Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials
Comprehensive Overview
Published in The BMJ in 2024, this study asked which type and intensity of exercise works best for treating major depressive disorder, and how those effects compare with established treatments like antidepressants and talk therapy, since existing guidelines offer little clear, consistent advice on which exercise to prescribe. Researchers conducted a systematic review and network meta-analysis, a statistical method that allows many different treatments to be compared simultaneously even when they were not tested head-to-head in the same trial, pooling data from 218 randomized controlled trials encompassing 495 treatment arms and 14,170 participants who met clinical criteria for major depression, whether diagnosed by a clinician or identified through validated screening questionnaires. The researchers compared numerous exercise types, including walking or jogging, yoga, strength training, dancing, mixed aerobic exercise, and tai chi or qigong, against active control conditions such as usual care or a placebo pill, as well as against cognitive behavioral therapy and antidepressant medications. The topline finding was that multiple forms of exercise produced clinically meaningful reductions in depression, with effects broadly comparable to psychotherapy and medication, and walking or jogging, yoga, and strength training emerging as the most well-supported and tolerable options.
Outcomes and Implications
The single most important finding was that, compared with active controls, walking or jogging produced a moderate reduction in depression symptoms, yoga and strength training produced similarly meaningful reductions, and these effects were comparable in size to those seen with cognitive behavioral therapy and stronger than those seen with SSRI antidepressants taken alone. Effects were proportional to intensity, with vigorous exercise such as running outperforming lighter activity such as walking, and yoga and strength training stood out as the best-tolerated options, with fewer participants dropping out than in active control conditions. The benefits also appeared to differ somewhat by sex and age: strength training and cycling seemed to work better for women, yoga and tai chi appeared more effective for men, and yoga was somewhat more effective for older adults while strength training suited younger participants better, though the authors caution these are study-level patterns rather than proven individual differences. Dance showed the single largest effect of any modality, but the finding came from only a handful of small trials in young women, so the authors do not yet recommend it broadly. Because access to psychotherapy and medication remains limited worldwide, with only about half of people in high-income countries and a fifth elsewhere receiving adequate treatment coverage, the authors argue that exercise, especially vigorous walking or jogging, yoga, or strength training, should be offered as a core treatment for depression alongside these established options, particularly given its comparatively low cost and reduced stigma.