Exercise Matches or Exceeds Medication for Depression and Anxiety: Major Global Review

What Did the Global Review Find About Exercise and Depression?

The umbrella review, published in the British Journal of Sports Medicine in February 2026, synthesized evidence from multiple systematic reviews and meta-analyses — representing the highest level of evidence in the scientific hierarchy. By aggregating results across tens of thousands of participants spanning ages 10 to 90, the authors were able to draw robust conclusions about the effectiveness of exercise for mental health conditions.

For depression, the findings were striking. Aerobic exercise — activities that elevate heart rate such as running, swimming, cycling, and dancing — produced the largest and most consistent benefits. The effect sizes were comparable to, and in some analyses exceeded, those reported for first-line pharmacological treatments (SSRIs and SNRIs) and psychological therapies (cognitive behavioral therapy). Supervised exercise programs delivered in group settings produced particularly strong results, likely due to the combined benefits of physical activity, social connection, and professional guidance.

The review also examined a separate Cochrane systematic review specifically focused on exercise for depression, which confirmed the findings with high confidence. The Cochrane review found that exercise was effective for reducing depression symptoms compared to active control conditions, with the benefits observed across different exercise modalities, intensities, and durations. The consistency of the findings across multiple independent reviews strengthens the conclusion that exercise is a genuinely effective treatment, not merely a statistical artifact.

How Does Exercise Help with Anxiety?

The evidence for exercise as an anxiety treatment was equally compelling, though the pattern of results differed from depression. While aerobic exercise was the clear standout for depression, the review found that virtually all forms of exercise produced moderate positive effects for anxiety reduction. Aerobic exercise, resistance training, mind-body practices (yoga, tai chi), and mixed exercise programs each demonstrated significant benefits.

This broader effectiveness may reflect the multiple mechanisms through which exercise reduces anxiety. Acute exercise has been shown to reduce muscle tension, lower circulating stress hormones (cortisol and adrenaline), increase levels of endocannabinoids and endorphins that promote calm and well-being, and activate the parasympathetic nervous system. Regular exercise also improves sleep quality, builds self-efficacy, provides structured routine, and can reduce sensitivity to the physical sensations of anxiety (such as elevated heart rate) through a process called interoceptive exposure.

The effects were observed across all age groups, with particularly strong benefits noted for young adults and new mothers — populations that face elevated risk of anxiety disorders. For children and adolescents, a pooled analysis found moderate effect sizes favoring exercise for both depression and anxiety symptoms, suggesting that physical activity should be considered as part of mental health support strategies in schools and youth programs.

Should Exercise Replace Medication for Mental Health?

While the findings are remarkable, mental health experts caution against interpreting them as a reason to abandon established treatments. Depression and anxiety exist on a spectrum of severity, and treatment should be tailored to individual needs. For mild to moderate depression and anxiety, the evidence supports exercise as a first-line intervention that may be sufficient on its own, particularly for patients who prefer non-pharmacological approaches or who experience troublesome side effects from medication.

For moderate to severe depression and anxiety, exercise is best viewed as a powerful augmentation strategy that can enhance the effectiveness of medication and psychotherapy. Several studies have shown that combining exercise with antidepressant medication produces better outcomes than either treatment alone. Exercise may also help mitigate some common medication side effects, including weight gain and sexual dysfunction associated with SSRIs.

The practical challenge lies in implementation. Prescribing exercise is more complex than prescribing a pill — it requires consideration of the patient's physical abilities, preferences, access to facilities, and motivational barriers. Many people with depression experience profound fatigue, anhedonia (loss of interest), and low motivation that make initiating exercise extremely difficult. Healthcare providers may need to start with very modest activity goals and gradually increase intensity, ideally with professional support and social engagement. The review's finding that supervised group exercise produces the best outcomes suggests that exercise referral programs and community-based activity groups could be particularly valuable components of mental health care.