Exercise effectively treats depression and may decrease suicide attempts

A 2023 meta-analysis of randomized controlled trials (RCTs) found that supervised, group or non-group, moderate- or vigorous-intensity, aerobic or resistance exercises (excluding mind–body activities such as yoga) decreased depressive symptoms among participants with depression, with a number needed to treat of 2 and an effectiveness comparable to first-line treatments such as psychotherapy and medication.1 Another 2023 meta-analysis of RCTs found that exercise decreased suicide attempts among people with mental or physical illness.2

Psychological barriers to exercise should be addressed

For people with depression, these include amotivation, low energy, and perceived fatigue, among others.3 While meta-analyses have found positive effects of exercise interventions, these largely involved willing participants with professional support.1,2 Addressing psychological barriers is important for exercise implementation.

Exercise prescriptions should be specific and exercise supervised

Clinicians should specify the frequency, intensity, time, and type of exercise for patients.4 Moderate- to vigorous-intensity aerobic or resistance exercise for 45–60 minutes 3–5 times per week has been shown to have antidepressive effects,3 although any physical activity is better than none,5 and supervision by an exercise professional can maximize effects.1,3 Most importantly, patients should be involved in the choice of exercise to increase adherence.5

Behavioural change techniques, tailored to each stage of change, can increase exercise initiation and adherence5

Clinicians should begin with motivation-building techniques, then progress to action-oriented strategies, and, finally, focus on maintenance. They should regularly assess progress, adapt strategies as needed, and provide positive reinforcement. Fortier and colleagues5 have provided a practical guide for exercise among people with depression.5

Exercise interventions are generally safe

Exercise in this population is well tolerated, with minor adverse events such as joint pain, headache, and fatigue.1,2 Patients should be screened for pre-existing comorbidities such as injuries, physical inability, and conditions such as severe cardiovascular disease that increase the risk of exercise.1 Among those without such comorbidities, clinical supervision is not necessary for safety.4

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