Patients with depression and anxiety often seek alternatives to standard treatment recommendations. A comprehensive approach to mental health issues may involve diet and lifestyle changes, supplements, medication, and talk therapy, and clinicians need to know which are most effective. Aerobic exercise effectively reduces depression and anxiety symptoms, and a new meta-analysis shows that, in some cases, it may match or outperform medication and psychotherapy. A tailored exercise prescription is a cost-effective, accessible, and effective therapy for depression and anxiety.
The Study
A meta-meta-analysis (yes, two meta’s) in the British Journal of Sports Medicine was performed on randomized controlled trials examining exercise interventions for depression and anxiety symptoms in 79,551 participants. All population groups, including children and adults aged 10-90 with clinically diagnosed and subclinical symptoms, were included. Populations with chronic physiological conditions were excluded to better isolate the effects of exercise, allowing researchers to determine whether exercise alone improves mental health independently.
Exercise interventions were categorized as aerobic (e.g., running, walking, cycling), resistance (e.g., strength training), mind-body (e.g., yoga, tai-chi, qigong), or mixed. The standard mean difference (SMD) was used to measure the effect size. Values closer to 0 indicate smaller differences, with values of -0.2 indicating a small effect, -0.5 a medium effect, and -0.8 a large effect.
Overall, exercise reduced depression (SMD=-0.61) and anxiety symptoms (SMD=-0.47) among all populations and exercise types. For comparison, the effectiveness of pharmacological treatments (SMD=-0.36) and psychotherapies (SMD=-0.34) was less.
There were differences among exercise subgroups (greatest effects bolded):
Depression
- Population: youth aged <18 (SMD=-0.53), young adults aged 18-30 (SMD=-0.81), adults (SMD=-0.66), late adulthood (SMD=-0.41), postnatal (SMD=-0.70), prenatal (SMD=-0.46)
- Exercise categories: aerobic (SMD=-0.81), resistance (SMD=-0.62), mind-body (SMD=-0.53), mixed (SMD=-0.60)
- Group (SMD=-0.71) versus individual (SMD=-0.38), supervised (SMD=-0.69), unsupervised (SMD=-0.46)
- Exercise intensity: low (SMD=-0.69), moderate (SMD=-1.02), moderate to vigorous (SMD=-0.78), vigorous (SMD=-0.65)
- Exercise duration: >24 weeks (SMD=-1.11), 9-24 weeks (SMD=-0.44), up to 8 weeks (SMD=-0.76)
- Exercise frequency: >/=3 days per week (SMD=-0.52), 1-2 days per week (SMD=-0.43)
- Clinically diagnosed depression (SMD=-0.73), non-clinically diagnosed depressive symptoms (SMD=-0.81)
Anxiety
- Population: young adults aged 18-30 (SMD=-0.59), adults (SMD=-0.40)
- Exercise categories: aerobic (SMD=-0.60), resistance (SMD=-0.56), mind-body (SMD=-0.50), mixed (SMD=-0.45)
- Group-based exercise (SMD=-0.60)
- Exercise intensity: low (SMD=-0.68), moderate (SMD=-0.06), vigorous (SMD=-0.17)
- Exercise duration: >24 weeks (SMD=-0.03), 9-24 weeks (SMD=-0.50), up to 8 weeks (SMD=-0.70)
- Exercise frequency: >/=3 days per week (SMD=-0.50), 1-2 days per week (SMD=-0.71)
- Clinically diagnosed anxiety (SMD=-0.42)
We see that group-based and supervised interventions had higher effect sizes for depression, suggesting an added antidepressant effect of social support. There is a need for more research to understand the effects of exercise on anxiety across the entire lifespan.
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Conclusions
In looking at the greatest effect of the individual variables, it seems that what works for depression may not work best for anxiety, which highlights the importance of personalized prescriptions. This may be challenging in some patients, considering some present with co-occurring depression and anxiety. The important thing is to encourage patients to get moving, no matter what.
The authors conclude, “Given the cost effectiveness, accessibility and additional physical health benefits of exercise, these results underscore the potential for exercise as a first line intervention, particularly in settings where traditional mental health treatments may be less accessible or acceptable.”
→ Download the full study here.
Reference
Munro NR, Teague S, Somoray K, et al. Effect of exercise on depression and anxiety symptoms: systematic umbrella review with meta-meta-analysis. Br J Sports Med. 2026 Feb 10:bjsports-2025-110301. doi: 10.1136/bjsports-2025-110301. Epub ahead of print. PMID: 41667154.
