Study: Exercise Improves Most Forms of Depression Treatment

March 21, 2024

High-intensity exercise treats depression as effectively as do cognitive behavior therapy (CBT) and medication, according to a new study that found combining SSRIs, a type of antidepressant, with exercise improved depressive symptoms more than medication alone.¹

The systematic review and meta-analysis led by a research team from the University of Queensland, Australia, found that the more intense the physical activity, the more effective it was at managing depression. More specifically, vigorous exercises (e.g., running, interval training, strength training, mixed aerobic exercise) reduced depression symptoms in participants more than light physical activity (e.g., walking and hatha yoga), although the latter did provide some benefit.

These findings emerged from examinations of 218 randomized controlled trials, including 14,170 participants diagnosed with depression, to determine the effectiveness of exercise, psychotherapy, and antidepressants in treating depression.

When the researchers narrowed their analysis by demographics, they discovered that strength training and cycling positively impacted more women than men, and yoga or qigong provided more benefits to men than women. Yoga appeared more effective among older adults, and younger adults received better results from strength training. The duration and frequency of exercise did not affect the results.

The study also suggested that men appeared to benefit more than women from combining yoga, Tai Chi, or aerobic exercise with psychotherapy. Yoga and aerobic exercise combined with psychotherapy seemed more effective among older adults.

Participants gained the most benefits from group classes or scheduled exercises. The more autonomy participants had over their exercise programs, the weaker the outcome. “When provided with more freedom, the low self-efficacy that is symptomatic of depression may stop patients from setting an appropriate level of challenge (e.g., they may be less likely to choose vigorous exercise),” the study’s authors wrote.

The researchers cautioned that definitive conclusions are impossible to draw, and more studies are needed. “Our review did not uncover clear causal mechanisms, but the trends in the data are useful for generating hypotheses,” they wrote. “It is unlikely that any single causal mechanism explains all the findings in the review.”

“Exercise should be considered alongside traditional interventions as a core treatment for depression,” report author Michael Noetel, Ph.D., said in a press release. “No matter how often people exercised, whether they had other health issues or how severe their depression was, in all scenarios, exercise had a meaningful impact on their depression. Of course, anyone getting treatment for depression should talk to their doctor before changing what they are doing, but most people can start walking without many barriers.”

Exercise and Depression

Members of ADDitude’s reader panel confirm several findings from the study published in The BMJ (British Medical Journal).

“Strenuous full-body aerobic activities like boxing, karate, swimming, or boulder climbing help me get my thoughts in the right place and boost my mood and energy,” one panelist wrote. “Physical activity also helps me fall asleep and feel less stressed overall.”

“Running helps with my anxiety and depression,” another reader said. “It’s like a vacation for my overstimulated brain.”

A recent retiree who goes to the gym six days a week for group fitness classes and strength training sessions with a personal trainer shares that physical activity helps him feel calmer and more focused. “Exercise gives me a sense of accomplishment and community,” he says. “It is truly my second medication.”

Exercise Benefits Children and Teens with ADHD

The benefits of physical activity are not limited to adults; exercise improves the mental health of children and adolescents with neurodevelopmental disorders (NDDs), including ADHD, learning and motor disorders, autism spectrum disorder (ASD), and intellectual disability, according to a recent systematic review and meta-analysis published in JAMA Pediatrics.²

The researchers found that high-frequency (more than 27) 40-minute sessions of physical activity significantly benefited cognitive function, psychological well-being (e.g., self-esteem, quality of life), internalizing (e.g., anxiety and depression), and externalizing (e.g., aggression and disruptive behavior disorders) behaviors in children and adolescents aged 5-17 years with NDDs. They examined 59 studies with more than 3,000 participants.

ADDitude caregivers recognized similar results from their children after participating in physical activities.

One reader takes their son to the YMCA at least three times per week. “Depression can really take hold of my 10-year-old son,” the parent said. “We see great improvements after physical activity. He enjoys the elliptical, rower, spin bikes, automatic stepper, and treadmill.”

“My daughter has been playing hockey since she was young,” a reader said. “She says she can slow her brain down when she’s on the ice and think more clearly, and it’s as if her ‘ADHD evaporates.’”

“Intense cardio activities, like cross-country skiing and soccer, help my son burn off some of his boundless energy, and he gains self-confidence by being good at something nonacademic,” a reader said.

Another reader said, “My oldest is a distance runner. He is committed and gets up early to run his miles or workout. Running gives him that needed dopamine hit to keep his ADHD symptoms under control at the start of the school day.”

Incorporating Exercise in Depression Treatment Plans

A 2023 treatment survey of 11,000 ADDitude readers reaffirms both studies’ findings. Roughly half of the respondents who use this treatment rated exercise as “extremely” or “very” effective. A staggering 94% of caregivers and 95% of adults recommend exercise to treat ADHD symptoms. Yet only 13 % of these respondents said a doctor had recommended exercise to reduce symptoms, and only 37% of all respondents said physical activity was part of their treatment plan.

The BMJ study encourages clinicians to consider exercise a viable alternative to drug treatment or adjuvant for those already taking medication. “The findings support the inclusion of exercise, particularly vigorous exercise, in clinical practice guidelines for depression,” they wrote. “This may help bridge the gap in treatment coverage by increasing the range of first-line options for patients and health systems.”

Sources

¹Noetel, M., Sanders, T., Gallardo-Gómez, D., Taylor, P., del Pozo Cruz, B., van den Hoek, D. et al. (2024). Effect of Exercise for Depression: Systematic Review and Network Meta-Analysis of Randomised Controlled Trials. BMJ. doi:10.1136/bmj-2023-075847.

²Liu C, Liang X, Sit CHP. (2024). Physical Activity and Mental Health in Children and Adolescents with Neurodevelopmental Disorders: A Systematic Review and Meta-Analysis. JAMA Pediatr. doi:10.1001/jamapediatrics.2023.6251.

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