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Exercising may provide more benefit as a first-line treatment for mental health conditions. Kay Nietfeld/picture alliance via Getty Images
  • A large new analysis of meta-studies finds that exercise is more beneficial for conditions such as anxiety and depression than standard psychotherapy or medications.
  • The new study found that essentially all forms of exercise produced significant mental health benefits.
  • Shorter, high intensity exercise programs produced the greatest effect.
  • Exercise provided the greatest mental health benefit to people with depression, or who had been diagnosed with HIV and kidney disease, pregnant and postpartum women, and otherwise healthy adults.

An expansive analysis of existing research concludes that physical activity should be viewed as a first-choice treatment for people living with mental health issues. The analysis distills the conclusions of nearly 100 meta-reviews of randomized controlled trials.

Physical activity is 1.5 times more effective at reducing mild-to-moderate symptoms of depression, psychological stress, and anxiety than medication or cognitive behavior therapy, according to the study’s lead author, Dr. Ben Singh.

While the value of physical activity for people with depression and anxiety is widely recognized, it is not considered for managing such conditions as often as the study asserts it should be.

All forms of exercise can benefit mental health, the study found, although higher-intensity activities produce the strongest benefits.

The study found that briefer exercise programs provide more benefits than extended regimens. The benefits of physical activity interventions diminished with longer-duration programs.

This means that individuals with mental health issues need not commit to intensive, long-term exercise to achieve the maximum therapeutic benefit.

The study is published in BJM Sports Medicine.

The World Health Organization (WHO) reports that almost a billion people globally are living with a mental disorder, most typically anxiety issues and depression.

Roughly 301 million people have an anxiety disorder, and this figure includes 58 million children and adolescents. There were 280 million individuals living with depression.

While the most recent mental health data from the WHO comes from 2019 before the COVID-19 pandemic, the WHO’s initial estimate for 2020 suggests an increase in mental health disorders of 26%–28%.

The study encompassed 97 meta-reviews of 1,039 randomized controlled trials involving 128,119 participants.

While this body of research generally concluded that exercise produced effects similar to those of psychotherapy and pharmacotherapy, variations in study methodologies made developing an overall consensus a challenge.

The trials evaluated differing forms of exercise, in varying dosages. They also involved different population subgroups, comparing them to different control groups.

In the end, said Dr. Singh, “It showed exercise is an effective way to treat mental health issues — and can be even more effective than medication or counseling.”

Victoria University’s Professor Vasso Apostolopoulos, who was not involved in the study, told Medical News Today that there is a growing body of research supporting the benefits of exercise on a range of mood states, including anxiety, stress, and depression.

The effect may occur, she said, “through physiological and biochemical mechanisms, including endorphins, mitochondria, mammalian target of rapamycin, neurotransmitters and the hypothalamic-pituitary-adrenal axis, and via the thermogenic hypothesis.”

The thermogenic hypothesis suggests that the increase in body temperature that occurs with exercise may reduce muscular tension and alter neuronal activity, thus reducing anxiety.

Prof. Apostolopoulos also noted that exercise has been shown to reduce inflammation “via several different processes (inflammation, cytokines, toll-like receptors, adipose tissue and via the vagal tone), which can contribute to better health outcomes in people suffering from mood disorders.

“As a researcher, and seeing the positive effects exercise has on overall health, in particular in mental health, exercise is a good option or a complimentary add-on therapy to current treatments.”
— Prof. Vasso Apostolopoulos

The analysis found that physical activity produced a median reduction in mental health issues from 42% to 60%. Psychotherapy and pharmacotherapy produced a much smaller improvement, between 22% and 37%.

“We found [that] doing 150 minutes each week of various types of physical activity — such as brisk walking, lifting weights and yoga — significantly reduces depression, anxiety, and psychological distress, compared to usual care, such as medications,” said Dr. Singh.

Exercise offered the greatest benefits, the analysis concluded, to people with depression, HIV and kidney disease, pregnant and postpartum women, and otherwise healthy adults.

The study does not explore the benefits exercise may provide across all stages of life. However, it found that it was effective for anyone 18 and older, including older adults.

“Of note, for people who were older than 45+ and/or de-conditioned, many studies showed that walking 20–40 mins [each] day was particularly effective for improving depression and anxiety,” said Dr. Singh.

The study confirms that exercise “should be a legitimate first-line treatment for mental health issues and not just an ‘added extra’ as it’s often seen in medicine,” said Dr. Singh.

Since psychiatrists’ and psychologists’ expertise is in mental health, Dr. Singh and Prof. Apostolopoulos agreed that they should partner with health professionals with knowledge of physical activity and exercise to develop a patients’ comprehensive treatment plan.

“A treatment plan may include a combination of lifestyle approaches, such as exercising regularly, eating a balanced diet, and socializing, alongside treatments such as psychotherapy and medication.”
— Dr. Ben Singh