). Exercise as a Drug for Mental Health and Longevity (No. 142) [Audio podcast episode]. In Psychiatry & Psychotherapy Podcast. Emotion Connection. https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/episode-142-exercise-as-a-drug-for-mental-health-and-longevity
Puder, D. (Host). (2022, Dec. 9). Exercise for the Brain (No. 165) [Audio podcast episode]. In Psychiatry & Psychotherapy Podcast. Emotion Connection. https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/episode-165-exercise-for-the-brain
Puder, D. (Host). (2023, May 12). Exercise & Mental Health 2023 Update (No. 179) [Audio podcast episode]. In Psychiatry & Psychotherapy Podcast. Emotion Connection. https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/episode-179-exercise-amp-mental-health-2023-update
Puder, D. (Host). (2024, May 4). 5 Factors and Domains of Psychiatric Care (No. 207) [Audio podcast episode]. In Psychiatry & Psychotherapy Podcast. Emotion Connection. https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/episode-207-5-factors-and-domains-of-psychiatric-care?rq=207
Recchia, F., Leung, C. K., Chin, E. C., Fong, D. Y., Montero, D., Cheng, C. P., Yau, S. Y., & Siu, P. M. (2022). Comparative effectiveness of exercise, antidepressants, and their combination in treating non-severe depression: A systematic review and network meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 56(23), 1375–1380. https://doi.org/10.1136/bjsports-2022-105964
Sabe, M., Chen, C., Sentissi, O., Deenik, J., Vancampfort, D., Firth, J., Smith, L., Stubbs, B., Rosenbaum, S., Schuch, F. B., & Solmi, M. (2022). Thirty years of research on physical activity, mental health, and wellbeing: A scientometric analysis of hotspots and trends. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.943435
Sansone, R. A., & Sansone, L. A. (2012). Antidepressant adherence: are patients taking their medications?. Innovations in clinical neuroscience, 9(5-6), 41–46. https://pmc.ncbi.nlm.nih.gov/articles/PMC3398686/
Santos, F. R., Sigulem, D., Areco, K. C., Gabbay, M. A., Dib, S. A., & Bernardo, V. (2015). Hope matters to the glycemic control of adolescents and young adults with type 1 diabetes. Journal of health psychology, 20(5), 681–689. https://doi.org/10.1177/1359105315573429
Singh, B., Maher, C., & Brinsley, J. (2023a, March 1). Exercise is even more effective than counselling or medication for depression. But how much do you need? The Guardian. Retrieved from https://www.theguardian.com/lifeandstyle/2023/mar/02/exercise-is-even-more-effective-than-counselling-or-medication-for-depression-but-how-much-do-you-need
Singh, B., Olds, T., Curtis, R., Dumuid, D., Virgara, R., Watson, A., Szeto, K., O’Connor, E., Eglitis, E., Ferguson, T., Miatke, A., Simpson, C. E. M., Maher, C. (2023b). Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. British Journal of Sports Medicine, 57,1203-1209. https://doi.org/10.1136/bjsports-2022-106195
Sonstroem, R. J., & Morgan, W. P. (1989). Exercise and self-esteem: rationale and model. Medicine and science in sports and exercise, 21(3), 329–337. https://pubmed.ncbi.nlm.nih.gov/2659918/
Spence, J. C., McGannon, K. R., & Poon, P. (2005). The Effect of Exercise on Global Self-Esteem: A Quantitative Review. Journal of Sport and Exercise Psychology, 27(3), 311-334. Retrieved Dec 20, 2024, from https://doi.org/10.1123/jsep.27.3.311
Swartz, M. S., Perkins, D. O., Stroup, T. S., Davis, S. M., Capuano, G., Rosenheck, R. A., Reimherr, F., McGee, M. F., Keefe, R. S., McEvoy, J. P., Hsiao, J. K., Lieberman, J. A., & CATIE Investigators (2007). Effects of antipsychotic medications on psychosocial functioning in patients with chronic schizophrenia: findings from the NIMH CATIE study. The American journal of psychiatry, 164(3), 428–436. https://doi.org/10.1176/ajp.2007.164.3.428
Szuhany, K. L., & Otto, M. W. (2020). Efficacy evaluation of exercise as an augmentation strategy to brief behavioral activation treatment for depression: A randomized pilot trial. Cognitive Behaviour Therapy, 49(3), 228–241. https://doi.org/10.1080/16506073.2019.1641145
Tian, S., Liang, Z., Qui, F., Yu, Y., Wang, C., Zhang, M., & Wang, X. (2024). Optimal exercise modality and dose to improve depressive symptoms in adults with major depressive disorder: A systematic review and Bayesian model-based network meta-analysis of RCTs. Journal of Psychiatric Research, 176, 384–392. https://doi.org/10.1016/j.jpsychires.2024.06.031
Verhoeven, J. E., Han, L. K. M., Lever-van Milligen, B. A., Hu, M. X., Révész, D., Hoogendoorn, A. W., Batelaan, N. M., van Schaik, D. J. F., van Balkom, A. J. L. M., van Oppen, P., & Penninx, B. W. J. H. (2023). Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders. Journal of Affective Disorders, 329, 19–29. https://doi.org/10.1016/j.jad.2023.02.064
Wang, S.-M., Han, C., Bahk, W.-M., Lee, S.-J., Patkar, A. A., Masand, P. S., & Pae, C.-U. (2018). Addressing the side effects of contemporary antidepressant drugs: A comprehensive review. Chonnam Medical Journal, 54(2), 101–112. https://doi.org/10.4068/cmj.2018.54.2.101
Warburton, D. E. R., Nicol, C. W., & Bredin, S. S. D. (2006). Health benefits of physical activity: The evidence. CMAJ, 174(6), 801–809. https://doi.org/10.1503/cmaj.051351
Wegner, M., Helmich, I., Machado, S., Nardi, A. E., Arias-Carrion, O., & Budde, H. (2014). Effects of exercise on anxiety and depression disorders: review of meta- analyses and neurobiological mechanisms. CNS & neurological disorders drug targets, 13(6), 1002–1014. https://doi.org/10.2174/1871527313666140612102841
Zhou, C., Puder, D., & Fabiano, N. (2024). How to prescribe physical activity for depression. Sports Psychiatry, 0(0). https://doi.org/10.1024/2674-0052/a000099