Can Exercise Beat Depression Anxiety Medication Blog Banner
Most of us have worked with a client who was having a hard time with their mental health. The low energy, the missed sessions, the days when they were just not themselves, whatever we tried with the programme. For many, the advice was to speak to their GP, who might recommend medication or therapy. That advice still stands. But a run of high-quality research over the last two years has put a third option firmly on the table, and it is one we are uniquely placed to deliver.
As fitness professionals we all know exercise is good for you, but this research is now saying exercise can be as effective as a pill for some people with depression. It is a genuinely exciting finding and is invaluable for us as coaches. Now, exercise is not a replacement for medication or therapy, and we are certainly not claiming it is. What the evidence does show, however, is that for a lot of people, structured physical activity belongs in the treatment plan, sitting alongside the clinical care they are receiving, and sometimes as a first-line option in its own right.
This article takes a look at what the recent research says, which types and doses of exercise show the strongest effects, how exercise compares with psychotherapy and antidepressants, and most importantly where the line sits for us. We are not clinicians. We do not diagnose, we do not treat and we never advise anyone to come off their medication. What we do is support, motivate and programme, and we know when to point someone toward a professional. Done well, that is a powerful contribution to a person’s recovery.
The piece of research that reset the conversation was a large systematic review and network meta-analysis published in the BMJ in 2024. A network meta-analysis is a way of pooling many separate trials so that treatments which were never directly tested against each other can still be compared on the same scale. The team pulled together 218 randomised controlled trials covering over 14,000 adults with depression, and ranked exercise modalities against each other and against the established treatments.
The authors found that exercise produced moderate reductions in depression compared with no treatment, with the largest effects for walking or jogging, yoga and strength training (Noetel et al., 2024). The effects were strong enough that the authors concluded exercise should be considered a core treatment for depression alongside psychotherapy and medication, not an optional extra. Importantly, the more vigorous the activity, the larger the benefit tended to be, which is a useful steer when we are programming.
Another large piece of research is also worth knowing about. A 2024 network meta-analysis published in the Lancet journal eClinicalMedicine compared psychological, pharmacological, physical and combined treatments for adults with a new episode of depression. This research was done specifically to inform NICE guidance in England, so it is grounded in the UK clinical context rather than being a purely academic exercise.
That review found that for less severe depression, several non-drug options including group exercise performed well, and for more severe depression, group exercise combined with antidepressants emerged as one of the effective approaches (Mavranezouli et al., 2024). The pattern across both reviews is consistent. Exercise is not a fringe idea. It is sitting in the same conversation as the treatments your clients may already be using.
This phrase needs handling with care. The research does not say exercise beats medication for everyone. It does not say anyone should stop taking their antidepressants. What the better-quality trials suggest is that for many people with mild to moderate depression, the size of the improvement from a structured exercise programme is broadly comparable to what is seen with antidepressants or with psychotherapy.
A 2023 systematic review and meta-analysis in the British Journal of Sports Medicine looked specifically at exercise as a treatment for depressive symptoms and found a clear, consistent effect, with higher-intensity exercise generally producing larger improvements (Heissel et al., 2023). The authors were careful to point out the usual caveats about study quality, but the direction of travel is not in doubt.
There are two caveats to keep in mind. First, the comparison being made is usually against mild to moderate depression, not the most severe presentations, where medication and specialist care are most important. Second, antidepressants take effect whether or not the person feels motivated, whereas exercise requires the person to actually do it, and depression is a condition that strips away motivation. That second point is where a good coach can make a huge difference, and we will come back to it.
The framing for a client is that exercise is a very effective tool supported by evidence, it works best as part of a plan that includes their GP or therapist, and the decision about medication is always one for them and their doctor. We never position training as a reason to come off treatment.
What we have discussed so far has been mainly about depression, but anxiety responds to exercise too, and the two often travel together in the same client. A 2025 systematic review and meta-analysis from a UK research team looked at both aerobic and resistance exercise across depression and anxiety. For depression the effect was large, and for anxiety it was moderate but still clearly favoured exercise over the control conditions.
The same review is a useful reminder that it is not only running and cycling that help (Banyard et al., 2025). Resistance training produced real reductions in both depression and anxiety symptoms, which is reassuring for the many clients who would rather lift than run. For anxious clients in particular, the predictability and structure of a strength session, knowing exactly what is coming and being able to measure progress, seems to be part of the benefit rather than incidental to it.
Put simply, the cardio and the strength work we already do both help with mood, and the research backs that up. We do not need to reinvent our programming. We need to apply it with care and frame it in a way the client can engage with.
From the evidence we have gathered, a few patterns are consistent enough to enable us to programme accordingly. None of this is a clinical prescription, it is a guide to where the strongest signals are so that we can make sensible choices with clients who are already under appropriate care.
Vigorous activity tends to outperform gentle activity for mood, within reason. That does not mean hammering a depressed client into the ground, it means that a brisk, slightly challenging effort generally does more than a gentle stroll. Walking and jogging came out near the top in the BMJ review, which is good news because they need no equipment and almost anyone can start.
Yoga performed strongly and was one of the best-tolerated modalities, which is also important because tolerance and adherence are everything in this population. Strength training also performed well across both the depression and anxiety evidence. The honest summary is that the best type of exercise for a given client is very often the one they will actually keep doing.
| Modality | What the Evidence Suggests | Best Suited To |
|---|---|---|
| Walking and jogging | Among the largest effects for depression; vigorous effort helps more | Almost any client; easy, free entry point |
| Yoga | Strong effect and very well tolerated | Anxious clients, beginners, those wary of the gym |
| Strength training | Solid reductions in both depression and anxiety | Clients who prefer structure and measurable progress |
| Mixed aerobic and resistance | Reliable, broad benefit across both conditions | Most general clients as a sustainable default |
The frequency that is mentioned most is in the region of three sessions a week, building toward the kind of weekly activity totals already recommended for general health. Consistency over several weeks is what produces the mood benefit. A single great session does very little. A modest session repeated for two months does a lot.
This is the part that is so important to get right. We are not mental health professionals. We do not diagnose depression or anxiety, we do not provide therapy and we never give clinical advice. What we offer is something clinical services often struggle to provide, which is regular, supportive, skilled contact with someone who is genuinely on the client’s side and who can make the activity itself enjoyable and achievable.
Our role is to work alongside clinical care, never to replace it. If a client tells you they are seeing their GP or a therapist, that is a good thing and we support it. The ideal scenario is a client who is receiving appropriate clinical care and training with us, with each part reinforcing the other. The structured physical activity we deliver is one of the evidence-backed legs of the stool, and our job is to make that leg as strong and as sustainable as possible.
In England, NICE guideline NG222 lists group exercise and structured physical activity programmes among the first-line options for less severe depression, so what we do is recognised in the formal clinical guidance. That should give you the confidence to talk about exercise as a legitimate part of someone’s mental health plan, while always keeping clear about the limits of our role.
Programming for a client whose mood is part of the goal looks a little different from programming purely for performance. The biggest single factor is adherence, because depression erodes motivation and a programme that is not done has no effect at all. Everything below is built around making it more likely the client turns up and keeps turning up.
Start lower than you think you need to. An early win is worth far more than an optimal stimulus the client cannot face repeating. Build the first few weeks around sessions that finish with the client feeling better than when they walked in, not wrecked. The aim early on is to attach a positive feeling to the act of training so the habit takes root.
Keep it simple and predictable. For anxious clients especially, knowing exactly what the session holds removes a source of stress rather than adding one. A repeatable structure that progresses gently beats constant novelty. Track progress visibly so the client can see they are getting somewhere, because a sense of progress is itself an antidepressant of sorts.
Use the social side deliberately. Turning up to meet you, or training in a small friendly group, builds in accountability and connection, both of which independently support mood. For a client who is isolated, the human contact in a session can be as valuable as the exercise.
Because motivation is exactly what depression takes away, the behaviour-change side of coaching becomes the main event rather than a nice-to-have. Tiny, non-negotiable minimums work well. Agreeing that the client will simply turn up and do ten minutes, with full permission to stop there, removes the all-or-nothing thinking that derails so many people. More often than not they do more once they have started, but the deal is the ten minutes.
Plan for the bad weeks in advance, while the client is feeling relatively well. Agree together what a realistic minimum looks like on a low day, so that a dip does not become a full stop. Frame missed sessions as data rather than failure. A client who has lapsed and come back has learned something useful about their own pattern, and our job is to welcome them back without judgement.
Celebrate showing up at least as much as performance. For most clients the win that is so important in the early phase is consistency, not numbers on the bar. Reinforce the behaviour you want to see repeated.
Knowing when something is beyond our scope is one of the most professional skills we have. We are not there to assess risk or to manage a mental health crisis, but we are often the person a client sees regularly, so we may notice changes. If a client’s mood seems to be getting worse rather than better, if they mention they are struggling to cope, or if anything they say gives you concern for their safety, the right move is to gently and supportively encourage them to speak to their GP or another professional.
Keep that conversation simple, warm and free of any attempt to fix it yourself. Something like letting them know you have noticed they have seemed low, that you care about how they are doing, and that talking to their GP could really help, is enough. You do not need to have the answers. You need to point toward the people who do.
If a client ever discloses thoughts of harming themselves, take it seriously, stay calm and encourage them to contact their GP, NHS 111, or a support line such as Samaritans on 116 123 in the UK, which is free and available around the clock. In an emergency where someone is in immediate danger, that is a 999 situation. Knowing these signposts exist, and being ready to share them kindly, is part of being a responsible coach. We support, we encourage and we direct people to the right help.
The evidence has moved to a point where we can say with confidence that exercise is a very effective tool for depression and anxiety, comparable in many cases to the established treatments and recognised in formal UK clinical guidance. For a lot of our clients, the training we already deliver is doing more for their mental health than either we or they fully realised.
The opportunity for us is to take that seriously and programme with care, building sessions around adherence, enjoyment and consistency rather than chasing the perfect stimulus. The responsibility that comes with it is to stay firmly within our lane, to work alongside clinical care rather than instead of it, and to know when to point a client toward a professional. Get both of those right and you become one of the most valuable people in a client’s recovery, not because you replaced their doctor, but because you stood alongside them and kept them moving.
Banyard, H., Edward, K.L., Garvey, L., Stephenson, J., Azevedo, L. and Benson, A. (2025). The Effects of Aerobic and Resistance Exercise on Depression and Anxiety: A Systematic Review With Meta-Analysis. International Journal of Mental Health Nursing, 34(2), e70054. Click here to review the full research article.
Heissel, A., Heinen, D., Brokmeier, L.L., Skarabis, N., Kangas, M., Vancampfort, D., Stubbs, B., Firth, J., Ward, P.B., Rosenbaum, S., Hallgren, M. and Schuch, F. (2023). Exercise as Medicine for Depressive Symptoms? A Systematic Review and Meta-Analysis With Meta-Regression. British Journal of Sports Medicine, 57(16), pp.1049-1057. Click here to review the full research article.
Mavranezouli, I., Megnin-Viggars, O., Pedder, H., Welton, N.J., Dias, S., Watkins, E., Nixon, N., Daly, C., Keeney, E., Eckhardt, J., Pilling, S. and Kendall, T. (2024). A Systematic Review and Network Meta-Analysis of Psychological, Psychosocial, Pharmacological, Physical and Combined Treatments for Adults With a New Episode of Depression. eClinicalMedicine, 75, 102780. Click here to review the full research article.
Noetel, M., Sanders, T., Gallardo-Gomez, D., Taylor, P., del Pozo Cruz, B., van den Hoek, D., Smith, J.J., Mahoney, J., Spathis, J., Moresi, M., Pagano, R., Pagano, L., Vasconcellos, R., Arnott, H., Varley, B., Parker, P., Biddle, S. and Lonsdale, C. (2024). Effect of Exercise for Depression: Systematic Review and Network Meta-Analysis of Randomised Controlled Trials. BMJ, 384, e075847. Click here to review the full research article.
National Institute for Health and Care Excellence (2022). Depression in Adults: Treatment and Management. NICE Guideline NG222. Click here to review the full guideline.
If this article has changed how you think about the part you play in a client’s mental health, the next step is to build the skills to do it well and within scope. The reality is that many of our clients are carrying more than they show, and the coaches who feel confident having a supportive conversation, spotting when to signpost and keeping clear about their role are the ones clients trust most.
Our Mental Health First Aid CPD gives you exactly that grounding, how to recognise when someone is struggling, how to have a supportive conversation and how to point them toward professional help, all kept firmly within a coaching scope. Pair it with our Life Coaching Course to sharpen your behaviour-change and goal-setting toolkit, and the whole package becomes a natural extension of your PT qualification. Together they turn the ideas in this article into practical, everyday coaching skills.
Mental Health First Aid Course – Live-Virtual
Life Coaching Course – Distance Study
Twenty-nine systematic reviews. Eight hundred and sixty-three separate trials. Twenty-four different treatments, all pointed at…
Many of us have a client who has started moving differently. They take the stairs…
Few moments in a client's life involve as much physical change, and as much uncertainty…
A cancer diagnosis used to mean rest, wait and recover. For a long time the…
Most of us, at some point in our careers, will have had a client that’s…
Most of us have a client whose blood pressure sits a little higher than they…