The current treatment paradigm for depression and anxiety consists of several different approaches. The mainstay of therapy for depression and anxiety remains the various types of psychopharmacology treatments, evidence-based cognitive behavioral therapy, or preferably, both. When patients seek care at a psychiatrist’s office, these are the approaches that are more expected. How surprising it can be to learn that the guidelines from the American Psychiatric Association include exercise as both a first-line treatment for mild depression or as an augmenting, or add-on, treatment for people with both more severe depression or anxiety.
Let’s explore this a bit further.
In his paper, P. Carek and others showed that physical activity can be associated with similar rates of efficacy versus pharmaceuticals for mild depression, and that prolonged physical inactivity was associated with the development of psychiatric disorders. Eventually the conclusion was that exercise was considered an effective and cost-efficient treatment alternative. However in more severe cases of depression, pharmacotherapy was superior. In their study, Paluska, et.al. noted that aerobic exercise or strength training were both associated with decreased depression symptoms, but exercise did not seem to prevent development of depression. Exercise was also noted to be better to help with treatment of
acute anxiety, but it was less effective for the treatment of chronic anxiety. Rebar reviewed and compiled many studies and estimated that the treatment effect of exercise in reducing depression symptoms was about 40% (estimated interval 6 to 93%). In a randomized study of physical activity versus placebo for depression, Henrikkson showed that in either low-intensity or high-intensity activity, there was a statistically lower risk of anxiety or depression in the people doing their assigned activity versus those assigned to a placebo form of activity.
Another study randomized adults with major depression already on antidepressants to a 10-week activity program with body awareness training for a minimum of 150 minutes per week versus a single consultation with a provider about “activity”. Those who were sent to the extensive training on average had about a 10-point drop on a commonly-used scale for
assessment of depression. Notably in more detailed analysis of studies supporting exercise there are methodological flaws in the studies that limit their reliability. However, in none of the studies was it found that exercise was associated with increased cost or other complications that forced a recommendation against activity.
Putting all this together, the best conclusion to draw is as follows: exercise of either low or high intensity, either aerobic activity or strength training, for at least the minimum amount of time per week recommended (150 minutes per week), is associated with a positive effect for mild depression or as an add-on treatment for incompletely treated major depression. There may also be a smaller benefit to help with anxiety. These interventions, under the supervision of a treating provider, can be useful to help with major depression. Lace up those shoes and help yourself walk those blues away!
Carek, Peter, et.al. Int Journal Psych Med. 2011; 41(1): 15-28.
Paluska, SA and TL Schwenk. Sports Medicine. 2000 Mar; 29(3): 167-80.
Rebar, AL, et al. Health Psychol Rev. 2015; 9(3); 366-80.
Henrikkson, Malin, et.al. J Affect Disorders. 2022 Jan 15; 297: 26-34.
“Exercise or body awareness training therapy as add-on for major depression: a control study." J Affect Disorders. 2014 Oct; 168:98-106.
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