Two women walking through a park carrying yoga mats

Exercise for Depression: Which Types Work and How Hard to Train

11 min read

The NHS lists exercise as one of the main treatments for mild depression. Three large reviews published in 2023 and 2024 pooled hundreds of trials on exercise and depression. All three found lower depression symptoms in the people who exercised.

This guide covers what each review found, which types of exercise did best, how hard to train, and how exercise fits with your treatment. It also covers the weak points, because many of these trials were of low quality.

If you need help now
Call 999 or go to A&E if your life is at risk or you do not feel you can keep yourself safe. If you need help urgently but it is not an emergency, call 111 and select the mental health option. You can call Samaritans on 116 123 to talk to a trained volunteer. If you have felt down for a while and do not feel like your usual self, the NHS advises you to see a GP.
218
Randomised trials of exercise in people with major depression
Noetel et al. 2024, BMJ, 14,170 participants
0.62
Effect size for walking or jogging, the largest of the five main types reported
Noetel et al. 2024, BMJ, versus active controls
NNT 2
Number needed to treat with exercise, compared with no exercise
Heissel et al. 2023, BJSM, 41 studies
1,039
Trials covered by an overview of 97 reviews on activity, depression and anxiety
Singh et al. 2023, BJSM, 128,119 participants
Sources: Noetel et al. 2024, Heissel et al. 2023, Singh et al. 2023. Effect sizes are standardised differences in depression scores, shown without the minus sign.

How to read the numbers

Each review is a meta-analysis, a study that pools the results of many trials into one estimate. Each reports an effect size. This is the gap in depression scores between the exercise group and the comparison group, expressed on a standard scale so results from different questionnaires line up. A larger number means a bigger drop in symptoms. The reviews report these as negative numbers, because symptoms went down. This guide shows them without the minus sign.

The comparison group matters. Some trials compared exercise with a control group who did not exercise. Others compared exercise with an active control, such as usual care or a placebo tablet. Beating an active control is a harder test. You will also see the term risk of bias. It rates how well a trial was designed and run. A trial at low risk of bias gives the most trustworthy result.

The widest view: 97 reviews

Ben Singh and colleagues at the University of South Australia published an umbrella review in the British Journal of Sports Medicine in 2023. An umbrella review pools other reviews. Theirs covered 97 reviews, made up of 1,039 trials and 128,119 adults. They ranged from healthy adults to people with mental health disorders or chronic diseases.

Compared with usual care, physical activity had what the authors called medium effects on depression, with a median effect size of 0.43. The effect on anxiety was similar at 0.42, and the effect on psychological distress was 0.60. The largest benefits showed up in people with depression, HIV and kidney disease, in pregnant and postpartum women, and in healthy individuals.

Two patterns stood out. Higher intensity activity was linked with greater improvements in symptoms. Longer programmes showed smaller effects than shorter ones. This second finding comes from comparing different trials, so it is no reason to stop exercising after a few weeks. The authors concluded physical activity should be a mainstay approach for depression, anxiety and distress. The main weakness sits in the source material: 77 of the 97 reviews scored critically low on a standard tool for rating review quality.

Exercise in people with depression

The Singh review mixed many groups together. Andreas Heissel and colleagues narrowed the focus. Their 2023 meta-analysis, also in the British Journal of Sports Medicine, included only adults with a diagnosis of major depressive disorder, the clinical term for major depression, or with depression scores above a screening threshold. Each trial compared aerobic or resistance exercise, or both, with a control group who did not exercise.

Across 41 studies and 2,264 participants, exercise had a large effect on depressive symptoms, with an effect size of 0.946. The authors converted this to a number needed to treat of 2. In plain terms, for every two people who exercised, about one more person improved than in a control group who did not exercise.

Exercise versus no exercise, by subgroup Effect size for lower depressive symptoms, larger means a bigger drop 0.946 All 41 studies 0.998 Major depressive disorder 1.026 Supervised exercise 0.666 Low risk of bias only
Source: Heissel et al. 2023, British Journal of Sports Medicine. Meta-analysis of randomised trials in adults with depression. Subgroups: 20 studies in major depressive disorder, 40 with supervised exercise, 12 rated low risk of bias. Values shown without the minus sign.

The effect held in people with major depressive disorder and in supervised programmes. It shrank when the analysis kept only the 12 studies at low risk of bias. Those studies showed a moderate effect of 0.666 and a number needed to treat of 2.8, or about one extra person improving for every three who exercise. This figure comes from the best-run trials, so it is the most reliable estimate in the paper.

Based on their results, the authors advised offering exercise as an evidence-based treatment, with a focus on supervised and group exercise, moderate intensity, and aerobic training. They also warned of two limits: many trials were small, and methods varied widely between them.

Which type of exercise works best

Michael Noetel and colleagues published a network meta-analysis in the BMJ in 2024, covering 218 randomised trials with 14,170 participants who met clinical cut-offs for major depression. They compared each type of exercise with active controls such as usual care or a placebo tablet. A network meta-analysis compares many treatments in one model, including pairs no single trial compared directly.

Effect on depression by exercise type Effect size versus active controls, larger means a bigger drop in symptoms Walking or jogging 0.62 Yoga 0.55 Strength training 0.49 Mixed aerobic exercise 0.43 Tai chi or qigong 0.42
Source: Noetel et al. 2024, BMJ. Network meta-analysis of 218 randomised trials in adults with major depression. Values are Hedges' g, shown without the minus sign. Confidence in these estimates was low for walking or jogging and very low for the other types.

The authors reported moderate reductions in depression for five main types of exercise. Among these, walking or jogging had the largest effect, followed by yoga and strength training. The effects grew with the intensity prescribed. Strength training and yoga appeared to be the most acceptable types, which the authors described as well tolerated compared with other treatments.

Exercise appeared equally effective in people with and without other health conditions, and at different starting levels of depression. The weak point is trial quality. Only one of the 218 studies met the Cochrane criteria for low risk of bias. For this reason, the authors rated their confidence as low for walking or jogging and very low for every other type. They suggested future trials blind participants and staff to reduce expectancy effects, where people improve partly because they expect to.

"These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression."
Noetel et al. 2024, BMJ

How hard to train

Two of the three reviews linked harder exercise with bigger gains. Singh and colleagues found higher intensity activity was associated with greater improvements. Noetel and colleagues found the effects were proportional to the intensity prescribed. Heissel and colleagues advised moderate intensity. Our coaching view: start at moderate effort, then add harder sessions as your fitness allows.

The NHS test for moderate intensity: your heart rate rises, you breathe faster and feel warmer, and you can still talk but not sing. At vigorous intensity, you breathe hard and fast and cannot say more than a few words without pausing for breath. Brisk walking counts as moderate. Running counts as vigorous.

How exercise fits with NHS treatment

For mild depression, the NHS lists guided self-help, exercise and talking therapies among the treatments a GP might recommend. A GP might refer you to a group exercise class designed to help with depression. The NHS notes NICE recommends group exercise as an option for less severe depression, usually more than one session a week with a trained practitioner for 10 weeks. Many GP surgeries also offer exercise on prescription, sometimes free or at a reduced cost.

You do not need a GP to start talking therapy. You can refer yourself to an NHS talking therapies service if you are registered with a GP and aged 18 or over, or 16 or over in some areas.

For moderate or severe depression, the NHS lists antidepressants, a combination of antidepressants with talking therapy, and for severe depression a referral to a mental health team. If you take an antidepressant, speak to your GP before you change it. The NHS warns you might get withdrawal symptoms if you stop suddenly, and says you will be advised to reduce the dose gradually. The Noetel authors framed exercise as a treatment to consider alongside psychotherapy and antidepressants.

A practical way to start

The steps below are our coaching suggestion, built on the review findings and NHS advice, not a protocol from a single trial.

Pick a type you will keep
Walking or jogging, yoga and strength training had the largest effects in the Noetel analysis. Choose the one you enjoy most. The NHS notes exercise you enjoy is easier to keep doing.
Train with other people
Supervised programmes showed a large effect in the Heissel analysis, and the authors also advised group exercise. The NHS suggests options such as classes at a leisure centre, walking groups like Ramblers Wellbeing Walks, and exercise on prescription from your GP.
Start small, then build
If you have not exercised for a while, the NHS advises starting gradually and building toward 150 minutes of moderate activity a week. A brisk 10-minute walk is a fair first step.
Raise the effort over time
Once moderate sessions feel manageable, add some harder efforts, such as brisk hill walks, jogging intervals or heavier strength sets. Two of the reviews linked higher intensity with bigger gains.

Tell your GP or therapist you plan to start, so they can fit exercise into your care. The NHS advises you speak to your GP first if you have not exercised for some time or have a medical condition.

Common mistakes

  • Stopping medication because you have started exercising. Speak to your GP first. The NHS warns of withdrawal symptoms if you stop an antidepressant suddenly.
  • Waiting to feel motivated before you start. Book a class or arrange a walk with a friend, so the plan does not depend on how you feel on the day.
  • Hunting for the one perfect exercise. Five main types gave moderate effects in the Noetel analysis, and the NHS notes exercise you do not enjoy is hard to keep doing.

Frequently asked questions

Does exercise help depression?
Three large reviews found lower depression symptoms in people who exercised. The NHS lists exercise as one of the main treatments for mild depression. Many of the trials were small or at risk of bias, so the exact size of the benefit is uncertain.
What is the best exercise for depression?
In the 2024 Noetel analysis of 218 trials, walking or jogging had the largest effect of the five main types reported, followed by yoga and strength training. Strength training and yoga appeared to be the most acceptable types to participants.
Is exercise as good as antidepressants?
The Noetel analysis set out to compare exercise with psychotherapy, antidepressants and control conditions. Its summary does not rank exercise against antidepressants, and confidence in most estimates was low or very low. The authors concluded exercise could be considered alongside psychotherapy and antidepressants as a core treatment. Do not stop or change any medicine without speaking to your GP.
How much exercise do I need?
The NHS advises adults to aim for 150 minutes of moderate activity a week, and to build up gradually if you have not exercised for a while. NICE group programmes usually run more than once a week for 10 weeks.
Can my GP prescribe exercise?
Yes. The NHS says many GP surgeries prescribe exercise as a treatment for conditions including depression. Depending on your area, a programme might be free or offered at a reduced cost.

The bottom line

From an overview of 1,039 trials to a network meta-analysis of 218 trials in people with major depression, the evidence points the same way: people who exercised had lower depression symptoms. Walking or jogging, yoga and strength training did best, and harder sessions were linked with bigger gains. Supervised programmes showed a large effect. Trial quality was often low, so treat the exact numbers with caution. Use exercise alongside the treatment your GP or therapist recommends, and talk to them before you change any of it. If you feel unsafe, call 999. For urgent help, call 111 and select the mental health option, or call Samaritans on 116 123.

Start training with support
DT Fitness London builds coached strength and conditioning plans around your week, with sessions matched to your current fitness.
Book a consultation at dtfitnesslondon.com

Related reading

Sources

Back to blog