Is Exercise as Effective as Medications or Talk Therapy?

In the United States, when someone is experiencing a chronic health condition or persistent negative mood states, medications or talk therapy tend to be first to the rescue. Exercise is sometimes relegated to the category of “complementary and alternative medicine” for those who have tried medications and therapy and found them to be “ineffective” based on either provider opinion or a patient’s experience of subjective relief. However, this is not the case everywhere. In countries like Australia, behavioral approaches coined “lifestyle management,” which include exercise, is considered a front-line approach.

A new meta-review by a group of behavioral scientists from the University of South Australia highlighted the equivalence of physical activity to medications and psychotherapy in the treatment of depression, anxiety, various chronic diseases, and maintenance of overall health. The current findings, published in the British Journal of Sports Medicine, showed that physical activity has a medium effect size on depression, anxiety, and chronic disease, which is larger than the typical small effect sizes found in behavioral health research. This association improved with increased intensity of movement compared to treatment as usual. Critically, the effect size for physical activity on depression (median effect size = -0.43) and on anxiety (median effect size = -0.42) was comparable, though slightly greater, than medication or therapy (median effect size ranges = -0.22 to -0.37)

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Though there have been dozens of randomized controlled trials or meta-analytic studies exploring the positive health impacts of exercise, they are typically limited due to examining very narrow demographics at a time, which may not generalize well to the larger population. The authors of the newest study attempted to include as many forms of physical activity as possible without focusing on specific subgroups of any one population to see what patterns emerged from data, which included over 128,000 participants across 1,039 clinical trials.

Any adult 18 years or older who participated in a research trial that aimed to increase physical activity was included in the analysis. Physical activity was defined as “any bodily movement produced by the contraction of skeletal muscles that results in a substantial increase in caloric requirements over resting energy expenditure.” The physical activity intervention had to occur across time (versus a single physical activity event, like a one-time marathon). Studies which included confounding variables in their intervention such as dietary changes, medications, or psychotherapy were excluded to be able to highlight the impact of physical activity alone on health outcomes. Participants included in the study ranged from 29 to 86 years old, with a median age of 55 years old.

Results showed depression and depressive symptoms were significantly reduced with a medium effect size as a result of physical activity in over 62,000 participants across 875 randomized controlled trials (RCTs) from 72 meta-analyses. Anxiety symptoms were significantly reduced with a medium effect size as a result of physical activity in over 10,000 participants across 171 RCTs from 28 meta-analyses. Psychological distress significantly reduced with a medium effect size in more than 500 participants across six RCTs from one systematic review. Importantly, effect sizes varied highly by the assessment instrument used, highlighting the importance of measurement-based care, utilizing validated screening tools to assess symptomology in patients and research participants.

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Perhaps even more promising than the massive number of participants for whom these impacts of physical activity on mood symptoms held true is the finding that all modes of exercise were effective in reducing depression and anxiety symptoms. Regardless of strength-based movement, mind-body practices like yoga and tai chi, aerobic exercise, or mixed-mode exercises which include both aerobic and resistance training, exercise was shown to be effective in improving negative emotions and health distress. Higher intensity exercises were found to be more effective in ameliorating depression symptoms than lower or moderate-intensity exercises, while both moderate and higher intensity physical activity was found to be effective for reducing anxiety symptoms.

As the overall physical activity treatment was extended beyond 12 weeks, the amount of reduction in mood symptoms paradoxically diminished. This highlights the importance of structuring physical activity interventions for discrete periods of time, consistent with how individuals set effective behavioral goals, compared to giving patients open-ended guidance on physical activity which is not time-bound. Limiting physical activity interventions to a “sweet spot” of roughly three months is also more effective for patients, medical systems, and payers alike, reducing the burden of healthcare costs while maximizing health outcomes.

Weekly physical activity close to or under 150 minutes each week is ideal, compared to exercise beyond 150 minutes weekly which showed diminishing health impacts. Exercising a moderate amount, of 4-5 times per week, was found to be more closely tied to better mood than exercising at higher frequency like daily or at lower frequency like only 1-2 times each week. For anyone wondering what the optimal length of an exercise session may be, the authors found 30-60 minute exercise sessions are most effective. Given the potential benefits of physical activity as an intervention and the minimal negative side effects, it stands to reason that exercise should be considered a front-line approach for mood and chronic health problems when possible. Or at least, exercise should be given equal consideration as medications and psychotherapy for improving health outcomes.