Tejal Somvanshi
Exercise should be considered a first-line treatment for depression, not just an optional add-on, according to a University of Ottawa psychiatrist. The recommendation comes amid growing evidence that structured physical activity can significantly reduce depressive symptoms.
Dr. Nicholas Fabiano, a psychiatry resident at the University of Ottawa, argues in a British Journal of Sports Medicine editorial that mental health professionals should prescribe specific exercise plans alongside—or even before—medication and talk therapy.
“Ignoring exercise as a treatment for depression isn’t just a missed opportunity. It might even cross the line into negligence,” says Fabiano. “The research is clear: physical activity really does help with depressive symptoms.”
The push for exercise as a depression treatment is backed by substantial research. A 2024 analysis published in the British Medical Journal reviewed 218 clinical trials with over 14,000 participants. It found that walking, jogging, yoga, and strength training all showed moderate effectiveness in reducing depression symptoms. The benefits increased with exercise intensity, while yoga and strength training had the highest adherence rates.
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Rather than vague advice to “get more exercise,” Fabiano recommends structured plans following the FITT principle—Frequency, Intensity, Time, and Type. Clinical guidance published in the Canadian Medical Association Journal suggests 45-60 minutes of moderate to vigorous exercise, 3-5 times weekly.
The effectiveness appears significant. Some meta-analyses suggest exercise can have a “number needed to treat” (NNT) of approximately 2, meaning for every two patients who follow the regimen, one will show substantial improvement. This rivals many medication treatments.
Canada’s CANMAT guidelines now recommend exercise as a first-line treatment for mild to moderate depression and as a secondary therapy for more severe cases.
Exercise works through multiple pathways. It regulates neurotransmitters like serotonin and dopamine, enhances brain plasticity, reduces inflammation, and provides psychological benefits like improved self-efficacy and social interaction.
Different exercises may work better for different people. Some research indicates strength training may be particularly effective for women, while yoga shows special benefits for men and older adults. Walking and jogging remain broadly effective across demographics.
Fabiano acknowledges that depression itself creates barriers to exercise. Symptoms like fatigue and lack of motivation make starting difficult. He suggests addressing these barriers through supervised programs, group settings, and gradually increasing activity levels based on individual capabilities.
Implementation remains a challenge. Fabiano calls for systemic changes, including exercise training in medical education, updating clinical guidelines, securing insurance coverage, and creating direct referral pathways to exercise professionals.
“If we don’t hesitate to prescribe a pill, why do we hesitate with exercise?” Fabiano asks.
Technology could help bridge the gap. The 2025 American College of Sports Medicine worldwide trends report ranks wearables as the top fitness trend, with exercise for mental health also in the top 10. These tools could help track adherence and progress.
Context matters too. Research shows that leisure-time physical activity (chosen, enjoyable movement) produces greater mental health benefits than obligatory or occupational activity. This suggests prescriptions should focus on finding enjoyable, sustainable forms of movement rather than rigid regimens.
The push comes as recent neurological research links moderate-to-vigorous physical activity with a 14-40% lower risk of depression, anxiety, and sleep disorders. For many patients, exercise won’t replace medication or therapy entirely, but integrating structured physical activity into treatment plans could significantly improve outcomes. The challenge now lies in transforming this evidence into standard clinical practice.
