That exercise is good for the mind is nothing new, but now a high-level scientific review This study has quantified that feeling: exercise can alleviate depression in a way similar to psychological therapy. Far from presenting movement as a miracle cure, the work opens the door to considering physical activity as another, albeit quite powerful, component of treatment.
The analysis, led by a team from the University of Lancashire (United Kingdom) and published in the prestigious Cochrane Collaboration, suggests that move regularly It provides moderate benefit in depressive symptoms compared to doing nothing or receiving only control interventions. For millions of people in Europe and the rest of the world, where depression is a leading cause of ill health and disability, this is an inexpensive, accessible option with added health benefits.
What exactly does the Cochrane review say?
The new review updates previous analyses from 2008 and 2013 and incorporates 73 randomized clinical trials with nearly 5.000 adults with depression. In these studies, researchers compared structured exercise programs with lack of treatment, control interventions (for example, basic health education) and also with psychotherapies and antidepressant drugs.
Overall, the results indicate that participants who exercised gained a “moderate benefit” in reducing symptoms compared to those who did not exercise or only received minimal interventions. In practical terms, this translates into less persistent sadness, somewhat more energy, and a slight improvement in daily functioning, although not to the same degree in all cases.
When the exercise was compared to the psychological therapyThe review found a very similar effect on the severity of depression. This comparison is based on 10 trials with a level of evidence considered to be moderate certaintyThis lends some weight to the idea that proper training can be as effective as sitting in a psychologist's office, at least for some patients.
In the case of antidepressant medicationsThe data also leaned towards a comparable effect of exercise, but here the security of evidence is lowerMany studies were small, with fewer than 100 participants, and with methods that could be improved, so the authors urge caution before drawing definitive conclusions about a total equivalence between pills and running shoes.
Intensity, type of exercise, and number of sessions
One of the most repeated messages from researchers is that you don't need to kill yourself at the gym to notice changes: the evidence suggests that light or moderate intensity exercise It can be even more beneficial than very demanding sessions. Activities such as brisk walking, cycling at a comfortable pace, or doing strenuous housework They would fall into this category, accessible to a large part of the population.
When the programs were analyzed based on their structure, the trials that combined mixed exercises (aerobic plus strength training) They obtained better results than those based solely on aerobic exercise, such as running or cycling. strength trainingWhether using weights, resistance bands, or body weight, it seems to provide an extra benefit that is still being explained from a biological and psychological point of view.
The duration of the interventions also matters. According to the review, the greatest benefits were observed in programs that accumulated between 13 and 36 sessions of physical activity. That is, committing to several weeks or months of supervised practice increases the chances of noticing a perceptible improvement in mood, beyond the typical ups and downs of the first few days.
However, no single exercise emerged as the clear winner. The authors emphasize that no clearly superior modality was identifiedThis leaves considerable room to adapt the activity to each person's preferences and limitations. Some very popular options, such as yoga, qigong, or structured stretching, are excluded from the analysis, as they are considered pending lines of research for future work.
In everyday life, many experts recommend starting with easy-to-integrate forms of moderate activity, such as Walking briskly, climbing stairs, cycling at low speed, or practicing light sports (badminton, for example). Vigorous exercise, such as fast running, demanding hiking trails, or playing intense basketball or tennis matches, is usually only recommended for trained and supervised individuals.
Safety, side effects, and quality of evidence
One of the clear advantages of exercise over other treatments is its low rate of side effectsIn the trials included in the Cochrane review, complications related to physical activity were infrequent and generally limited to specific musculoskeletal injuries in those who exercised, such as overloads or joint discomfort.
On the other side of the scale were the participants who received antidepressant medication They reported common adverse effects of these drugs, such as tiredness, digestive discomfort, or changes in appetiteAlthough these are well-known and manageable reactions in clinical practice, this contrast reinforces the idea that exercise, when prescribed sensibly, is a a reasonably safe option with added benefits for cardiovascular, metabolic and bone health.
However, the authors themselves insist that the results should be interpreted with caution. Many of the trials on physical activity were small, short studies with methodological deficienciesWhen the analysis is limited to the most rigorous studies, the positive effect of exercise on depression remains statistically significant, but its magnitude is reduced.
For this reason, health psychology experts point out that, although there are indications that exercise “It would be no less effective” than psychological therapy or antidepressantsThis assertion still rests on a limited number of studies and, therefore, carries a certain weight. considerable uncertaintyThere is a lack of solid information to state with complete certainty in which specific cases physical activity can replace more traditional treatments.
The revision update adds 35 more trials compared to previous versions, but the General conclusions hardly changeThis is largely because most new studies are still small and have few participants, making it difficult to draw categorical messages applicable to the entire population with depression.
Who does it work best for and how can you apply it in real life?
One of the big questions that remains open is whether the exercise It is equally effective in cases of mild, moderate, or severe depressionThe Cochrane review does not offer clear answers on this point, nor does it allow us to know for sure whether certain modalities (for example, strength versus aerobic) are preferable depending on the patient's profile.
Furthermore, a large part of the trials included in the analysis were carried out in structured and supervised programswhich tend to attract motivated people with a certain level of physical fitness and a willingness to commit to the protocol. This raises questions about the extent to which the results can be transferred to the general population served by the public health system, both in Spain and in other European countries.
The review excluded more pragmatic studies based on exercise tips or behavioral supportThese are precisely the most common interventions in primary care. One example is the TREAD trial, conducted in the United Kingdom, which compared usual care with the same care plus the support of a physical activity facilitator. By excluding studies of this type, the review's snapshot primarily reflects what happens in controlled test conditionsnot so much in the everyday context of health centers.
In clinical practice in Europe, including Spain, most guidelines recommend viewing physical activity as a companion toolNot as an automatic replacement for medication or psychotherapy. That is, encouraging people with depression to move more, but without withdrawing effective treatments already in place except under professional supervision and with an individualized assessment.
In fact, several mental health specialists emphasize that, until larger and more realistic trials combining behavioral support, follow-up in primary care, and adapted exercise programsThe most prudent approach is to integrate movement within a broader framework that includes therapy, medication when necessary, and lifestyle changes.
What researchers think and what remains to be known
The lead author of the review, Professor Andrew Clegg, highlights that its findings point to exercise as a a safe, affordable and reasonably effective alternative to help manage depressive symptoms. At the same time, he insists that “it works well for some people, but not for everyone,” so the key is finding the right approach. strategies that each individual can and wants to maintain over time.
Clegg and his team emphasize that it remains essential to have larger studies with high methodological qualityA single, large, well-designed trial, they argue, can provide more useful information than several small, low-quality studies. This would help clarify key issues, such as... optimal program duration, the most appropriate intensity or the role of factors such as age, sex or the presence of other diseases.
Other experts, such as health psychologist Jeff Lambert, welcome the fact that the available evidence supports the role of exercise, but they don't hide their reservations. They point out that it's still too early to say for sure whether certain people will benefit. They should change their medication or therapy to exercise exclusively.nor whether certain profiles (for example, those with more severe depression) respond better or worse to structured physical activity.
It is also not entirely clear whether the benefits persist beyond the intervention period. Most trials included a limited-time monitoringThe study focuses on the weeks or months of the exercise program. It remains to be seen whether the improvement is sustained long-term and what additional support is needed for people to remain active after the study ends.
While these doubts are being clarified, most recommendations agree that it makes sense. promote physical activity as part of a comprehensive plan mental health care, always with a realistic adaptation to the personal situation, tastes and possibilities of each patient.
The available evidence positions exercise as an important piece of the puzzle in the fight against depression: It does not replace all treatments on its own.However, it can be as effective as therapy in many cases and, above all, provide valuable support when combined with regular medical and psychological care.