Major evidence review supports an “exercise prescription” for most adults to boost mental health and well-being

When you head to your week­ly yoga class or lift weights at the gym, you’re doing some­thing good for your phys­i­cal health: get­ting more fit today, and so pro­tect­ing your body into the future.

What you may not always think about, though, is that you’re also pro­tect­ing your­self from anx­i­ety and depression—about as much as you would be if you were going to ther­a­py or tak­ing med­ica­tion. At least that’s the con­clu­sion of a very large new study that syn­the­sizes decades of research on exer­cise and men­tal health.

The study doesn’t just pro­vide this key insight—in fact, the researchers were also able to iden­ti­fy what kind of exer­cise and how much of it is best for men­tal health.

How body supports mind:

Researchers ana­lyzed the results from more than 1,000 ran­dom­ized con­trolled trials—one of the strongest types of stud­ies. These exper­i­ments, with over 128,000 par­tic­i­pants, had com­pared exer­cise to stan­dard treat­ments like sim­ply learn­ing about fit­ness or get­ting help set­ting goals.

The par­tic­i­pants engaged in a vari­ety of phys­i­cal activ­i­ties, from yoga and tai chi to aer­o­bics and dance to strength train­ing. Some peo­ple had var­i­ous health con­di­tions, while oth­ers were suf­fer­ing from depres­sion, anx­i­ety, or post-trau­mat­ic stress dis­or­der. In the orig­i­nal stud­ies, they or their clin­i­cians rat­ed their symp­toms of depres­sion, anx­i­ety, and dis­tress before and after the exer­cise pro­gram or treatment.

The results sug­gest­ed that exer­cis­ing helped peo­ple reduce their depres­sion, anx­i­ety, and dis­tress even more than usu­al treatments.

“Phys­i­cal activ­i­ty can be an effec­tive treat­ment for men­tal health prob­lems,” says Ben Singh, lead author and research fel­low at the Uni­ver­si­ty of South Aus­tralia. He thinks it works in sev­er­al ways: by releas­ing endor­phins and boost­ing our mood, improv­ing sleep, reduc­ing stress, sup­port­ing self-esteem and con­fi­dence, and mak­ing us feel accom­plished and purposeful.

The find­ings sug­gest that exer­cise is par­tic­u­lar­ly help­ful in cer­tain sit­u­a­tions. While the type of exer­cise didn’t mat­ter, peo­ple got more men­tal health ben­e­fits out of high­er-inten­si­ty exer­cise. If you’re doing some­thing that makes you breathe hard, in oth­er words, that’s a good sign.

And it seems like you don’t have to exer­cise obses­sive­ly to see ben­e­fits. The sweet spot was four to five ses­sions per week—not every day, but most days. Work­outs don’t have to be long; there was no dif­fer­ence between 30-minute work­outs and hour­long ones. The researchers sug­gest that this mod­er­ate amount of exer­cise may feel more man­age­able, so it doesn’t become a bur­den in people’s lives.

The ben­e­fits of exer­cise might not be imme­di­ate, says Singh, but they should show up with­in weeks or months. Beyond that, the longer peo­ple engaged in exer­cise, the less addi­tion­al­ly ben­e­fi­cial it became for their men­tal health. This may be because they were stick­ing to the pro­gram less, due to wan­ing moti­va­tion or, per­haps, injury. It could also be because the exer­cise itself began to feel less nov­el and more repetitive.

Depend­ing on what you’re deal­ing with in your life, you may be a bet­ter can­di­date to ben­e­fit from exer­cise. In this study, the groups who saw the biggest reduc­tions in depres­sion were healthy peo­ple, as well as those with depres­sion diag­noses, kid­ney dis­ease, HIV, or chron­ic obstruc­tive pul­monary dis­ease. The groups who saw the biggest reduc­tions in anx­i­ety were those with anx­i­ety dis­or­ders or can­cer. It’s pos­si­ble, the researchers sug­gest, that these peo­ple may have had more room for improve­ment in terms of their men­tal health.

An exercise prescription:

If exer­cise is so help­ful for feel­ings of depres­sion and anx­i­ety, why aren’t doc­tors pre­scrib­ing it more? In the Unit­ed States, the researchers explain, exer­cise, sleep, and diet changes are con­sid­ered “com­ple­men­tary alter­na­tive treat­ments” if ther­a­py and drugs don’t work. But in oth­er coun­tries, such as Aus­tralia, these lifestyle fac­tors are addressed ear­li­er on.

“Phys­i­cal activ­i­ty is a safe and effec­tive way to improve men­tal health, and it is a treat­ment that should be con­sid­ered along­side oth­er treat­ments, such as ther­a­py and med­ica­tion,” says Singh.

One rea­son why it may not be con­sid­ered is the dif­fi­cul­ty of mon­i­tor­ing exer­cise and get­ting peo­ple to fol­low rec­om­men­da­tions. Depres­sion, in par­tic­u­lar, can reduce our moti­va­tion and ener­gy. If that’s the case, Singh sug­gests a few ways to get your­self moti­vat­ed to exercise:

• Start small. If you’re not used to exer­cis­ing, start with small goals, such as walk­ing for 10 min­utes a day or doing some light stretch­ing. As you get more com­fort­able with exer­cise, you can grad­u­al­ly increase the inten­si­ty or dura­tion of your workouts.
• Find an activ­i­ty you enjoy. If you don’t enjoy the type of exer­cise you’re doing, you’re less like­ly to stick with it. Try dif­fer­ent activ­i­ties until you find one that you real­ly enjoy. Some peo­ple enjoy run­ning, swim­ming, bik­ing, yoga, danc­ing, or hik­ing. You may also want to try group exer­cise class­es or work­ing out with a friend.
• Make exer­cise a habit. The more you exer­cise, the eas­i­er it becomes. Try to make exer­cise a reg­u­lar part of your rou­tine, such as going for a walk after work or work­ing out first thing in the morning.
• Set real­is­tic goals. Don’t try to do too much too soon. Start with small goals and grad­u­al­ly increase the inten­si­ty or dura­tion of your work­outs as you get more fit.
• Reward your­self. When you reach a goal, reward your­self with some­thing you enjoy. This will help you stay moti­vat­ed and on track.
• Don’t give up. There will be days when you don’t feel like exer­cis­ing. But it’s impor­tant to push through these days and keep exer­cis­ing. The more you exer­cise, the bet­ter you’ll feel.

For peo­ple deal­ing with depres­sion, in par­tic­u­lar, Singh sug­gests going easy on your­self and get­ting help when needed—the account­abil­i­ty of an exer­cise bud­dy, or advice from doc­tors or ther­a­pists to help you stick to it. “Exer­cise can be a help­ful part of treat­ment, but it’s not a cure,” he says. It’s “not a replace­ment for cur­rent treat­ments such as med­ica­tions and counseling.”

That said, it’s some­thing you can do that is acces­si­ble, with few side effects, and with many ben­e­fits besides the men­tal health ones. Why not give it a try?

– Kira M. New­man is the man­ag­ing edi­tor of Greater Good and the co-edi­tor of The Grat­i­tude Project. Based at UC-Berke­ley, Greater Good high­lights ground break­ing sci­en­tif­ic research into the roots of com­pas­sion and altru­ism. Copy­right Greater Good.

The Study:

Effec­tive­ness of phys­i­cal activ­i­ty inter­ven­tions for improv­ing depres­sion, anx­i­ety and dis­tress: an overview of sys­tem­at­ic reviews (British Jour­nal of Sports Med­i­cine). From the abstract:

• Objec­tive: To syn­the­sise the evi­dence on the effects of phys­i­cal activ­i­ty on symp­toms of depres­sion, anx­i­ety and psy­cho­log­i­cal dis­tress in adult populations.
• Results: … The largest ben­e­fits were seen in peo­ple with depres­sion, HIV and kid­ney dis­ease, in preg­nant and post­par­tum women, and in healthy indi­vid­u­als. High­er inten­si­ty phys­i­cal activ­i­ty was asso­ci­at­ed with greater improve­ments in symp­toms. Effec­tive­ness of phys­i­cal activ­i­ty inter­ven­tions dimin­ished with longer dura­tion interventions.
• Con­clu­sion and rel­e­vance: Phys­i­cal activ­i­ty is high­ly ben­e­fi­cial for improv­ing symp­toms of depres­sion, anx­i­ety and dis­tress across a wide range of adult pop­u­la­tions, includ­ing the gen­er­al pop­u­la­tion, peo­ple with diag­nosed men­tal health dis­or­ders and peo­ple with chron­ic dis­ease. Phys­i­cal activ­i­ty should be a main­stay approach in the man­age­ment of depres­sion, anx­i­ety and psy­cho­log­i­cal distress.

The Study in Context:

• Can you grow your hip­pocam­pus? Yes. Here’s how, and why it matters
• Three ways to pro­tect your men­tal health dur­ing –and after– COVID-19
• Solv­ing the Brain Fit­ness Puz­zle Is the Key to Self-Empow­ered Aging