Exercise should be the primary treatment for depression and other common mental health conditions, according to researchers at the University of South Australia (UniSA).
The most comprehensive review of research to date shows that mild to moderate symptoms of depression, anxiety and psychological distress can be improved by physical activity. According to their survey, exercise is 1.5 times more effective than advice and the best drugs.
The study found that exercise interventions of 12 weeks or less reduced mental health symptoms the most.
“Importantly, research shows that it doesn’t take a lot of exercise to make a positive change to your mental health,” says lead author, clinical exercise physiologist Ben Singh of UniSA.
Mental health disorders are a leading cause of health problems worldwide. Costly for individuals and for society as a whole, poor mental health affected 1 in 8 people in 2019, and recent studies show that up to 1 in 5 people experience higher levels of psychological distress in middle age. .
Previous studies have shown that patients with depression, anxiety, or other forms of psychological distress can benefit from physical activity just as much as they would from psychotherapy or pharmaceutical treatment.
“Physical activity is known to help improve mental health,” says Singh, “yet, despite the evidence, it has not been widely adopted as a first-choice treatment.”
Because individual studies have examined such a variety of physical activity types, intensities, population subgroups, and comparison groups, it can be difficult for clinicians to make sense of the evidence suggesting that the physical activity is beneficial in the treatment of mental health disorders.
Singh and his colleagues at UniSA therefore conducted a larger type of study called an umbrella review, to assess how all kinds of physical activity affect depression, anxiety and psychological distress in adults.
A global review examines a collection of reviews rather than individual studies to provide an overall picture of what existing research says about a specific topic. Simply put, it provides “global” coverage of all the evidence on a topic.
The research team extracted all eligible studies published before 2022 from 12 electronic databases. Overall, they analyzed 97 reviews which included 1039 trials with over 128,119 participants.
Comparing the effects of exercise to those of usual care in all populations, they found that exercise improved symptoms of depression, anxiety and psychological distress 1.5 times better than talk therapy or medication.
“We also found that all types of physical activity and exercise were beneficial, including aerobic exercise such as walking, resistance training, Pilates, and yoga,” says Singh.
Certain types of exercise seemed to help in different ways. For example, yoga and other mind-body exercises helped reduce anxiety the most, while resistance exercises helped fight depression the most.
“Higher-intensity exercise had greater improvements for depression and anxiety, while longer durations had weaker effects compared to short- and medium-duration bursts,” says Singh.
The fact that longer interventions were less effective than shorter interventions may seem to run counter to common sense. The authors suggest that it is possible that this finding shows that people may find it difficult to stick to longer exercise programs which may have an impact on psychological benefits.
Women who were pregnant or had just given birth, people with depression, HIV and kidney disease, and people in good health benefited the most.
Researchers say this may reflect populations that are more likely to have higher symptoms of depression and anxiety and lower levels of physical activity, and therefore have more room for improvement than populations non-clinical.
It should be noted that the majority of available evidence described mild to moderate depression, with fewer reviews on anxiety and psychological distress. Further research in various areas of mental health may lead to stronger conclusions.
Of course, the results do not rule out that medication and therapy are important treatments for many mental health conditions; rather, they suggest that exercise is also an important treatment, and one that deserves renewed attention.
“Physical activity is highly beneficial for improving symptoms of depression, anxiety, and distress in a wide range of adult populations, including the general population, people with diagnosed mental disorders, and people with chronic illnesses” , conclude the authors.
The review was published in the British Journal of Sports Medicine.