Study of 128,119 People Reveals Exercise Outperforms Drugs in Treating Depression

Millions of people worldwide take antidepressants each day. Millions more sit in therapy sessions seeking relief from anxiety and psychological distress. Yet new research from the University of South Australia suggests a different prescription might work better than both.

Scientists analyzed data from 128,119 participants across 1,039 trials and discovered something that challenges decades of clinical practice. Physical activity delivered results that medications and counseling could not match. Not by a small margin, either.

Published in the British Journal of Sports Medicine, the findings arrived with a number that made researchers take notice. Exercise proved 1.5 times more effective than traditional treatments for managing depression and anxiety. For an intervention that costs nothing, produces no side effects, and offers dozens of additional health benefits, the implications reach far beyond mental health clinics.

97 Reviews and 1,039 Trials Paint Clear Picture

University of South Australia researchers undertook what they describe as the most comprehensive review to date. Lead researcher Dr. Ben Singh and his team examined 97 systematic reviews that encompassed 1,039 individual trials. No previous study had attempted to synthesize this much evidence about exercise and mental health in one place.

Scientists used an umbrella review methodology. Rather than examining individual studies, they analyzed collections of reviews to provide complete coverage of existing research. Think of it as zooming out to see the full picture instead of focusing on isolated pieces.

Twelve electronic databases yielded eligible studies published before January 2022. Results showed physical activity improved symptoms of depression, anxiety, and psychological distress across all populations studied. Effect sizes measured as standardized mean differences painted a consistent story about exercise benefits.

Depression showed a median effect size of 0.43. Anxiety came in at 0.42. Psychological distress registered at 0.60. Negative numbers indicate symptom reduction, and these figures compare to or exceed the effects observed for psychotherapy and pharmacotherapy, which range from negative 0.22 to negative 0.37.

12 Weeks or Less Shows Fastest Results

Duration matters, but perhaps not in the way most people expect. Exercise interventions lasting 12 weeks or shorter proved most effective at reducing mental health symptoms. Longer programs showed smaller effects.

Speed of impact becomes clear when comparing short interventions to extended ones. Programs running 12 weeks or less delivered a median effect size of 0.84 for depression. Medium-duration programs spanning 12 to 23 weeks dropped to 0.46. Long interventions of 24 weeks or more fell to 0.28.

Dr. Singh explained this counterintuitive finding. “Higher intensity exercise had greater improvements for depression and anxiety, while longer durations had smaller effects when compared to short and mid-duration bursts.”

Researchers suggest several possible reasons for declining effectiveness over time. Adherence becomes harder to maintain with longer programs. Participants may find extended interventions burdensome, which impacts psychological benefits. Programs might fail to provide sufficient progression of activity levels, leading to reduced effectiveness. Or perhaps the initial expectancy effect diminishes after people experience early improvements.

Five Groups Saw Biggest Mental Health Gains

Benefits appeared across all populations studied, but five groups experienced the largest improvements. People diagnosed with depression topped the list. Pregnant and postpartum women came next, followed by healthy individuals, people with HIV, and people with kidney disease.

Clinical populations showed larger effect sizes than non-clinical groups. Scientists believe this reflects baseline conditions. People with depression, anxiety, or chronic illness typically experience higher symptom levels and lower physical activity rates. More room for improvement exists when starting from a more severe baseline.

Pregnant and postpartum women face unique mental health challenges. Hormonal changes, sleep disruption, and life adjustments create vulnerability to depression and anxiety. Exercise interventions provided substantial relief for this group without the concerns about medication effects on developing babies or nursing infants.

People with HIV and kidney disease often struggle with depression related to their diagnoses and treatment burdens. Physical activity addressed both their mental health symptoms and aspects of their disease management, creating compound benefits.

Healthy individuals also saw improvements, though effect sizes were measured as smaller than in clinical populations. Even people without diagnosed mental health conditions experience stress, worry, and mood fluctuations that exercise can address.

Walking to Yoga All Deliver Benefits

Mode of exercise matters less than movement itself. Researchers found that all types of physical activity delivered benefits. Aerobic exercise, such as walking worked. Resistance training worked. Pilates worked. Yoga worked.

Different modes showed slight variations in effectiveness for specific conditions. Resistance exercise produced the largest effects on depression symptoms with a median effect size of 0.64. Yoga and other mind-body modalities proved most effective for reducing anxiety at negative 0.42.

Mixed-mode interventions that combined multiple exercise types registered at a negative 0.47 for depression. Aerobic exercise alone came in at 0.45. Stretching and yoga interventions measured at 0.46.

All roads lead to improvement, in other words. People who hate running can lift weights. People who dislike gyms can practice yoga at home. People with limited mobility can try Pilates or water aerobics. Personal preference and physical capability matter more than finding one perfect exercise type.

Higher Intensity Workouts Pack More Punch

Intensity creates measurable differences in outcomes. Low, moderate, and high-intensity exercise all reduced depression symptoms, but higher intensities worked better.

Low-intensity exercise produced a median effect size of 0.22 for depression. Moderate intensity jumped to negative 0.56. High intensity reached 0.70. Similar patterns emerged for anxiety, though with fewer studies to analyze.

Neurological mechanisms help explain why intensity matters. Physical activity improves depression through increased expression of neurotrophic factors, greater availability of serotonin and norepinephrine, regulation of hormonal stress responses, and reduced systemic inflammation. Low-intensity movement may not provide sufficient stimulus to trigger these physiological changes.

Public health guidelines already recommend moderate and vigorous intensity activity for physical health. Mental health benefits add another reason to push past comfortable intensity levels.

Small Doses Make Big Difference

Weekly duration findings surprised researchers. Interventions providing 150 minutes or less per week showed larger effects than those exceeding 150 minutes. For depression, programs under 150 minutes weekly registered a median effect size of 0.58. Programs over 150 minutes dropped to negative 0.29.

Shorter weekly commitments may be easier for people to maintain. Compliance improves when demands feel manageable rather than overwhelming. Someone struggling with depression already faces low energy and motivation. Asking for massive time investments creates another barrier to treatment.

Dr. Singh emphasized accessibility when discussing the findings. “Importantly, the research shows that it doesn’t take much for exercise to make a positive change to your mental health.”

Small, achievable doses remove excuses and lower barriers to entry. A person can walk for 30 minutes five days per week and hit 150 minutes total. Breaking it into 10-minute sessions three times daily works just as well. Flexibility makes adherence more likely.

970 Million People Live With Mental Disorders

Scale of the mental health crisis demands better solutions. World Health Organization data shows that one in every eight people worldwide lives with a mental disorder. That translates to 970 million individuals.

Poor mental health extracts enormous economic costs. Global spending reaches approximately $2.5 trillion annually. Projections estimate that figure will rise to $6 trillion by 2030 without intervention changes.

Depression leads mental health-related disease burden globally. Anxiety claims the title of the most prevalent mental health disorder. COVID-19 pandemic effects pushed psychological distress rates between 35 and 38 percent worldwide.

Australia provides a microcosm of the problem. One in five people aged 16 to 85 experienced a mental disorder in the past year. United States statistics mirror this pattern, with the Centers for Disease Control and Prevention estimating that 50 percent of Americans will be diagnosed with some mental health problem during their lifetime. One in five experiences it in any given year.

Current treatment approaches struggle to meet demand. Medication and therapy work for many people, but not everyone. Side effects, costs, availability, and personal preferences limit traditional treatment options. Exercise offers an alternative that circumvents many of these obstacles.

Exercise Overlooked Despite Strong Evidence

Evidence supporting physical activity for mental health has existed for years. Hundreds of research trials have examined exercise effects on depression, anxiety, and psychological distress. Many suggest that movement may match psychotherapy and pharmacotherapy in effectiveness.

Yet clinical practice lags behind research findings. Dr. Singh noted the disconnect. “Physical activity is known to help improve mental health. Yet despite the evidence, it has not been widely adopted as a first-choice treatment.”

Clinical guidelines vary by country. The United States recommendations list psychotherapy or pharmacotherapy as initial treatment approaches. Lifestyle interventions, including exercise, qualify as complementary alternative treatments where standard approaches prove ineffective or unacceptable.

Australia takes a different approach on paper. Clinical guidelines recommend lifestyle management as first-line treatment. In practice, however, doctors often prescribe medication first.

Several barriers prevent wider adoption. Patient resistance plays a role. People seeking help for depression may lack the motivation or energy to begin exercise programs. Clinicians face difficulty prescribing and monitoring physical activity in clinical settings. Medication involves a simple prescription. Exercise requires behavior change, ongoing support, and individualized programming.

The volume of research also creates problems. Thousands of studies examining different exercise types, intensities, populations, and comparison groups make evidence synthesis difficult. Clinicians cannot review every trial when making treatment decisions. Umbrella reviews like this one help by distilling massive evidence bases into actionable conclusions.

Clinical Practice Should Prioritize Movement

Researchers call for fundamental changes in how mental health care approaches treatment. Prof. Carol Maher, senior researcher on the study, outlined the vision. “We hope this review will underscore the need for physical activity, including structured exercise interventions, as a mainstay approach for managing depression and anxiety.”

Making exercise a mainstay approach means positioning it alongside medication and therapy, not as an afterthought. People with mild to moderate depression and anxiety should receive exercise prescriptions as standard care.

Many patients with mental health conditions also have comorbidities. Exercise addresses both problems simultaneously. A person with depression and diabetes benefits from improved mood and better blood sugar control. Someone with anxiety and heart disease gets symptom relief plus cardiovascular protection.

Short-term interventions deliver therapeutic benefits without requiring intensive long-term programs. A 12-week supervised exercise program could provide initial relief and establish habits that people maintain independently. Health systems could implement group classes or outdoor walking programs at minimal expense.

Physical activity produces no harmful side effects when done appropriately. Antidepressants can cause weight gain, sexual dysfunction, or emotional blunting. Exercise builds strength, improves sleep, protects against chronic disease, and extends longevity. Even if mental health improvements matched rather than exceeded medication, the additional benefits would tip the scales toward exercise.

ary intervention. 970 million people living with mental disorders need solutions that work, cost little, and cause no harm. Movement checks all three boxes.