Exercise can reduce symptoms of depression in adults to a similar degree as established psychological therapies and may offer comparable benefits to antidepressant medication, according to an updated Cochrane review of randomized trials.
Across a large and diverse evidence base, exercise produced a moderate reduction in depressive symptoms compared with no treatment or control conditions, while showing little-to-no difference in efficacy when directly compared with psychotherapy or pharmacotherapy, although certainty varied by comparison and outcome.
“Our findings suggest that exercise appears to be a safe and accessible option for helping to manage symptoms of depression,” lead author Andrew Clegg, PhD, University of Central Lancashire, Preston, UK, said in a statement.
“This suggests that exercise works well for some people, but not for everyone, and finding approaches that individuals are willing and able to maintain is important,” said Clegg.
The review was published online January 7 in the Cochrane Database of Systematic Reviews.
Global Health Burden
Depression is a leading cause of poor health and disability, affecting over 280 million people worldwide.
Antidepressant medications and psychological therapies can be effective in alleviating depressive symptoms but may be limited by side effects, access, and adherence.
Exercise has been proposed as an alternative or adjunctive intervention because it is widely available, low cost, and associated with broader physical health benefits.
A 2013 Cochrane review of 37 relevant studies found exercise may have a moderately beneficial effect on depressive symptoms, as reported byMedscape Medical News.
The updated review synthesized evidence from 73 randomized controlled trials including nearly 5000 adults with depression. The studies compared exercise with no treatment or control interventions, as well as psychological therapies and antidepressant medications.
When exercise was compared with no treatment or control interventions, pooled results from 57 trials showed a moderate reduction in depressive symptoms at the end of treatment (standardized mean difference [SMD], -0.67), although the certainty of evidence was rated as low. Long-term effects were uncertain, as few studies followed participants beyond the intervention period.
In head-to-head comparisons with psychological therapies, data from 10 trials showed little-to-no difference between exercise and psychotherapy in reducing depressive symptoms (SMD, 0.03), supported by moderate-certainty evidence.
The five trials that compared exercise with antidepressant medications similarly suggested little-to-no difference in their effect on depressive symptoms at the end of treatment (SMD, -0.11), but investigators noted the evidence as low-certainty.
The review also found that light- or moderate-intensity exercise may provide a larger benefit than vigorous exercise, and that between 13 and 36 sessions of exercise may be more beneficial than either fewer or more sessions.
No single exercise modality was clearly superior, although mixed aerobic and resistance training appeared more effective than aerobic exercise alone.
The benefits of exercise compared to no therapy, psychological therapy, or antidepressants on quality of life were inconsistent and uncertain, researchers wrote.
Standard Evidence-Based Option
The authors cautioned that long-term follow-up was lacking in most of the studies, “which means that the duration of any benefits is unclear, although those reported appeared to decline over time following completion of the exercise program.”
Adverse events from exercise were uncommon and generally mild, most often involving musculoskeletal symptoms, while medication groups more frequently reported gastrointestinal effects, fatigue, or sexual dysfunction.
“Although we’ve added more trials in this update, the findings are similar. Exercise can help people with depression, but if we want to find which types work best, for who and whether the benefits last over time, we still need larger, high-quality studies,” Clegg commented.
In a statement from the UK nonprofit Science Media Center, Brendon Stubbs, PhD, with King’s College London, said this updated review strengthens the case for exercise as an “evidence-based option in depression management, though long-term data remains limited.”
“In clinical practice, this supports integrating exercise into treatment plans for depression, given its favorable adverse event profile compared to pharmacological side effects,” Stubbs said.
“Ultimately, for people with depression, the evidence indicates that exercise may offer similar short-term benefits to therapy or medication for some, but decisions on switching or combining approaches should be made collaboratively with healthcare providers, considering individual circumstances,” he added.
Also weighing in, Jeffrey Lambert, PhD, with University of Bath, UK, highlighted the “rigorous methods” investigators used to identify and analyze the available evidence.
“However, as the authors note, its conclusions are limited by the quality of the trials it includes. Many of the exercise studies were small and had methodological weaknesses, and when the analysis is restricted to the most robust trials, the apparent benefit of exercise for depression becomes smaller, although still statistically significant,” Lambert said in the statement.
“The review also cannot tell us confidently whether exercise works better for more or less severe depression, whether effectiveness varies by exercise type, or whether people should switch from medication or therapy to exercise alone,” Lambert cautioned.
He said it’s also important to note that the review mainly focused on structured, often supervised exercise programs, which tend to attract motivated volunteers who are willing and able to take part.
“This limits how well the findings apply to the wider population of people with depression,” Lambert said.
“In real-world practice, and in the absence of more pragmatic studies, physical activity is probably best viewed as a helpful option or addition to existing treatments, rather than as a direct replacement for established care. Further high-quality studies that combine behavioral support with routine care settings are still needed,” Lambert concluded.
The review had no specific funding. Clegg had no relevant disclosures. Stubbs is on the editorial board of the Journal of Physical Activity and Health, Ageing Research Reviews, Mental Health and Physical Activity, The Journal of Evidence Based Medicine, and The Brazilian Journal of Psychiatry; and has received honorarium from a co-edited book on exercise and mental illness (Elsevier), an associated education course, and unrelated advisory work from ASICS and FitXR LTD. Lambert reported being a member of the Editorial Board of Mental Health and Physical Activity and funding from the NIHR Mental Health Research Group at The University of Bath.