It’s been widely reported that exercise might be a more effective treatment for reducing symptoms of depression.

On average, according to a high-quality study from the University of South Australia, physical activity appears to be 1.5 more effective than standard treatments. That is, better than medication or psychotherapy.

Could it be true?

The researchers analysed 97 meta-reviews of more than a thousand randomised controlled trials – and exercise was consistently more beneficial in treating mild-to-moderate symptoms of depression, psychological stress and anxiety.

Perhaps the most important conclusion of the study is that physical activity should be designated as a first-line mental health treatment, rather than an add-on.

This means a prescribed exercise program would have equal standing with medication and psychotherapy.

These findings need a nuanced reading and we’ll get back to that.

How much exercise?

As the authors advised in a Conversation piece, shorter, high intensity exercise programs “produced the greatest effect”.

People who benefited most were those with depression, or those confronting serious health issues or challenges.

Notably, people diagnosed with HIV and kidney disease, and pregnant and postpartum women significantly benefited from exercise.

The mood of otherwise healthy adults was also improved.

Pregnant and post-partum women in mental distress were among those who most benefited. Photo: Getty

Exercising for six to 12 weeks “has the greatest benefits, rather than shorter periods”.

The authors write that “longer-term exercise is important for maintaining mental health improvements”.

Furthermore, they say, “exercise has additional benefits compared to medications, such as reduced cost, fewer side effects and offering bonus gains for physical health, such as healthier body weight, improved cardiovascular and bone health, and cognitive benefits”.

How does it work? What the authors say

Exercise is believed to impact mental health through multiple pathways, and with short and long-term effects. Immediately after exercise, endorphins and dopamine are released in the brain.

In the short term, this helps boost mood and buffer stress.

Long term, the release of neurotransmitters in response to exercise promotes changes in the brain that help with mood and cognition, decrease inflammation, and boost immune function, which all influence our brain function and mental health.

Regular exercise can lead to improved sleep, which plays a critical role in depression and anxiety.

It also has psychological benefits, such as increased self-esteem and a sense of accomplishment, all of which are beneficial for people struggling with depression.

Different treatments, different benefits

On the face of it, the idea of exercise trumping long-standard treatments – medication and psychotherapy – seems to be a somewhat wild claim.

Until you take a moment to think through what the functions of medication and psychotherapy.

Medication isn’t designed to make you cheery but to regulate mood. It takes a number of weeks for symptoms to improve. And you tend to feel better, in that you don’t feel lost in a hole, and you are less likely to fall back into that hole.

Psychotherapy tends to involve exploration of life history and experience. This helps you understand the events in life that may have led to your distress.

Cognitive behavioural therapy explored the way you think and act and how your thoughts and actions affect the way you feel. This can lead you to recalibrate how you perceive the world and the decisions you make in response to what’s going on around you.

Both of these treatments work in the longer term. While exercise tends to give people an almost immediate lift.

What the researcher says

Study co-author and UniSA research fellow Ben Singh, in an email, said:

“Exercise operates differently by directly impacting symptoms and potentially addressing underlying issues contributing to mental health challenges.

“Its swifter impact is often noted in symptom relief. Over the long term, regular physical activity can play a crucial role in maintaining mental wellness and addressing root causes.”

It’s also important to remember that not everyone needs medication or psychotherapy.

“This underscores the significance of considering exercise as a primary tool in mental health care,” he said.

This is especially the case “for individuals with mild depression or a predisposition to such conditions”.

The big challenge – whether you’re seeking to improve the health of your head or your heart – is sustaining your exercise program in the long term.