Exercise May Ease Depression Symptoms as Effectively as Therapy

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 confidence in that evidence was lower.

Depression remains a major global health challenge, affecting more than 280 million people worldwide and contributing substantially to disability. Exercise stands out as a low-cost, widely accessible option that can also improve physical health, making it attractive to both patients and healthcare professionals.

Inside the Cochrane review

The analysis was led by researchers at the University of Lancashire and compiled results from 73 randomized controlled trials involving nearly 5,000 adults diagnosed with depression. The studies compared exercise with no treatment or control conditions, as well as with psychological therapies and antidepressant medications.

Overall, exercise produced moderate reductions in depressive symptoms compared with no treatment. When compared with psychological therapy, exercise delivered similar improvements, based on evidence of moderate certainty from ten trials. Comparisons with antidepressant medication also suggested comparable effects, but the supporting evidence was limited and rated as low certainty. Only a small number of studies followed participants after the intervention ended, so the long-term impact remains unclear.

Safety and side effects

Side effects were reported infrequently. Participants in exercise programs occasionally experienced muscle or joint injuries, while those taking antidepressants reported typical medication-related effects such as fatigue and gastrointestinal discomfort.

“Our findings suggest that exercise appears to be a safe and accessible option for helping to manage symptoms of depression,” said Professor Andrew Clegg, the review’s lead author. “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 indicated that light to moderate intensity activity may be more beneficial than very vigorous exercise. The strongest improvements in symptoms were associated with completing approximately 13 to 36 exercise sessions.

No single type of exercise clearly outperformed the others. However, programs that combined different forms of activity and included resistance training appeared more effective than aerobic exercise alone. Some activities—such as yoga, qigong, and stretching—were not assessed in this analysis and may be explored in future research. As with other findings, uncertainty remains regarding long-term benefits due to limited follow-up data.

Why the conclusions remain cautious

This update added 35 new trials to earlier versions of the review published in 2008 and 2013. Despite the expanded evidence base, the overall conclusions changed little. Many of the included studies were small—often involving fewer than 100 participants—making it more difficult to draw firm and generalizable conclusions.

“Although we’ve added more trials in this update, the findings are similar,” Professor Clegg said. “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.”