Regular physical activity may ease symptoms of depression about as effectively as psychological therapy, according to an updated Cochrane review. When researchers compared exercise with antidepressant medication, they found similar benefits, although the certainty of that evidence was lower.
Depression remains a major global health challenge, affecting more than 280 million people worldwide and contributing significantly to disability. Exercise stands out as a low cost and widely accessible option that also improves physical health, making it appealing to both patients and healthcare professionals.
Inside the Cochrane Review
The analysis was led by researchers at the University of Lancashire and drew on data from 73 randomized controlled trials involving nearly 5,000 adults diagnosed with depression. These studies examined how exercise compared with no treatment or control conditions, as well as with psychological therapies and antidepressant drugs.
Overall, the findings showed that exercise led to moderate reductions in depressive symptoms compared with no treatment. When measured against psychological therapy, exercise produced similar improvements, based on moderate certainty evidence from ten trials. Comparisons with antidepressant medication also suggested comparable effects, but the supporting evidence was limited and considered low certainty. Few studies tracked participants after treatment ended, leaving the long-term impact unclear.
Safety and Side Effects
Reported side effects were uncommon. People in exercise programs occasionally experienced muscle or joint injuries, while those taking antidepressants reported typical medication-related issues 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."
What Kind of Exercise Works Best
The review found that light to moderate intensity activity may be more helpful than vigorous workouts. Greater improvements in depressive symptoms were linked to completing between 13 and 36 exercise sessions.
No single form of exercise clearly outperformed others. However, programs that combined different types of activity and resistance training appeared more effective than aerobic exercise alone. Some activities, including yoga, qigong and stretching, were not evaluated in this analysis and remain areas for future study. As with other findings, long-term benefits are still uncertain due to limited follow-up.
Why Conclusions Remain Cautious
This update added 35 new trials to earlier versions of the review published in 2008 and 2013. Even with the expanded evidence base, the main conclusions changed little. Many of the included studies were small, often involving fewer than 100 participants, which makes it harder to draw firm conclusions.
"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 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."