The best types of exercise for depression Original paper

In this meta-analysis, various types of exercise were assessed as effective at reducing depression symptoms, including walking/jogging, yoga, strength training, and dancing. However, the strength of evidence was considered low or very low for all outcomes.

The effect of different types of exercise on depression severity.

Depression severity was determined using questionnaires that assess depression symptoms. The questionnaires used included the Beck Depression Inventory, Hamilton Depression Rating Scale, and Patient Health Questionnaire-9.

14,170 participants with major depression.

Major depression in the context of this study was based on participants having clinician-diagnosed major depressive disorder (MDD) or exceeding the clinical threshold for depression symptomatology on a diagnostic questionnaire.

The researchers conducted a meta-analysis of 218 randomized controlled trials. The exercise types assessed included dance (5 trials), walking/jogging (51 trials), yoga (20 trials), strength training (22 trials), mixed aerobic exercise (51 trials), tai chi/qigong (12 trials), cycling (11 trials), and general physical activity counseling (4 trials). The exercise programs ranged in duration from 1 to 208 weeks, though not all trials reported duration. In the assessed trials, exercise was compared to various active controls, including placebo tablets, stretching, and social support.

Additionally, to provide comparative context, the investigators assessed the effect of other interventions, including cognitive behavioral therapy (CBT, 20 trials), selective serotonin reuptake inhibitors (SSRIs, 16 trials), and assignment to a nonintervention waitlist (53 trials).

All exercise types reduced depression severity, with the exception of physical activity counseling. The largest effect size was observed for dance, followed by walking/jogging. The confidence of evidence was rated as low for the effect of walking/jogging and very low for the effect of all other exercise types.

The effect of different exercise types on depression severity

In a dose-response analysis, there was evidence to suggest that exercise led to a greater benefit if it was more intense. For example, running appeared to be more effective than walking.

Among the effective exercise types (i.e., excluding physical activity counseling), all appeared as effective or more effective than SSRIs, and all appeared roughly as effective as CBT. All exercise types also appeared to be more effective than assignment to a waitlist control group.

Dropout rates were lower with strength training and yoga, although no exercise type resulted in an increased dropout rate compared to active controls.

A number of previous meta-analyses have found that physical activity can benefit depression.^[1][2][3][4] This current study is novel in that it was designed to isolate the effects of a broad range of different exercise types separately, finding that seemingly all forms of exercise appear to help with depression.

It’s diificult to say with certainty exactly how exercise improves depression symptoms, but a few mechanisms have been proposed. One compelling line of evidence suggests that exercise is beneficial for depression because it stimulates neuroplasticity, a broad term for the brain’s ability to alter itself, such as by creating and strengthening neural pathways. Some research indicates that depression can be perpetuated by a cognitive pattern called rumination, where people get “stuck” focusing on negative thoughts.^[5][6][7] By stimulating neuroplastic processes, exercise may create new neural pathways directed away from these negative thoughts, directed instead toward more positive thoughts and feelings, thereby improving symptoms.^{[8][9][10][11][12]} But this is just one possibility — for more on the mechanisms by which exercise may benefit depression, see this Editor’s Pick from October 2023.

In the current study, confidence in all results was considered to be low or very low. There were a few reasons for this, including the fact that participants often knew the goal of the experiment was to test whether exercise is beneficial for depression, which can create bias. However, in one previous meta-analysis, exercise was still found to reduce depression symptoms even when only analyzing studies that were at low risk of bias in quality assessment.^[2] Additionally, various different lines of evidence are consistent with the idea that exercise is beneficial for depression in addition to randomized controlled trials, including prospective cohort studies,^[13] animal experiments,^[14][15] and Mendelian randomization studies.^[16] So while large, high-quality randomized controlled trials are clearly warranted to strengthen the evidence base, it seems reasonable to believe that exercise can help with depression.

It’s also worth covering the finding that some exercises appeared better for reducing depression symptoms than others, with dancing standing out as the most effective. However, while it may be tempting to jump (or even dance) to conclusions about which type of exercise is best for depression, there are a few reasons why this would be premature.

For one thing, the exercise types were not evaluated under equal conditions. The bodies of evidence often differed according to the participant demographics (age, gender, race, etc.), the duration of the exercise program, the regions where the studies were conducted, the severity of participants’ depression, and a number of other factors that could feasibly influence the results. As just one example, the participants assigned to dance were 31 years old, on average, and were mostly women. Compare that to the higher average age of participants assigned to strength training (51 years old), aerobic and strength training (51 years old), and tai chi/qigong (59 years old), and it becomes clear a one-to-one comparison isn’t entirely fair.

Another factor to consider is that it’s not known how much the participants actually adhered to each of the exercise interventions. For example, maybe dancing appeared more effective because participants found dancing more fun and were therefore more likely to do it. Conversely, perhaps cycling appeared less effective because the participants didn’t find it as enjoyable, so they skipped sessions here and there. In other words, it’s entirely possible that the most effective exercise is just the one people will actually do consistently.

Strengthening this possibility was the finding in the current study that the benefits were larger the more the exercise was monitored by the investigators (thereby supporting greater adherence), whereas benefits were negligible when exercise was recommended without any guidance or oversight.

This speaks to an important issue regarding the implementation of exercise. For people with depression, beginning an exercise regimen can be difficult for a number of reasons, in large part because decreased motivation is a common symptom of the condition.^[17][18] With this in mind, there are a few strategies that may help make exercise a habit.

Enjoying exercise can improve adherence to that exercise.^[19][20][21] Studies vary as to what exercise types are found to be most enjoyable, which likely speaks to individual variability. Not everyone will like the same exercise types, so personal preference should be considered.

Another approach is exercising with another person or a group, for example, by participating in a recreational sports league, running group, or regular exercise class. Including a social component to exercise seems to increase motivation and adherence.^[22][23][24] Of course, some people may still find that exercising alone is preferable, so as with exercise type, personal preference should be considered.^[25]

There are also psychological techniques that can be worth trying. One of these is creating contextual cues related to exercise, like keeping workout shoes by the front door as a visual reminder that it’s a behavior you plan to practice regularly.^[26] Another method is using what are called implementation intentions, in which actions are pre-planned to deal with challenging situations.^[27][28] For example, if you typically exercise outside, have a planned out indoor exercise routine in case bad weather ever makes it too difficult to exercise outside.

Ultimately, exercise should be treated as one possible tool to help treat depression. Rather than worrying about what specific type of exercise is best, individuals should seek out physical activities that are most enjoyable to them personally and that can be adopted as a regular part of their life.