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When you're feeling depressed, anxious or simply emotionally drained, being told to “get some exercise” may be the last thing you want to hear.
Yet behind that sometimes-irritating advice is a growing body of research. Regular physical activity appears to have meaningful effects on mental health, and some large reviews have found surprisingly substantial improvements in symptoms of both depression and anxiety.
So, could exercise actually be considered a form of treatment?
The answer appears to be yes. In fact, if exercise was a pill, it would be one of the most powerful medicines ever developed.
Researchers have conducted dozens of randomized controlled trials examining exercise and depression. When the results of many of these studies are combined, a fairly consistent pattern emerges: people who exercise tend to experience greater improvements in depressive symptoms than people who remain inactive.
Even larger analyses looking at tens of thousands of participants have reported benefits for anxiety as well.
Some researchers have gone so far as to suggest that the improvements associated with exercise can be similar in size to those seen with psychotherapy or antidepressant medications.
That's certainly impressive—but it needs to be interpreted carefully.
Exercise studies are particularly difficult to conduct.
When researchers test a medication, participants can be given either the real drug or an identical-looking placebo without knowing which one they're taking. You obviously can't do that with exercise. Someone knows whether they've spent the past eight weeks walking, cycling or lifting weights.
That matters because simply believing that something will make you feel better can influence how you report your mood.
There are also difficulties in directly comparing exercise studies with antidepressant or psychotherapy studies because the research methods can be quite different.
So, while the evidence that exercise helps mental health is strong, saying that it definitively works “as well as an antidepressant” is harder to prove.
The encouraging news is that improving mental health doesn't necessarily require becoming a marathon runner.
Aerobic activities such as walking, cycling and running appear particularly helpful. And walking deserves special attention because it's inexpensive, accessible to most people and easy to adjust to your fitness level.
For depression, there may also be an advantage to exercising with other people or participating in supervised activities rather than always exercising alone.
That makes sense. A weekly walking group, fitness class or swimming session doesn't provide only physical activity. It also creates routine, social interaction and a reason to leave the house—all things that may be particularly valuable when someone is depressed.
Interestingly, when it comes to anxiety, harder isn't necessarily better. Research suggests that lower-intensity activity can be beneficial, meaning a brisk walk or comfortable bike ride may be enough to make a difference.
And don't expect one workout to change everything. While some people experience an immediate improvement in mood after exercising, the larger mental-health benefits appear to build with regular activity over time.
For years, you've probably heard about the famous “endorphin rush.”
The theory is that exercise causes the body to release endorphins—natural opioid-like chemicals—which create the euphoric feeling sometimes called a “runner's high.”
The real explanation appears to be considerably more complicated.
Scientists have questioned whether endorphins are actually responsible for this effect. Attention has instead turned toward endocannabinoids, naturally produced chemicals that interact with some of the same biological systems affected by cannabis. These substances may contribute to the relaxed or pleasantly uplifted feeling some people experience following exercise.
But that's only one possibility.
Exercise appears to influence the brain and body in several potentially important ways. It may help regulate inflammation, encourage the brain's ability to adapt and form new connections, and affect chemical signalling involving neurotransmitters such as dopamine.
Dopamine is especially interesting in depression because it plays a role in motivation, reward and our willingness to expend effort to achieve something.
That could help explain why exercise may eventually make it easier to become active in other areas of life as well.
Not everything needs a biochemical explanation.
Imagine someone experiencing depression who begins with a ten-minute walk around the neighbourhood. The next week, that becomes 15 minutes. Eventually, they're walking several kilometres.
They've accomplished something.
Exercise can provide a sense of progress, competence and control at a time when depression may make someone feel they have very little of any of those things.
Physical activity can also introduce structure into the day, provide distraction from repetitive negative thoughts, encourage people to spend time outdoors and create opportunities for social contact.
Those benefits can be important regardless of what's happening with neurotransmitters.
Of course, there's an obvious problem with prescribing exercise for depression.
Depression itself can make exercise extraordinarily difficult.
Low energy, poor motivation, disrupted sleep and loss of interest are common symptoms. Telling someone experiencing significant depression that they should simply exercise more ignores how difficult taking that first step can be.
That's why starting small may be more realistic than setting ambitious fitness goals.
A ten-minute walk counts. So does gardening, swimming, dancing, riding a bike or joining a beginner exercise class. The best exercise may simply be the activity you're willing and able to keep doing.
Exercise shouldn't be presented as a reason for someone with significant depression or anxiety to stop medication, psychotherapy or other treatment that is helping them.
Instead, physical activity can be viewed as another potentially valuable part of the mental-health toolkit.
And unlike many treatments, exercise brings an impressive collection of additional benefits—from stronger muscles and bones to better cardiovascular health, mobility and balance.
You don't need to chase a runner's high or train like an athlete.
Sometimes improving your mental health may begin with something much simpler: putting on a comfortable pair of shoes, stepping outside and taking the first walk around the block.
