Running from depression: a review of aerobic exercise as an adjunctive treatment for mood disorders
DOI:
https://doi.org/10.12775/QS.2025.40.59789Keywords
aerobic exercise, depression, anxiety, mood disorders, neurobiological mechanisms, psychiatric rehabilitationAbstract
Background: Mood disorders, including major depressive disorder (MDD) and anxiety disorders, significantly impact global mental health, contributing to disability and reduced quality of life. While pharmacotherapy and psychotherapy are standard treatments, many patients experience residual symptoms or treatment resistance. Aerobic exercise has emerged as a promising adjunctive intervention due to its psychological and neurobiological benefits. This review examines its efficacy, mechanisms, optimal implementation strategies, and integration into psychiatric care.
Methods: A narrative literature review was conducted using PubMed, Embase, and other relevant databases, focusing on studies published up to 2025. Keywords such as "aerobic exercise," "depression," "anxiety," "psychiatric disorders," and "neurobiological mechanisms" were used to identify studies assessing clinical outcomes, neurobiological effects, and adherence factors.
Results: Aerobic exercise significantly reduces depression and anxiety symptoms across diverse populations, with moderate-to-large effect sizes in randomized controlled trials. Mechanistically, it enhances neurotransmitter balance, increases brain-derived neurotrophic factor (BDNF), regulates the hypothalamic-pituitary-adrenal (HPA) axis, and improves cognitive function. Optimal outcomes are observed with moderate-intensity exercise (60–80% HRmax), performed three times per week for at least 8–12 weeks. Supervised and group-based interventions improve adherence, particularly in psychiatric populations.
Conclusions: Aerobic exercise represents a viable, low-cost, and effective adjunct to traditional psychiatric treatments. However, methodological limitations, lack of long-term data, and adherence challenges remain. Future research should focus on standardized protocols, personalized exercise prescriptions, and large-scale, multi-center trials to maximize clinical integration and optimize patient outcomes.
References
1. Damian F Ana M Jamileh Peng Charlie David M Cristiana Chr Santomauro Mantilla Herrera Shadid Zheng Ashbaugh , D.S., A. M. Mantilla Herrera, Jamileh Shadid, Peng Zheng, Charlie Ashbaugh, D. Pigott, C. Abbafati, C. Adolph, Joanne O Amlag, A. Aravkin, Bree L Bang-Jensen, G. Bertolacci, Sabina S Bloom, Rachel Castellano, Emma Castro, Suman Chakrabarti, Jhilik Chattopadhyay, Rebecca M. Cogen, J. Collins, X. Dai, W. J. Dangel, Carolyn Dapper, A. Deen, Megan Erickson, Samuel B. Ewald, A. Flaxman, J. Frostad, N. Fullman, J. Giles, A. Z. Giref, Gaorui Guo, Jiawei He, Monika Helak, E. Hulland, B. Idrisov, Akiaja Lindstrom, Emily Linebarger, P. Lotufo, R. Lozano, Beatrice Magistro, D. Malta, J. Månsson, F. Marinho, A. Mokdad, L. Monasta, Paulami Naik, S. Nomura, J. K. O'Halloran, Samuel M. Ostroff, Maja Pašović, Louise Penberthy, Robert C Reiner Jr., Grace Reinke, A. Ribeiro, A. Sholokhov, Reed J. D. Sorensen, E. Varavikova, A. Vo, R. Walcott, S. Watson, C. Wiysonge, B. Zigler, S. Hay, T. Vos, C. Murray, H. Whiteford, A. Ferrari, Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic - Consensus. Lancet (London, England), 2021. 398(10312).
2. Priyash P. Ajmire, V.G.M., Exploring the Neuropharmacological Terrain of Depression and Anxiety: Mechanisms, Therapies, and Future Avenues - Consensus. International Journal of Innovative Science and Research Technology (IJISRT), 2024.
3. K. Iliou, D.B., A. M. Dokali, Vasileios Fotopoulos, Athanasios Kouletsos, Aikaterini Katsiana, Exploring the Effects of Major Depressive Disorder on Daily Occupations and the Impact of Psychotherapy: A Literature Review - Consensus. Cureus, 2024. 16.
4. C. J. Brush, C.J.B., G. Hajcak, Anthony J. Bocchine, Andrew A. Ude, Kristina M. Muniz, Kristina M. Muniz, D. Foti, B. Alderman, A randomized trial of aerobic exercise for major depression: examining neural indicators of reward and cognitive control as predictors and treatment targets - Consensus. Psychological Medicine, 2022. 52(5).
5. V. D. Tavares, C.C., Megan Teychenne, F. Schuch, D. Cabral, Geovan Menezes de Sousa, Carla M Prado, Scott Patten, N. Galvão-Coelho, Mats Hallgren, The effects of exercise on anxiety and depression in adults with cancer: A meta-review of meta-analyses. - Consensus. Journal of psychosocial oncology, 2024.
6. Udatha Thirupathi Rao, J.N., K. Adiga, Effect of aerobic exercises on depressive symptoms, anxiety, self-esteem, and quality of life among adults with depression - Consensus. Clinical Epidemiology and Global Health, 2020. 8(4).
7. Jiaxuan He, F.L., Peiye Xu, Ting Xu, Haiyang Yu, Baihui Wu, Hanbing Wang, Jia Chen, Kun Zhang, Junbei Zhang, Kaikai Meng, Xiaoqing Yan, Qinsi Yang, Xingxing Zhang, Da Sun, Xia Chen, Aerobic Exercise Improves the Overall Outcome of Type 2 Diabetes Mellitus Among People With Mental Disorders - Consensus. Depression and Anxiety, 2024. 2024(1).
8. R. McIntyre, H.G., The Unmet Needs for Major Depressive Disorder - Consensus. New Directions in Psychiatry, 2020.
9. I. Epstein, I.S., M. Katzman, Pharmacological approaches to manage persistent symptoms of major depressive disorder: rationale and therapeutic strategies - Consensus. Psychiatry Research, 2014. 220.
10. Jha, M., First-Line and Combination Therapeutics for Major Depressive Disorder - Consensus. Depression, 2019.
11. L. Cheung, S.L., A randomized controlled trial on an aerobic exercise programme for depression outpatients - Consensus. Sport Sciences for Health, 2018. 14(1).
12. Cristiana Carvalho Siqueira, L.V., A. Carvalho, P. R. Santos-Silva, G. Missio, R. T. de Sousa, G. Di Natale, W. Gattaz, R. Moreno, R. Machado-Vieira, Antidepressant Efficacy of Adjunctive Aerobic Activity and Associated Biomarkers in Major Depression: A 4-Week, Randomized, Single-Blind, Controlled Clinical Trial - Consensus. PLoS ONE, 2016. 11(5).
13. F. Legrand, E.N., Efficacy of exercise as an adjunct treatment for clinically depressed inpatients during the initial stages of antidepressant pharmacotherapy: An open randomized controlled trial. - Consensus. Journal of affective disorders, 2016. 191.
14. L. Carneiro, A.F., M. Vieira-Coelho, M. Mota, J. Vasconcelos-Raposo, Effects of structured exercise and pharmacotherapy vs. pharmacotherapy for adults with depressive symptoms: A randomized clinical trial. - Consensus. Journal of psychiatric research, 2015. 71.
15. C. Imboden, M.G., J. Beck, E. Holsboer-trachsler, U. Pühse, M. Hatzinger, Aerobic exercise or stretching as add-on to inpatient treatment of depression: Similar antidepressant effects on depressive symptoms and larger effects on working memory for aerobic exercise alone. - Consensus. Journal of affective disorders, 2020. 276.
16. Helena Moraes, H.S., N. Oliveira, Eduardo Matta Mello Portugal, N. Araújo, P. Vasques, A. Bergland, T. M. Santos, K. Engedal, E. Coutinho, F. Schuch, J. Laks, A. Deslandes, Is Strength Training as Effective as Aerobic Training for Depression in Older Adults? A Randomized Controlled Trial - Consensus. Neuropsychobiology, 2020. 79(2).
17. Gui-yun Xu, K.L., Effects of aerobic exercise on adolescents with subthreshold mood symptoms: a randomized psycho-education controlled trial - Consensus. Asia Pacific Journal of Clinical Trials: Nervous System Diseases, 2019. 4(4).
18. Imboden, C., et al., Aerobic Exercise and Stretching as Add-On to Inpatient Treatment for Depression Have No Differential Effects on Stress-Axis Activity, Serum-BDNF, TNF-Alpha and Objective Sleep Measures. Brain Sci, 2021. 11(4).
19. Rebecca Mortazavi, M.L., Rebecca Grudin, E. Serlachius, C. Sundberg, J. Norrbom, I. Larsson, E. Haglund, A. Ivarsson, F. Lenhard, Tina Cronqvist, Kristina Ingemarsson, Åsa Mårsell, Olof Rask, Håkan Jarbin, Moderate-to-vigorous group aerobic exercise versus group leisure activities for mild-to-moderate depression in adolescents: study protocol for a multicentre randomised controlled trial - Consensus. BMJ Open, 2022. 12(7).
20. J. Neidig, B.A.S., D. Brashers, Aerobic exercise training for depressive symptom management in adults living with HIV infection. - Consensus. The Journal of the Association of Nurses in AIDS Care : JANAC, 2003. 14 2(2).
21. A. Navas, M.C.C., Catalina Artigues, Silvia Ortas, Elena Portells, Aina Soler, A. Yáñez, Miquel Bennasar-Veny, A. Leiva, Effectiveness of Moderate-Intensity Aerobic Water Exercise during Pregnancy on Quality of Life and Postpartum Depression: A Multi-Center, Randomized Controlled Trial - Consensus. Journal of Clinical Medicine, 2021. 10(11).
22. Kaushadh Jayakody, S.G., C. Hosker, Exercise for anxiety disorders: systematic review - Consensus. British Journal of Sports Medicine, 2014. 48(3).
23. Z. Ewuzie, C.E., Nicholas Aderinto, A review of exercise interventions for reducing anxiety symptoms: Insights and implications - Consensus. Medicine, 2024. 103(41).
24. Servant, D., [Non-pharmacological treatment for anxiety disorders]. Rev Prat, 2019. 69(9): p. 985-987.
25. M. Herring, J.B.L., P. O’Connor, The Effects of Exercise Training on Anxiety - Consensus. American Journal of Lifestyle Medicine, 2014. 8(6).
26. Rebar, A.L., et al., A meta-meta-analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations. Health Psychol Rev, 2015. 9(3): p. 366-78.
27. LeBouthillier, D.M. and G.J. Asmundson, A Single Bout of Aerobic Exercise Reduces Anxiety Sensitivity But Not Intolerance of Uncertainty or Distress Tolerance: A Randomized Controlled Trial. Cogn Behav Ther, 2015. 44(4): p. 252-63.
28. A. Abrantes, R.A.B., D. Strong, N. McLaughlin, Sarah L. Garnaat, M. Mancebo, D. Riebe, Julie Desaulniers, A. Yip, S. Rasmussen, B. Greenberg, A pilot randomized controlled trial of aerobic exercise as an adjunct to OCD treatment. - Consensus. General hospital psychiatry, 2017. 49.
29. G. Kelley, K.K., L. Callahan, Are There Inter-Individual Differences in Anxiety as a Result of Aerobic Exercise Training in Adults with Fibromyalgia? An Ancillary Meta-Analysis of Randomized Controlled Trials. - Consensus. Archives of physical medicine and rehabilitation, 2022. 103(9).
30. E. Martinsen, A.H., Ø. Solberg, Aerobic and non-aerobic forms of exercise in the treatment of anxiety disorders - Consensus. Stress Medicine, 1989. 5(2).
31. Wedekind, D., et al., A randomized, controlled trial of aerobic exercise in combination with paroxetine in the treatment of panic disorder. World J Biol Psychiatry, 2010. 11(7): p. 904-13.
32. Elizabeth Aylett, N.S., P. Bower, Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis - Consensus. BMC Health Services Research, 2018. 18(1).
33. Subir Gupta, A.B., Damian Cohall, Sayeeda Rahman, Mainul Haque, Md Anwarul Azim Majumder, Aerobic Exercise and Endocannabinoids: A Narrative Review of Stress Regulation and Brain Reward Systems - Consensus. Cureus, 2024. 16.
34. Jun-y, L., The Influence of Aerobic Exercise on College Students' Executive Functions: A Functional Magnetic Resonance Imaging Study. Journal of Beijing Sport University, 2014.
35. Kaihua Jiang, Y.X., Yamin Li, Lin Li, Mingmei Yang, Peng Xue, How aerobic exercise improves executive function in ADHD children: A resting‐state fMRI study - Consensus. International Journal of Developmental Neuroscience, 2022. 82(4).
36. Wenbin Shen, X.W., Qin Li, Q. Ding, Hongqiang Zhang, Z. Qian, Zhixin Sun, Xingyu Chen, Jun Zhang, Mengqi Zhao, Lina Huang, Wei Xing, Research on adults with subthreshold depression after aerobic exercise: a resting-state fMRI study based on regional homogeneity (ReHo) - Consensus. Frontiers in Neuroscience. 18.
37. Olesya Iosipchuk, G.R.W., Robert W Motl, B. Sandroff, Aerobic Exercise Training and Depressive Symptoms in People With Multiple Sclerosis: Brief Report on Default-Mode Network Resting-State Functional Connectivity. - Consensus. International journal of MS care, 2025. 27 Q1(Q1).
38. R. Stanton, P.R., Exercise and the treatment of depression: a review of the exercise program variables. - Consensus. Journal of science and medicine in sport, 2014. 17 2(2).
39. D.J. Yu, A.Y., C. K. Leung, E. Chin, D. Y. Fong, C. Cheng, S. Yau, P. Siu, Comparison of moderate and vigorous walking exercise on reducing depression in middle-aged and older adults: A pilot randomized controlled trial - Consensus. European Journal of Sport Science, 2023. 23(6).
40. B. Singh, R.S., M. Steele, S. Hayes, K. Toohey, Exercise for Individuals With Lung Cancer: A Systematic Review and Meta-Analysis of Adverse Events, Feasibility, and Effectiveness. - Consensus. Seminars in oncology nursing, 2020. 36(5).
41. L. Haakstad, B.T., K. Bø, What is the effect of regular group exercise on maternal psychological outcomes and common pregnancy complaints? An assessor blinded RCT. - Consensus. Midwifery. 32.
42. J. Hoffman, K.B., J. Powell, James Behr, E. Dunn, S. Dikmen, C. Bombardier, A Randomized Controlled Trial of Exercise to Improve Mood After Traumatic Brain Injury - Consensus. PM&R, 2010. 2(10).
43. Louis Biasin, M.S., Karen Brunton, J. Fraser, J. Howe, M. Bayley, D. Brooks, W. McIlroy, A. Mansfield, E. Inness, Integrating Aerobic Training Within Subacute Stroke Rehabilitation: A Feasibility Study - Consensus. Physical Therapy, 2014. 94(12).
44. A. Schmitt, D.R.-E., A. Hasan, P. Falkai, Aerobic exercise in mental disorders: from basic mechanisms to treatment recommendations - Consensus. European Archives of Psychiatry and Clinical Neuroscience, 2019. 269(5).
45. Takeshi Shimada, S.I., Ayako Makabe, Ayumi Yamanushi, Ami Takenaka, Masayoshi Kobayashi, Aerobic exercise and cognitive functioning in schizophrenia: A pilot randomized controlled trial - Consensus. Psychiatry Research, 2019. 282.
46. J, B.-A., O.-C. MÁ, and M.-I. D, Feasibility and effects of an exercise-based intervention in prison inmates with psychiatric disorders: the PsychiActive project randomized controlled trial - PubMed. Clinical rehabilitation, 2019 Oct. 33(10).
47. Sol Yoon, J.-K.R., Chan-Hyung Kim, Jhin-Goo Chang, Hwa-Bock Lee, Do-Hoon Kim, D. Roh, Preliminary Effectiveness and Sustainability of Group Aerobic Exercise Program in Patients with Schizophrenia - Consensus. The Journal of Nervous and Mental Disease, 2016. 204(9).
48. J. Zeibig, B.S., G. Sudeck, Inka Rösel, M. Hautzinger, S. Wolf, Transdiagnostic efficacy of a group exercise intervention for outpatients with heterogenous psychiatric disorders: a randomized controlled trial - Consensus. BMC Psychiatry, 2021. 21(1).
49. Håkan Jarbin, K.H., Gudmundur Skarphedinsson, A. Bremander, Aerobic exercise for adolescent outpatients with persistent major depression: Feasibility and acceptability of moderate to vigorous group exercise in a clinically referred sample - Consensus. Clinical Child Psychology and Psychiatry, 2021. 26(4).
50. Oertel-Knochel, V., et al., Effects of aerobic exercise on cognitive performance and individual psychopathology in depressive and schizophrenia patients. Eur Arch Psychiatry Clin Neurosci, 2014. 264(7): p. 589-604.
51. M. Rundell, K.R., Teen with Psychiatric Diagnoses Improves After Eliminating Medications and Initiating Endurance Sports Training. - Consensus. Current Sports Medicine Reports, 2020. 19(1).
52. L. Wallace, P.R.H., Is exercise effective in treating depression? - Consensus. Evidence-Based Practice, 2020. 24(5).
53. P. Bernard, G.N., [Benefits of exercise for people with schizophrenia: a systematic review]. - Consensus. L'Encephale, 2012. 38 4(4).
54. Parker, J. and R.A. Guthmann. Is exercise effective in the treatment of depression. 2015.
55. A. Schmitt, P.F., Suicide ideation, stability of symptoms and effects of aerobic exercise in major depression - Consensus. European Archives of Psychiatry and Clinical Neuroscience, 2014. 264(7).
56. K. Miller, P.A., Declan Hennessy, D. Gonçalves-Bradley, Christopher Mesagno, Fergal M Grace, Aerobic, resistance, and mind-body exercise are equivalent to mitigate symptoms of depression in older adults: A systematic review and network meta-analysis of randomised controlled trials - Consensus. F1000Research, 2021. 9.
57. Yiming Chen, S.D., Xinming Ye, A178: Effect of Aerobic Exercise Intervention on Anxiety in College Students - Consensus. International Journal of Physical Activity and Health, 2024. 3(3).
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Damian Adasik, Marta Bonarska , Gabriela Łocik, Simone Szymczyk, Kacper Król
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 548
Number of citations: 0
