Can Exercise Really Help With Depression?

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Depression is a common and serious condition that affects more than 280 million people worldwide. It can take a toll not only on mood but also on physical health, daily functioning, relationships and overall quality of life. While antidepressant medications and psychological therapies (like talk therapy) are proven treatments, not everyone wants or is able to use these options. Many people are interested in alternatives, particularly exercise.

The large updated scientific review set out to answer an important question: How effective is exercise for treating depression, and how does it compare with other treatments like therapy or medication?

What did investigators study?

Researchers analyzed 73 randomized controlled trials involving nearly 5,000 adults with depression. These studies compared exercise with the following:

• No treatment, waiting lists or placebo-type controls
• Psychological therapies
• Antidepressant medications
• Other alternative treatments

The review included studies published up through November 2023, making it one of the most up-to-date and comprehensive looks at this topic.

What did they find?

Exercise versus no treatment
The strongest finding was that exercise can reduce symptoms of depression compared with doing nothing. Across dozens of studies, people who exercised reported moderate improvements in depressive symptoms by the end of treatment. This suggests that regular physical activity can be a meaningful tool for managing depression, especially for people who are not currently receiving other forms of care.

However, when researchers looked only at the highest-quality studies, the benefit was smaller, though still present. This means exercise likely helps, but the size of the benefit may vary.

Exercise versus therapy or antidepressants
When exercise was compared directly with psychological therapy or antidepressant medications, researchers found little to no difference in how much depressive symptoms improved. In other words, exercise appeared to work about as well as these established treatments in the short term — though this conclusion is based on a smaller number of studies.

This does not mean exercise should replace therapy or medication for everyone. Instead, it suggests exercise may be a reasonable alternative or additional option, depending on a person’s preferences, access to care and medical needs.

“Although we’ve added more trials in this update, the findings are similar,” said lead author Andrew Clegg, M.Sc., Ph.D., a professor of health services research at the University of Central Lancashire, U.K. “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. One large, well-conducted trial is much better than numerous poor quality small trials with limited numbers of participants in each.”

Investigators said one major gap in the research is what happens after treatment ends. Only a small number of studies followed participants long term, and the results were inconsistent. More research is needed to understand whether exercise helps people stay well over time.

Results on quality of life were mixed and uncertain. Some studies showed improvement, while others did not. Additionally, many of the studies had weaknesses, including small sample sizes.

Side effects from exercise were uncommon, but they did happen. A small number of participants reported muscle or joint injuries or worsening depression. Importantly, people taking antidepressants also experienced side effects, including fatigue, sexual dysfunction and digestive issues. Overall, exercise was about as acceptable to participants as therapy or medication, based on how many people completed the studies.

What does this mean for patients?

This review supports the idea that exercise can be a helpful part of depression treatment, especially for people who:

• Prefer nonmedication options
• Want to add exercise to existing treatment
• Are looking for accessible, low-cost strategies

“Our findings suggest that exercise appears to be a safe and accessible option for helping to manage symptoms of depression,” concluded Clegg. “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.”