January/February 2026
Exercise for depression: similar effects to other active treatments, finds review
By Rebecca Jenkins
Exercise has a similar effect on depressive symptoms as psychological therapy or pharmacological treatment, finds an updated systematic review.
Last updated in 2013, the new Cochrane Database of Systematic Reviews study analysed 73 randomised controlled trials (RCTs) of almost 5000 adults with depression, comparing exercise with no treatment, inactive treatment (e.g. no treatment, being put on a waiting list or being given a placebo treatment) or another active treatment (e.g. medication or psychological therapy).
In the 10 trials (414 participants) comparing exercise with psychological therapy there was little to no difference in effect on depressive symptoms at the end of treatment, with similar findings for the five trials (330 participants) comparing exercise with pharmacological treatment.
Researchers also found exercise was moderately more effective than a control intervention for reducing depressive symptoms.
People undertaking moderate-intensity exercise reported larger benefits compared with participants doing either light or vigorous exercise, the review found.
‘The greatest benefit was shown for people who received between 13 and 36 sessions of exercise; this benefit was reduced to a moderate effect for those who undertook fewer sessions or more sessions,’ the researchers reported.
No single type of exercise was clearly better than another for reducing depressive symptoms, but mixed or resistance exercise appeared more effective than aerobic exercise.
The authors noted that the addition of 35 trials (at least 2526 participants) had little effect on the estimate of the benefit of exercise from the 2013 review.
‘If further research is to take place, it should focus on improving trial quality, assessing which characteristics of exercise are effective for different people, and exploring health equity,’ they concluded.
Professor Simon Rosenbaum, Co-Lead of the Nutrition, Exercise and Social Equity (NExuS) Research Group, Discipline of Psychiatry and Mental Health, UNSW Sydney, said the updated review showed the overall conclusions about exercise and depression had not changed over the past decade.
‘The key implication is no longer whether exercise works, but that the field now needs to shift from efficacy questions toward implementation questions, specifically, how we support people to become and remain active, particularly those facing intersecting psychological social and structural barriers,’ he told Medicine Today.
The review reinforced that the specific modality of exercise was less important than engagement, he noted, meaning the clinical focus should be on helping patients find forms of movement they enjoyed, felt safe doing and could realistically sustain.
‘A critical limitation is that most trials have not been designed to recruit or report across diverse populations in ways that allow meaningful equity analyses,’ Professor Rosenbaum added.
‘For clinicians, this means that while exercise can be recommended with confidence on average, no single delivery model should be assumed to work for everyone.’
Professor Rosenbaum noted barriers such as cost, poverty, disability, comorbid illness, unsafe environments, cultural relevance and social support strongly shaped uptake and adherence to exercise and were often the same factors that underpinned inequities in depression outcomes.