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Exercise therapy for depression

Exercise can improve your health. This is a well known fact. While enhancing physical health, it has become widely accepted exercise can improve mental health too. This article will help you understand why health professionals are increasingly including exercise in depression interventions. You will discover exercise improves symptoms and can help to prevent relapse, as effectively as traditional treatments for depression.


What is depression?

Sadness is one of our most commonly experienced emotions. It is only natural to feel sad in response to feeling alone, losing a friend or partner, or going through a difficult time. We can also feel sad without knowing why. While sadness is an emotion commonly experienced at times in our lives, depression involves more than feeling sad. Depression makes life harder.


Symptoms of depression1a, 1b include feeling ‘down’ (e.g., depressed mood), loss of appetite/weight, and changes to sleeping patterns (e.g., insomnia). There can be fatigue, lack of motivation, agitation, and it can be harder to concentrate. Pleasure is experienced less (e.g., anhedonia) and libido is reduced. Other symptoms include feelings of helplessness, hopelessness and worthlessness, and thoughts of self-harm / suicide. When depressed, we may experience some or many of these debilitating symptoms.


Exercise can help reduce depression

A growing body of research shows exercise is effective in treating depression. Exercise has been shown to improve overall mood as well as reduce symptoms and this is supported by research2, 3, 4, 5. Interestingly, research reviews6, 7, 8, 9 as well as meta-analyses10, 11 have also demonstrated this positive impact of exercise. It can reduce depression in different groups of people, such as women with post-partum12 depression (e.g., following pregnancy) and post-menopausal13, 14 depression. Symptoms can be reduced in people with obesity15, 16 issues. Exercise also reduces depression in the elderly17, 18, 19 as well as children and adolescents20, 21, 22.


Exercise is also known to improve symptoms associated with depression. For example, exercise can alleviate insomnia23, 24 (see also meta-anlyses25, 26) and improve appetite27, 28. Regular exercise has been associated with pleasure29, 30, 31, 32 and improving symptoms such as energy levels33, 34 and self-esteem35, 36, 37, 38. Exercise can also ease anxiety39, 40, 41, which often occur during depression. A sense of achievement can also be gained.


Exercise can help prevent relapse

Relapse is when depression re-occurs. Relapse prevention simply refers to preventing more episodes. It is essential to include relapse prevention when treating depression. Several studies have shown that exercise helps to reduce relapse19, 42, 43, 44. This means after overcoming depression, exercise can decrease the chances of becoming depressed again.


Exercise may also have a positive longer term impact on mental health. Longitudinal studies conclude there are reduced depression rates years after participating in exercise programs. Several studies found a positive long term impact on depressive symptoms22, 45. One research study even found that exercise reduces relapse more than an antidepressant medication18.


Exercise, medication and counselling

Blumenthal,Babyak and colleagues compared exercise with medication in their research18, 43, 46 into depression therapy. They found that exercise was as effective as antidepressant medication in treating symptoms43, 46, also found by other researchers47. Interestingly, exercise may be better than some antidepressants for reducing relapse18.


Cognitive Behaviour Therapy (CBT) is considered the gold standard when it comes to depression interventions. Should you combine it with exercise? In an interesting study, researchers compared two groups being treated for depression. One group was only given CBT while a second group received both exercise and CBT. Combining CBT with exercise was found to reduce symptoms more than using CBT by itself48. Some studies have found exercise to be as good as counselling49, 50 and one research study even concluded exercise comparable to CBT51 in when treating depression.


Such research suggests exercise is as good as, if not better than some medications when treating depression, and that exercise can be as useful as some counselling therapies. On a deeper level; however, the recommendation is simply to include exercise in depression treatments. Exercise helps on a physiological as well as a psychological level, and without the costs of a therapist or the side-effects of a medication. And exercise can be fun.



This article has given you insight into how beneficial exercise is in alleviating symptoms of depression and reducing relapse. You learnt how exercise can be as effective as some psychiatric medications as well as some psychological interventions. All of this means exercise can help you whether you are depressed or not. The recommendation here is for you to start exercising right away because it is fun and may help keep the blues away.



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1b. World Health Organization. (2004). International Statistical Classification of Diseases and Health Related Problems. (ICD-10)


2. Di Lorenzo, T.M., Bargman, E.P., Stucky-Ropp, R., Brassington, G.S., Frensch, P.A. and La Fontaine, T. (1999). Long term effects of aerobic exercise on psychological outcomes. Preventive Medicine, 28 (1), 75-85.


3. Hassmen, P., Koivula, N. and Uutela, A. (2000). Physical exercise and psychological well-being: a population study in Finland. Preventive Medicine, 30 (1), 17-25.


4. Klein, M.H., Greist, J.H., Gunman, A.S., Neimeyev, R.A., Lesser, D.P., Busuell, N.J. and Smith, R.E. (1985). A comparative outcome study of group psychotherapy vs. exercise treatments for depression. International Journal of Mental Health, 13, 148–77.


5. Martinsen, E.W., Medhus, A. and Sandvik, L. (1985). Effects of aerobic exercise on depression: a controlled study. British Medical Journal (Clin. Res. Ed.)., 291 (6488),109.


6. Dirmaier. J., Steinmann, M., Krattenmacher, T., Watzke, B., Barghaan, D., Koch, U. and Schulz, H. (2012). Non-pharmacological treatment of depressive disorders: a review of evidence-based treatment options. Reviews on Recent Clinical Trials, 7 (2), 141-149.


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8. Scully, D., Kremer, J., Meade, M.M., Graham, R. and Dudgeon, K. (1998). Physical exercise and psychological well being: A critical review. British Journal of Sports Medicine, 32, 111-120.


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10. Lawlor, D.A. and Hopker, S.W. (2001). The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials. British Medical Journal, 322 (7289), 763-767.


11. Craft, L.L. and Landers, D.M. (1998). The effect of exercise on clinical depression and depression resulting from mental illness: a meta-analysis. Journal of Sport and Exercise Psychology, 20, 339-357.


12. Daley, A.J., MacArthur, C. and Winter, H. (2007). The role of exercise in treating postpartum depression: A review of the literature, Journal of Midwifery & Women's Health, 52 (1), 56–62.


13. Gutiérrez, C.V., Luque, G.T.,  Medina, G.M.A, del Castillo, M.J.A, Guisado, I.M., Barrilao, R.G. and Rodrigo, J.R. (2012). Influence of exercise on mood in postmenopausal women. Journal of Clinical Nursing, 21 (7-8), 923-928.


14. Tworoger, S.S., Yasui, Y., Vitiello, M.V., Schwartz, R.S., Ulrich, C.M., Aiello, E.J., Irwin, M.L., Bowen, D., Potter, J.D. and McTiernan, A. (2003). Effects of a yearlong moderate-intensity exercise and a stretching intervention on sleep quality in postmenopausal women. Sleep, 26 (7), 830-836.


15. Fabricatore, A.N., Wadden, T.A., Higginbotham, A.J., Faulconbridge, L.F., Nguyen, A.M., Heymsfield, S.B. and Faith, M.S. (2011). Intentional weight loss and changes in symptoms of depression: a systematic review and meta-analysis. International Journal of Obesity, 35 (11), 1363-1376.


16. Barton, S.B., Walker, L.L., Lambert, G., Gately, P.J. and Hill, A.J. (2004). Cognitive change in obese adolescents losing weight. Obesity Research, 12 (2), 313-319.


17. Blake, H., Mo, P., Malik, S. and Thomas, S. (2009). How effective are physical activity interventions for alleviating depressive symptoms in older people? A systematic review. Clinical Rehabilitation, 23 (10), 873-887.


18. Blumenthal, J.A., Babyak, M.A., Moore, K.A., Craighead, W.A., Herman, S., Khatri, P., Waugh, R., Napolitano, M.A., Doraiswami, P.M. and Krishnan, K.R. (1999). Effects of exercise training on older adults with major depression. Archives of Internal Medicine, 159, 2349–2356.


19. Strawbridge, W.J., Deleger, S., Roberts, R.E. and Kaplan, G.A. (2002). Physical activity reduces the risk of subsequent depression for older adults. American Journal of Epidemiology, 156 (4), 328 334.


20. Williamson, D., Dewey, A., Steinberg, H. (2001) Mood change through physical exercise in nine- to ten-year old children. Perceptual and Motor Skills, 93, 311–316.


21. Crews, D.J., Lochbaum, M.R. and Landers, D.M. (2004) Aerobic physical activity effects on psychological well-being in low-income Hispanic children. Perceptual and Motor Skills, 98, 319-324.


22. Strohle, A., Hofler, M., Pfister, H., Muller, A., Hoyer, J., Wittchen, H. and Lieb, R. (2007). Physical activity and prevalence and incidence of mental disorders in adolescents and young adults. Psychological Medicine, 37, 1657–1666.


23. King, A.C., Oman, R.F., Brassington, G.S., Bliwise, D.L. and Haskell, W.L. (1997). Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. Journal of the American Medical Association, 277, 32-37.


24. Uchida, S., Shioda, K., Morita, Y., Kubota, C., Ganeko, M. and Takeda N. (2012). Exercise effects on sleep physiology. Frontiers in Neurology, 3, 48.


25. Kubitz, K.K., Landers, D.M., Petruzzello, S.J. and Han, M.W. (1996). The effects of acute and chronic exercise on sleep. Sports Medicine, 21 (4), 277–291.


26. O’Connor, P.J. and Youngstedt, M.A. (1995). Influence of exercise on human sleep. Exercise and Sport Science Reviews, 23, 105–134.


27. Neil A King, N.A., Caudwell, P.P., Hopkins, M., Stubbs, J.R., Naslund, E. andBlundell, J.E. (2009). Dual-process action of exercise on appetite control: increase in orexigenic drive but improvement in meal-induced satiety. American Journal of Clinical Nutrition.90 (4), 921-927.


28. Martins.C., Truby,H. and Morgan,L.M. (2007).Short-term appetite control in response to a 6-week exercise programme in sedentary volunteers. British Journal of Nutrition, 98, 834–42.


29. Besenski, L.J. (2009). Health-enhancing physical activity and eudaimonic well-being. Master’s thesis, University of Saskatchewan, Saskatoon, Canada.


30. Deslandes, A., Moraes, H., Ferreira C.,Veiga, H., Silveira, H., Mouta, R., Pompeu, F.A.M.S., Coutinho, E.S.F. and Lakset, J. (2009). Exercise and mental health: Many reasons to move . Neuropsychobiology, 59, 191–198.


31. Elder, J.P., Arredondo, E., Ji, M., Marshall, S., McKenzie, T., Nichols, J., Sallis, J., Talavera, G., Arranda, M., Ricanor, M.J., Hara A,, Cox, B., Cuestas, L., Brongiel, I., Gonzalez, A., Hernandez, M., Holguin, M., Levy, S., Macias, G., Medina, V., Mercado, S., Nuno, J., Quintanar, E. and Rivera, D. (2011). Effects of a promotor-based intervention to promote physical activity. American Journal of Public Health, 101 (12), 2261-2268.


32. Shomaker, L.B., Tanofsky-Kraff, M., Zocca, J.M., Field, S.E., Drinkard, B. and Yanovski, J.A. (2012). Depressive symptoms and cardiorespiratory fitness in obese adolescents. Journal of Adolescent Health, 50 (1), 87-92.


33. Shapiro, D., Cook, I.A., Davydov, D.M., Ottaviani, C., Leuchter, A.F. and Abrams, M. (2007). Yoga as a Complementary Treatment of Depression: Effects of Traits and Moods on Treatment Outcome. Evidence-Based Complementary and Alternative Medicine, 4 (4), 493-502.


34. Woolery, A., Myers, H., Sternlieb, B. and Zeltzer, L. (2004). A yoga intervention for young adults with elevated symptoms of depression. Alternative Therapies in Health and Medicine, 10, 60–63.


35 Cohen, G.E. and Shamus, E. (2009). Depressed, Low Self-Esteem: What Can Exercise Do For You? Internet Journal of Allied Health Sciences and Practice, 7 (2). http://ijahsp.nova.edu


36. Caruso, C.M. and Gill, D.L. (1992). Strengthening physical self-perceptions through exercise. Journal of Sports Medicine and Physical Fitness, 32 (4), 416-427.


37. Spence, J.C., Poon, P. and Dyck, P. (1997). The effect of physical-activity participation on self-concept: A meta-analysis. Journal of Sport and Exercise Psychology, 19, S109.


38. Mann, M., Hosman, C.M., Schaalma, H.P. and de Vries, N.K. (2004). Self-esteem in a broad-spectrum approach for mental health promotion. Health Education Research, 19 (4), 357-72.


39. Stathopoulou, G., Powers, M.B., Berry, A.C., Smits, J.A.J. and Otto, M.W. (2006). Exercise Interventions for Mental Health: A Quantitative and Qualitative Review. Clinical Psychology: Science and Practice, 13 (2), 179–193.


40. Carek, P.J., Laibstain, S.E. and Carek, S.M. (2011). Exercise for the treatment of depression and anxiety. International Journal of Psychiatry in Medicine, 41 (1), 15-28.


41. Petruzzello, S.J., Landers, A.C., Hatfield, B.D., Kubitz, K.A. and Salazar, W. (1991). A meta-analysis on the anxiety-reducing effect of acute and chronic exercise: Outcomes and mechanisms. Sports Medicine, 11, 143–182.


42. Babiss, L.A. and Gangwisch, J.E. (2009).Sports participation as a protective factor against depression and suicidal ideation in adolescents as mediated by self esteem and social support. Journal of Developmental and Behavioral Pediatrics, 30 (5), 376-384.


43. Babyak, M., Blumenthal, J.A., Herman, S., Khatri, P., Doraiswamy, M., Moore, K., Craighead, W.E., Baldewicz, T.T. and Krishnan, K.R. (2000). Exercise treatment for major depression: Maintenance of therapeutic benefit at 10 months. Psychosomatic Medicine, 62 (5), 633-638.


44. Dishman, R.K., Hales, D.P., Pfeiffer, K.A., Felton, G.A., Saunders, R., Ward, D.S., Dowda, M., and Pate, R.R. (2006).  Physical self-concept and self-esteem mediate cross-sectional relations of physical activity and sport participation with depression symptoms among adolescent girls. Health Psychology, 25, 396–407.


45. Mobily, K.E., Rubinstein, L.M., Lemke, J.H., O’Hara, M.W. and Wallace, R.B. (1996). Walking and depression in a cohort of older adults: The Iowa 65+ Rural Health Study. Journal of the American Planning Association, 4, 119–135.


46. Blumenthal, J.A., Babyak, M.A., Doraiswamy, P.M., Watkins, L., Hoffman, B.M., Barbour, K.A, Herman, S., Craighead, W.E., Brosse, A.L., Waugh, R., Hinderliter, A. and Sherwood, A. (2007). Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosomatic medicine, 69 (7), 587-596.


47. Carek, P.J., Laibstain, S.E. and Carek, S.M. (2011). Exercise for the treatment of depression and anxiety. International Journal of Psychiatry in Medicine, 41 (1), 15-28.


48. Gary, R.A., Dunbar, S.B., Higgins, M.K., Musselman, D.L. and Smith, A.L. (2010). Combined exercise and cognitive behavioral therapy improves outcomes in patients with heart failure. Journal of Psychosomatic Research, 69 (2), 119-131.


49. Byars, J.L. (2011). Stress, anxiety, depression, and loneliness of graduate counseling students: The effectiveness of group counseling and exercise. Dissertation. http://hdl.handle.net/2346/22090


50. Greist, J.H., Klein, M.H., Eischens, R.R., Faris, J., Gurman, A.S. and Morgan, W.P. (1979). Running as treatment for depression. Comprehensive Psychiatry, 20, 41-54.


51. Fremont, J., and Craighead, L.W. (1987). Aerobic exercise and cognitive therapy in the treatment of dysphoric moods. Cognitive Therapy and Research, 11 (2), 241–251.

By David Pollak Psychologist
All rights reserved. Any reproducing of this article must have the author name and all the links intact.

Author: Psychologist

Biography: David Pollak is a senior psychologist at Australian Psychology Solutions - the completely bulk billed Sydney Psychologist service. David practices in the eastern suburbs of Sydney Australia.


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