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Exercise to Treat Depression: Aerobic & Resistance Training Effective Antidepressants?

Exercise has emerged as an effective treatment for depression, rivaling medication and psychotherapy in its ability to reduce symptoms.

Both aerobic and resistance training provide mental health benefits, with a combination of the two being optimal.

However, exercise is vastly underutilized and more research is needed to uncover the mechanisms behind its antidepressant effects.


  • Exercise is as effective as antidepressant medication at reducing symptoms of depression.
  • Both aerobic and resistance exercise have mood-boosting capabilities.
  • The underlying biological mechanisms behind exercise’s mental health benefits are not yet fully understood.
  • Despite strong evidence for efficacy, exercise is rarely deployed as a frontline treatment for depression.

Source: Molecular Psychiatry (2023)

The Antidepressant Effects of Exercise

Aerobic Exercise

Over the past few decades, a growing body of evidence has firmly established aerobic exercise as an antidepressant.

Multiple meta-analyses of randomized controlled trials demonstrate a large effect size, with aerobic exercise reducing depressive symptoms as much as antidepressant medication and psychotherapy.

The optimal dose appears to be moderate-to-vigorous intensity aerobic activity for 45-60 minutes at least 3 days per week.

Virtually any form suffices, including walking, jogging, cycling, or dancing.

Resistance Exercise

While researched to a lesser extent than aerobic training, resistance exercise also alleviates depression.

Progressive resistance training utilizing free weights or weight machines at a high intensity (around 80% of one-repetition maximum) elicits comparable mood improvements to aerobic workouts in head-to-head studies.

The combination of aerobic and resistance exercise in a comprehensive fitness program may produce the most robust benefits.

How Exercise Treats Depression (Mechanisms)

The biological mechanisms behind exercise’s antidepressant effects remain hypothetical despite convincing clinical outcomes.

Leading theories center around normalization of neurotransmitter systems, enhancement of neurotrophic factors, reduction of inflammation, and correction of HPA axis dysfunction.

Exercise triggers release of mood-regulating neurotransmitters like serotonin and dopamine while boosting production of BDNF, a protein that stimulates neuron growth and connectivity.

It also curbs circulating inflammatory cytokines and regulates cortisol.

  • Neurochemical Adjustments: Exercise is known to modify the levels and activity of key neurotransmitters associated with mood regulation, including serotonin, dopamine, and norepinephrine. These chemicals play a crucial role in enhancing mood and are also targeted by many antidepressant medications. Regular physical activity increases the availability and efficiency of these neurotransmitters, offering a natural boost to mood.
  • BDNF and Brain Health: Exercise stimulates the production of Brain-Derived Neurotrophic Factor (BDNF), a protein essential for the health, growth, and maintenance of neurons. Increased levels of BDNF can lead to improved neural health, enhanced cognitive function, and reduced symptoms of depression. The boost in BDNF from regular exercise may help repair and protect brain cells from the effects of depression.
  • Inflammation Reduction: Chronic inflammation has been linked to depression. Physical activity, especially regular, moderate-to-vigorous exercise, has been shown to reduce inflammatory markers. This decrease in inflammation may contribute to the alleviation of depressive symptoms and offer a sense of physical well-being.
  • Stress Response and Resilience: Regular exercise can help regulate the body’s stress response system, the hypothalamic-pituitary-adrenal (HPA) axis. By reducing the sensitivity of this system, exercise can make individuals more resilient to stress, which is often a contributing factor in depression.

However, human studies have failed to consistently link measurable changes in these pathways to improvements in depression post-exercise.

The complex interconnectivity of the mechanisms means research may be overlooking important contributing factors.

Advanced “omics” profiling techniques from systems biology represent a promising avenue for future exploration.

Exercise is Rarely Used as a First-Line Treatment for Depression

Given the evidence supporting efficacy and favorable side effect profile, exercise stands out as an extremely viable first-line treatment for depression, either alone or in combination with traditional interventions.

Yet it continues to be drastically underutilized in clinical practice.

Reasons for this are unclear but probably involve some combination of stigma, limitations in insurance reimbursement protocols, lack of cross-disciplinary coordination, and knowledge gaps regarding optimal implementation.

An investment in large-scale research networks, similar to the NIH Drug Abuse Treatment Clinical Trials Network, represents a path forward.

These consortiums can systematically investigate the nuances of exercise prescription while delivering robust molecular profiling.

The resulting mechanistic insights will allow for targeted treatment matching and enhanced patient outcomes.

Integrative care models blending physical and mental health services may also help drive more widespread adoption of exercise therapy for depression.

The Case for Exercise Combination Treatments in Depression

Rather than replace existing options, exercise should augment current standards of care like selective serotonin reuptake inhibitors (SSRIs), psychotherapy, and repetitive transcranial magnetic stimulation (rTMS).

Combining treatment modalities leverages synergistic effects and targets multiple causal pathways simultaneously, increasing the likelihood of remission.

For example, SSRIs might “prime” neurotrophic factor production to enhance sensitivity to later exercise.

Exercise plus psychotherapy minimizes risk of medication side effects.

The addition of exercise to rTMS potentiates neuroplastic processes.

For patients with treatment-resistant symptoms unresponsive to solitary interventions, a multi-pronged approach including exercise holds special utility given its distinct mechanisms.

Responses to Exercise for Depression Vary Among Individuals

While some individuals exhibit large mood improvements from exercise alone, others show little or no response.

This variability probably stems from the heterogeneous biological roots of depression.

Advanced profiling of neurochemical and inflammatory biomarkers in patients prior to starting therapy can help predict optimal treatment regimens on an individualized basis.

People displaying inflammation, low BDNF, or monoamine imbalances seem especially responsive to exercise.

Machine learning algorithms applied to biological data may someday guide custom exercise prescriptions tailored to a patient’s phenotypic expression of depression.

Exercise Protocols for Depression Management

Aerobic Exercise Recommendations:

  • Frequency: Aim for at least three to five sessions per week. Consistency is key to experiencing the benefits.
  • Intensity: Engage in moderate-intensity aerobic exercises where you can talk but not sing during the activity. This could include brisk walking, jogging, cycling, or swimming.
  • Duration: Each session should last between 30 to 60 minutes. If you’re new to exercise, start with shorter durations and gradually increase as you build stamina.

Resistance Training Recommendations:

  • Frequency: Incorporate resistance training at least two days per week. Ensure these sessions are not on consecutive days to allow for muscle recovery.
  • Intensity: Focus on exercises that work for major muscle groups. Use a weight or resistance level heavy enough to tire your muscles after about 12 to 15 repetitions.
  • Duration: A session should include at least one set of 8-12 repetitions for each major muscle group. As you progress, you can increase to two or three sets for better results.

Combination Approach:

  • Consider alternating days between aerobic workouts and resistance training to cover all aspects of fitness and mood enhancement.
  • For example, you might do aerobic exercises on Monday, Wednesday, and Friday, and focus on resistance training on Tuesday and Thursday.

Mindfulness and Movement:

  • Incorporate activities that encourage mindfulness along with physical exertion, such as yoga or tai chi. These practices can help reduce stress and improve mental clarity, enhancing the mood-lifting effects of exercise.

Personalization and Progression:

  • Tailor your routine to fit your current fitness level, preferences, and any medical considerations. Start slow and gradually increase the intensity and duration of your workouts.
  • Set realistic goals and track your progress. Celebrate your achievements, no matter how small, to stay motivated.

Safety and Support:

  • If you’re new to exercise or have any health concerns, consult with a healthcare professional before starting any new workout regimen.
  • Consider working with a fitness professional or therapist who specializes in exercise for mental health to create a personalized plan and provide ongoing support.

Note: While exercise can be a powerful tool in managing depression, it should be part of a comprehensive treatment plan that may include medication, therapy, and lifestyle modifications. Always consult with healthcare professionals for a plan that’s best suited for your individual needs.

Exercise is a Useful Depression Treatment

In conclusion, current scientific consensus unambiguously confirms exercise as a frontline depression treatment on par with pharmaceuticals and counseling.

Yet it remains an afterthought in real-world clinical application.

Advancing integrative care models that formally incorporate exercise alongside traditional modalities – combined with larger investments into uncovering the precise neurobiological mechanisms – promises to revolutionize outcomes and reduce the massive disease burden imposed by depression.

The potential public health impact of finally utilizing this safe, low-cost, and broadly effective intervention cannot be overstated.


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