The Power of Prescription: Exercise and Mood

Lilian White, MD
Posted on July 1, 2024

Exercise has long been a key part of initial monotherapy or adjunctive treatment recommendations for conditions such as hypertension, diabetes, and high cholesterol. Guidelines for the treatment of depression have largely been limited to pharmacological or psychological interventions, with minimal discussion regarding exercise as a form of treatment. For example, the American Psychological Association’s clinical practice guideline for the treatment of depression recommends exercise for the treatment of depression only in patients for whom pharmacotherapy or psychotherapy are unsuccessful or not an option.

A POEM (patient-oriented evidence that matters) in the June 2024 issue of American Family Physician describes the impressive benefits of exercise for the treatment of depression. A meta-analysis of more than 14,000 patients with mild to severe depression was reviewed. As a distinction from previous reviews, this review focused largely on the use of exercises as initial rather than adjunctive treatment of depression.  

Exercise was found to have a positive effect on the treatment of depression. Exercise was comparable to the use of pharmacotherapy and psychotherapy. Participants in the study were not restricted by age, comorbidities, or severity of depression, making the results even more noteworthy.

Prescribed exercise (e.g., walking, yoga) tended to be more effective than encouraging patient autonomy in choosing an exercise. Similarly, behavioral change techniques and counseling regarding physical activity were less effective than prescribed exercise. Forms of exercise that tended to be the most effective included dance, walking or jogging, yoga, and strength training.

Many patients with depression also experience symptoms of anxiety. Exercise has also been found to reduce symptoms of anxiety, although the evidence overall is not as strong as for the treatment of depression.

Although exercise comes with some inherent risks of injury, the risk is overall low and likely outweighs the benefit of exercise for the treatment of depression, as well as its myriad benefits. For example, the rate of chronic injury for people practicing yoga is estimated to be 10%, with the majority recovering fully after injury. Adverse effects of selective serotonin reuptake medications are estimated to affect between 25% to 38% of patients.

In summary, exercise monotherapy is an effective treatment option for depression and deserves a more prominent place in treatment guidelines and clinical practice. The distinct benefit of providing the patient with an exercise prescription as opposed to counseling about or encouraging activity will change my own practice in making exercise recommendations in the future. It will be interesting to see how these recommendations become more refined with additional studies on specific types of exercise, duration, and intensity and its application for other mental health diagnoses over time.