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Exercise is defined as physical activity that is structured and engaged in with the goal of improving or maintaining physical health and includes both cardiovascular exercise and resistance training. Exercise is recommended as a first-line treatment for mild to moderate unipolar depression in the United Kingdom and Canada and recommended as an adjunctive treatment for depression in the United States.1–3
Exercise is an efficacious singular or adjunctive treatment for depression across a range of populations, producing medium to large antidepressant effects compared to control4–7 or no treatment.4,6,8 A meta-analysis of 25 trials7 found that exercise, relative to control intervention, produced an average 4.5-point decrease on the Hamilton Depression Rating Scale and a 6.5-point reduction on the Beck Depression Inventory, which is a large effect size. Some studies have found that exercise's antidepressant effect is smaller when analyses are restricted to only well-designed studies,4,6 although other reports suggest an underestimation of treatment effects due to publication bias.7
The antidepressant effects of exercise do not vary based on patient age or sex.7 Adherence to exercise interventions for people with depression is generally high, with an average of 81.3% compliance8 and a premature termination rate of approximately 15% to 18%.5,9
The effects of exercise on depression are evident in the short term, with mood boost evident immediately after an exercise session; in the long-term, with a regular exercise program, there are sustained improvements in depression.10 These effects are hypothesized to be mediated by several neurobiological processes, including neuroendocrine reactivity, oxidative stress adaptations and increases in cortical activity,10 and psychological processes, like increased social interaction and self-efficacy and distraction from depressogenic thoughts.4
Comparative Efficacy
Aerobic exercise produces antidepressant effects comparable to those of psychotherapy,4–6,11 including cognitive-behavioral therapy.6 Treatment completion rates are higher in aerobic exercise interventions than psychotherapy.6 No published studies have compared anaerobic exercise to psychotherapy for depression.
Aerobic exercise produces comparable antidepressant effects to pharmacotherapy for mild-moderate depression (eg, Beck Depression Inventory scores between 14 and 28),5,6 and treatment completion rates for exercise treatment and pharmacotherapy are similar.6 Aerobic exercise may have a more favorable side-effect profile compared to pharmacotherapies.6 No studies to date have compared anaerobic exercise to pharmacotherapy for depression.
Compared to monotherapy, exercise is an effective adjunctive treatment for depression, producing small to large...