Best depression treatment may be exercise, study says

But some experts still hesitant to prescribe it as first-line ‘medicine.’

Exercise as a treatment for severe depression is at least as effective as standard drugs or psychotherapy and by some measures better, according to the largest study to date of exercise as “medicine” for depression.

The study pooled data from 41 studies involving 2,265 people with depression and showed that almost any type of exercise substantially reduces depression symptoms, although some forms of exercise seemed more beneficial than others.

“We found large, significant results,” said Andreas Heissel, an exercise scientist at the University of Potsdam in Germany who led the study.

For people struggling with depression, he said, the findings show you don’t have to run marathons or otherwise train strenuously to benefit. “Something is better than nothing,” Heissel said.

The effects were robust enough that the study’s authors hope the finding will spur a move to make exercise a standard, prescribed therapy for depression.

That approach would represent a notable shift. The American Psychological Association’s clinical practice guidelines, updated in 2019, recommend seven types of psychotherapy and several antidepressants for the treatment of depression, but they do not mention exercise. The World Health Organization promotes exercise for mental health as an add-on to traditional treatments — not on its own.

But the study’s authors are confident. “We expect this review to lead to updated guidelines and recommendations for exercise as a first-line treatment option,” Heissel said.

Some depression experts are hesitant. “I think that exercise should be prescribed for everyone with depression,” said Murray B. Stein, a professor and vice chair for clinical research in the department of psychiatry at the University of California at San Diego who was not involved in the study. “I still feel the evidence is weak, though, that exercise be considered a first-line treatment for depression.”

Scientists and clinicians have known for some time that exercise protects us against developing depression. In large-scale epidemiological studies, active men and women become depressed at much lower rates than sedentary people, even if they exercise for only a few minutes a day or a few days a week.

But it’s trickier to test exercise as a treatment for existing depression. You have to study it like any medicine, by recruiting people with the condition and randomly assigning them to the intervention — in this case, exercise — or a control group and scrupulously tracking what happens.

In the study published in February in the British Journal of Sports Medicine, a global group of researchers pulled together every recent experiment using physical activity as depression therapy. They wound up with data from 41 studies about 2,265 volunteers, representing the largest sample yet on this topic.

The studies’ exercise programs included walking, running and weight training. Some consisted of group classes, others solo workouts, some supervised, some not. But all featured people with depression getting up and moving more.

DAVE COOPER/NYT 2022 Phil Lord uses battle ropes in November at a gym in Elkridge, Maryland. In large-scale studies, active men and women become depressed at much lower rates than sedentary people, even if they exercise only a few minutes a day or a few days a week.