Exercise is even more effective than counselling or medication for depression. But how much do you need?

Written by Ben Singh, Research fellow, University of South Australia

The world is currently grappling with a mental health crisis, with millions of people reporting depression, anxiety, and other mental health conditions. According to recent estimates, nearly half of all Australians will experience a mental health disorder at some point in their lifetime.

Mental health disorders come at great cost to both the individual and society, with depression and anxiety being among the leading causes of health-related disease burden. The COVID pandemic is exacerbating the situation, with a significant rise in rates of psychological distress affecting one third of people.

While traditional treatments such as therapy and medication can be effective, our new research highlights the importance of exercise in managing these conditions.

Our recent study published in the British Journal of Sports Medicine reviewed more than 1,000 research trials examining the effects of physical activity on depression, anxiety, and psychological distress. It showed exercise is an effective way to treat mental health issues – and can be even more effective than medication or counselling.

Harder, faster, stronger

We reviewed 97 review papers, which involved 1,039 trials and 128,119 participants. We found doing 150 minutes each week of various types of physical activity (such as brisk walking, lifting weights and yoga) significantly reduces depression, anxiety, and psychological distress, compared to usual care (such as medications).

The largest improvements (as self-reported by the participants) were seen in people with depression, HIV, kidney disease, in pregnant and postpartum women, and in healthy individuals, though clear benefits were seen for all populations.

We found the higher the intensity of exercise, the more beneficial it is. For example, walking at a brisk pace, instead of walking at usual pace. And exercising for six to 12 weeks has the greatest benefits, rather than shorter periods. Longer-term exercise is important for maintaining mental health improvements.

How much more effective?

When comparing the size of the benefits of exercise to other common treatments for mental health conditions from previous systematic reviews, our findings suggest exercise is around 1.5 times more effective than either medication or cognitive behaviour therapy.

Furthermore, exercise has additional benefits compared to medications, such as reduced cost, fewer side effects and offering bonus gains for physical health, such as healthier body weight, improved cardiovascular and bone health, and cognitive benefits.

Exercise is cheaper than medication, with fewer side effects. Unsplash, CC BY

Why it works

Exercise is believed to impact mental health through multiple pathways, and with short and long-term effects. Immediately after exercise, endorphins and dopamine are released in the brain.

In the short term, this helps boost mood and buffer stress. Long term, the release of neurotransmitters in response to exercise promotes changes in the brain that help with mood and cognition, decrease inflammation, and boost immune function, which all influence our brain function and mental health.

Regular exercise can lead to improved sleep, which plays a critical role in depression and anxiety. It also has psychological benefits, such as increased self-esteem and a sense of accomplishment, all of which are beneficial for people struggling with depression.

Not such an ‘alternative’ treatment

The findings underscore the crucial role of exercise for managing depression, anxiety and psychological distress.

Some clinical guidelines already acknowledge the role of exercise – for example, the Australian and New Zealand Clinical Guidelines, suggest medication, psychotherapy and lifestyle changes such as exercise.

However, other leading bodies, such as the American Psychological Association Clinical Practice Guidelines, emphasise medication and psychotherapy alone, and list exercise as an “alternative” treatment – in the same category as treatments such as acupuncture. While the label “alternative” can mean many things when it comes to treatment, it tends to suggest it sits outside conventional medicine, or does not have a clear evidence base. Neither of these things are true in the case of exercise for mental health.

Even in Australia, medication and psychotherapy tend to be more commonly prescribed than exercise. This may be because exercise is hard to prescribe and monitor in clinical settings. And patients may be resistant because they feel low in energy or motivation.

But don’t ‘go it alone’

It is important to note that while exercise can be an effective tool for managing mental health conditions, people with a mental health condition should work with a health professional to develop a comprehensive treatment plan – rather than going it alone with a new exercise regime.

A treatment plan may include a combination of lifestyle approaches, such as exercising regularly, eating a balanced diet, and socialising, alongside treatments such as psychotherapy and medication.

But exercise shouldn’t be viewed as a “nice to have” option. It is a powerful and accessible tool for managing mental health conditions – and the best part is, it’s free and comes with plenty of additional health benefits.

Authors: Ben Singh, Research fellow, University of South Australia