An evidence review published by The BMJ today suggests that walking, jogging, yoga, and strength training may be among the most effective exercises for alleviating depression, whether practised alone or combined with established treatments like psychotherapy and medication. Even lower-intensity activities such as walking or yoga have shown benefits, but the findings indicate that more vigorous exercise may yield more significant improvements in mood. The authors caution that confidence in results could be higher, necessitating further high-quality research. Nonetheless, they propose that these forms of exercise should be considered as core treatments for depression alongside other therapeutic interventions.
The World Health Organization estimates that over 300 million people worldwide suffer from depression, and exercise is often recommended in conjunction with psychotherapy and drugs. However, treatment guidelines and previous reviews of the evidence have not always been consistent in recommending the best way to prescribe exercise for depression. To resolve this uncertainty, researchers analysed databases, searching for randomised trials comparing exercise as a treatment for depression with established therapies such as SSRI antidepressants and cognitive behavioural therapy, active control groups like usual care, and untreated control groups.
The review identified 218 trials involving 14,170 participants, all assessed for bias. Information on the exercise interventions’ type, intensity, and frequency was recorded. At the same time, other potentially influential factors, such as sex, age, baseline levels of depression, and existing conditions, were considered. The results revealed significant reductions in depression for dance and moderate reductions for walking or jogging, yoga, strength training, mixed aerobic exercises, tai chi, and qigong, compared with active controls. Additionally, exercise combined with SSRIs or psychotherapy produced moderate, clinically meaningful benefits, suggesting an added advantage when exercise is used alongside these treatments.
Interestingly, walking and jogging were effective for both men and women. At the same time, strength training appeared more beneficial for women, and yoga or qigong was more effective for men. The analysis also showed that yoga benefited older adults, while strength training worked best for younger individuals. While lighter activities like walking and yoga provided clinically meaningful improvements, more vigorous exercises, such as running and interval training, produced more significant benefits. These effects were consistent across individuals with different health conditions and varying levels of depression.
Despite the positive findings, the authors note that the quality of the evidence remains low, and only a few trials monitored participants for periods longer than a year. They also acknowledge that many patients with depression may face barriers to participating in exercise, whether due to physical, psychological, or social factors. Nevertheless, the authors suggest that the combination of social interaction, mindfulness, and exposure to green spaces may play a role in the positive effects observed. They argue that their findings support the inclusion of exercise, particularly vigorous activity, in clinical guidelines for treating depression.
In a linked editorial, Juan Ángel Bellón from the University of Malaga highlights that primary care clinicians can now recommend exercise, psychotherapy, or antidepressants as standalone options for adults with mild to moderate depression. He acknowledges that engaging in regular exercise can be incredibly challenging for people with depression and calls for further studies using real-world data to evaluate the effectiveness of physical activity programmes for this population. Bellón also points out that the European Union has recently committed to promoting exercise across member states and urges health services, local authorities, and national governments to ensure that individualised and supervised exercise programmes are accessible to everyone.
More information: Michael Noetel et al, Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials, The BMJ. DOI: 10.1136/bmj-2023-075847
Journal information: The BMJ Provided by BMJ Group
