By Janani Sankaran, MD, MBA, FAAFP
& Tarika Vaitheeswaran
Can you imagine exercising when depressed? It often feels out of reach, but it can still show up as a quiet ally, gently helping ease the weight of symptoms. After a clinic day in which nearly 30% of visits involved mental health concerns, highlighting how untreated conditions spill into poor physical health management and a diminished quality of life, this three-minute listen felt like a breath of fresh air - a quiet yet powerful reminder of the untapped potential of movement as medicine. While psychotherapy and pharmacological treatments remain effective tools for the treatment of depression, they don’t fully address the individual needs of every patient, particularly those who are hesitant, resistant, or seeking more integrative care.
Evidence from 73 randomized controlled trials involving approximately 5,000 individuals with depression suggests that exercise can be as effective as pharmacological and psychological interventions. Despite being recommended as a first-line treatment in depression guidelines worldwide, exercise remains both underappreciated and underutilized. Prescribing regular physical activity in individuals with depression is often challenging, as it demands motivation, energy, and sustained effort, factors that are frequently impaired by the condition itself. For many, exercise is most effective as part of a combined approach, where other interventions help ease core symptoms and enable patients to engage in care and adopt healthier behaviors like exercise.
Regardless of whether exercise is viewed as a standalone treatment or an adjunct, the evidence supports its inclusion in the care plan for every patient with depression. Importantly, it does not need to be strenuous, light to moderate activity can be as effective as vigorous exercise. One of the most encouraging aspects is how quickly benefits can be felt. Unlike many interventions, exercise carries minimal risk and offers flexibility, allowing individuals to choose activities they enjoy.
The key lies in making exercise prescriptions specific and structured. Clinical experience suggests that clearly defined plans, detailing intensity, duration, and a stepwise progression, lead to significantly better adherence than general advice about being more active. In practice, a few additional minutes spent outlining an exercise prescription can meaningfully improve engagement, enhance clinical outcomes, and potentially reduce the burden of mental health complications.
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