An updated Cochrane review of randomized trials suggests exercise can reduce depressive symptoms compared with no treatment and may perform about as well as psychological therapy. Results were also similar to antidepressants, though the evidence there is less certain, and researchers say larger, higher-quality studies are still needed.
Depression is a major global health challenge, affecting more than 280 million people worldwide, and contributing substantially to disability. An updated Cochrane review assessed whether exercise can help adults diagnosed with depression.
Led by researchers at the University of Lancashire, the review analyzed 73 randomized controlled trials involving at least 4,985 adults. Across the included studies, exercise produced a moderate reduction in depressive symptoms compared with no treatment or control conditions.
When compared with psychological therapy, exercise showed similar effects on depressive symptoms, based on moderate-certainty evidence drawn from 10 trials. Comparisons with antidepressant medication also suggested similar effects, but the certainty of that evidence was lower, and the review noted that the long-term impact of exercise remains uncertain because relatively few studies followed participants after treatment ended.
Reported adverse events related to exercise were uncommon in the trials that tracked them, and typically involved muscle or joint problems; some reports also described worsening of depression. By contrast, antidepressant side effects commonly reported in clinical practice can include fatigue and gastrointestinal symptoms, though the review’s comparisons focused on trial data.
“Our findings suggest that exercise appears to be a safe and accessible option for helping to manage symptoms of depression,” said Professor Andrew Clegg, the review’s lead author. “This suggests that exercise works well for some people, but not for everyone, and finding approaches that individuals are willing and able to maintain is important.”
The review also found that light to moderate intensity activity may be more helpful than vigorous exercise, and that greater improvements were associated with completing roughly 13 to 36 sessions. No single exercise type clearly emerged as best overall, but programs that combined different activities and included resistance training appeared more effective than aerobic exercise alone.
Some activities—including yoga, qigong and stretching—were not evaluated in this analysis, leaving gaps for future research.
This update added 35 trials to earlier versions of the review published in 2008 and 2013. Despite the expanded evidence base, the authors said the overall conclusions changed little, in part because many trials were small—often enrolling fewer than 100 participants—making firm, long-term conclusions harder to draw.
“Although we’ve added more trials in this update, the findings are similar,” Clegg said. “Exercise can help people with depression, but if we want to find which types work best, for who and whether the benefits last over time, we still need larger, high-quality studies.”
Overall, the authors describe exercise as a low-cost, widely accessible option that can also improve physical health, while cautioning that it is not a universal solution and that treatment choices should reflect what individuals can sustain over time.
