Depression has always been a common condition, and has likely risen in the last few years. And while there are effective treatments, not all treatments are effective for every person. A new study, the largest of its kind to date, finds that exercise “interventions” appear to reduce depression symptoms about as much as conventional treatments, like medication and therapy. The authors recommend their findings be taken into account by organizations writing clinical guidelines which don’t currently consider exercise a first-line therapy for depression.
In the new meta-analysis, published in the British Journal of Sports Medicine, the authors culled data from 41 previous studies, made up of more than 2,200 participants. Each of the study’s participants had either started exercise routines of various descriptions or remained inactive (as controls). Overall, the effects of exercise were considered moderate to large, statistically speaking – comparable to the effect sizes of standard treatments, like antidepressants or talk therapy. Certain types of activity had greater impact – exercise supervised by professionals, group exercise programs, and moderate-intensity and aerobic exercise – but even light exercise was effective.
The authors explain the effect size this way: If 100 people were in the exercise group and 100 in the control group, about half of those in the exercise group would experience a meaningful reduction in their depression symptoms, compared to only 20 in the control group.
The new study is encouraging not only because it’s the largest of its kind but because it addresses some of the experimental bias that make findings hard to interpret, like flaws in study design, exercise among the control group, and so on. More research is still needed, the authors point out, including studies specifically designed to demonstrate that exercise isn’t worse than standard treatments (non-inferiority studies) and to figure out which kinds of exercise would be most effective for which subgroups of people. “Future large-scale research studies should also investigate which patients benefit most from which exercise condition,” they write, “and identify any groups for whom exercise might not be the optimal treatment choice.”
Still, the authors believe their study results should prompt clinical recommendations to include exercise as a primary treatment, rather than just an add-on. “Updated guidelines as well as routine clinical decisions regarding interventions for treating depression should consider the current findings,” they write. Especially, as they point out, since about two-thirds of people with depression do not receive treatment.
Separately, a new study from Amsterdam UMC, published in the Journal of Affective Disorders, put antidepressants and a running intervention head to head. People with depression and/or anxiety received either antidepressants (escitalopram or sertraline) or joined a running group (45 minutes, two times/week) for 16 weeks. At the end of this period, people in both groups had similar rates of remission from their depression and anxiety: the remission rate for people taking antidepressants was 45%, and in the running group, 43%. (Not surprisingly, people in the exercise group also experienced some physical benefits, like weight loss and reduction in blood pressure.)
Like the authors of the first study, this team also suggest elevating exercise as a treatment option and considering it “standard practice for those with depression and/or anxiety disorders.”
As with other treatments, exercise won’t be right for everyone. But more research, especially more fine-tuned research, can start to get at who may benefit from it and who may do better with other treatments. As we learn more from well-designed studies, more tailored treatments will be possible, and, hopefully, the treatment success rates for people living with depression will rise.