BY COCHRANE

Growing evidence suggests exercise can lift depression nearly as well as therapy, without a prescription.

An updated Cochrane review suggests that physical activity can reduce depression symptoms at a level similar to psychological therapy. When exercise was compared with antidepressant medication, the benefits appeared comparable as well, although researchers note that the supporting evidence in this case was less certain.

Depression is one of the leading causes of poor health and disability worldwide, affecting more than 280 million people. Because exercise is inexpensive, widely accessible, and linked to many physical health benefits, it has drawn increasing interest as a potential option for both patients and healthcare providers.

What the Researchers Reviewed

The review was carried out by researchers at the University of Lancashire and analyzed 73 randomized controlled trials involving nearly 5,000 adults living with depression. Across these studies, exercise was compared with no treatment or control approaches, as well as with established treatments such as psychological therapy and antidepressant medications.

How Exercise Compared With Other Treatments

Overall, the analysis found that exercise led to moderate improvements in depression symptoms when compared with no treatment or control interventions. When exercise was measured against psychological therapy, the two approaches produced similar reductions in symptoms, based on moderate certainty evidence from ten trials. Comparisons with antidepressant medication also pointed to similar effects, but the available evidence was limited and considered low certainty. Few studies followed participants after treatment ended, so long term outcomes remain unclear.

Side Effects and Safety

Side effects were uncommon across the studies. People assigned to exercise sometimes experienced muscle or joint injuries, while participants taking antidepressants reported typical medication related effects such as fatigue and gastrointestinal problems.

“Our findings suggest that exercise appears to be a safe and accessible option for helping to manage symptoms of depression,” said Professor Andrew Clegg, lead author of the review. “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.”

Exercise Intensity and Frequency

The researchers found that light to moderate intensity activity may provide more benefit than vigorous exercise. Greater improvements in depression symptoms were linked to completing between 13 and 36 exercise sessions.

No single type of exercise clearly stood out as the most effective. However, programs that combined different forms of activity and resistance training appeared to outperform aerobic exercise alone. Some types of exercise, including yoga, qigong and stretching, were not assessed in this review and remain topics for future research. As with other findings, long-term effects are still uncertain due to limited follow-up.

Why Stronger Evidence Is Still Needed

This update added 35 new trials to earlier versions of the review published in 2008 and 2013. Even with the additional studies, the overall conclusions changed very little. Many of the trials were small, often involving fewer than 100 participants, which limits how confidently the results can be applied more broadly.

Although we’ve added more trials in this update, the findings are similar,” said Professor Clegg. “Exercise can help people with depression, but if we want to find which types work best, for whom, 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.”

Keywords; depression, exercise