I think those who understand the best the power of exercise are the ones who actually practice it. Many doctors are sedentary themselves and lead chaotic lives. Also, some of them prefer to stick to conventional, well-established treatments that have delivered results over time.
At the very least, exercise should be recommended as an adjunct therapy.
As someone who is diagnosed bipolar 1, I really cannot overstate how much exercise has saved my life.
I do dance therapy, because it doesn't even FEEL like working out, but rather a joyous celebration of life and rhythm.
Therapy never did a damn thing for me personally, and antipsychotics have terrifying side effects (no more hallucinations, but congrats! You have kidney failure).
When I'm manic I dance vigorously for 3-6 hours a day, and that burns off that crazy Superman on meth energy so I can sleep and not take out my nervous energy on others.
When I'm depressed it's obviously far less, but I still force myself to do yoga or swim (I just learned that being submerged in water decreases blood pressure in mammals) and boogie as much as I can.
So thank you so much for advocating for an excellent treatment for those of us with mental illnesses. You're doing good work here!!
I would simply qualify this article by saying "focused exercise" is helpful, as opposed to random exercise. My wife for instance has a social group at the gym where they do their classes which she enjoys very much. For my part, I prefer solitary exercise with the emphasis on personal attainment.
The experience of exercise is so varied across individuals. You and I could try the same workout routine and love it or hate it. The liberating thing for me was realizing I could go to the gym and just... do whatever I felt like. I didn't need to follow a regimen or strict routine. And you can even broaden that to classes, sports, outdoorsing, whatever. The benefits are undeniable. Its about finding what clicks for an individual that keeps them coming back.
I am a perfect example. If I don’t get to the gym(power lifting), I notice it, could just stay in bed. I am keen to let others know just how much of a difference it can make. It can make ALL the difference. I want to yell it out! Move! Move! Move! So kudos to you for this.
This is an important point. The real question isn't whether exercise *works* for depression—the evidence is overwhelming that it does. The question is why we still treat it as optional rather than as a legitimate part of care.
That doesn't mean replacing therapy or medication. It means recognizing exercise as another evidence-based treatment that should be prescribed, supported, and personalized—not just suggested as "try to be more active."
I was eye-ball deep in research articles for a presentation I’m giving to mental health professionals on this exact topic when this landed in my inbox! What a lit review shows is almost all prescribing practitioners across the board understand the effectiveness of exercise, and practically nobody thinks it will make a condition worse.
Reasons for not prescribing are as you’d imagine, e.g. they don’t have any training in ExRx, there’s no referral pathway to existing exercise pros, they’re already tight on time. Contrary to what you might think, one’s personal exercise habit didn’t influence whether or not they prescribed. That being said, saving a better personal relationship to movement did increase their knowledge of it, allowing them to offer more refined advice. The most common ExRx is “aerobic exercise,” 20–30 minutes, moderate intensity.
The tricky thing is that, while “movement is medicine” is a catchy phrase, it’s not quite accurate. Medicine typically doesn’t require a fundamental shift in your habits, environment, or identity. Movement is nutrition. So, the training component isn’t just covering how to figure out the right dose (which we’ve made great headway on); it’s about understanding the practical and psychological barriers that make adopting new behaviors so difficult—even when we genuinely want the outcomes those behaviors are associated with. Oh, and then it’s trying to deliver all that information in a way the individual in front of you can hear it, in a couple minutes.
P.S. If you were drawn to this article because deep down you think getting off the computer and out on a 10-minute walk would make you feel better, YOU ARE RIGHT. What are you waiting for? Shut it down and let's go.
Those that say it's to do with mindset, it's not. Mindset is an end product, but what gets you there is your thinking. Actually, what we all need to focus on is our thinking and perception.
We all intellectually know that exercise helps us both physically and mentally, but it takes a certain type of person to actually adopt it into their actions. Remember this: your thoughts are your actions, your thoughts are your behaviours, your thoughts are your ideas. Your thoughts are your decisions. If you do not invest in your qualitative thinking, you cannot achieve the output of the action.
The framing "treat like medication" runs into a category problem. FITT is a real improvement over "just go work out." But medication succeeds because the threshold is low — swallow a pill. Therapy is higher — sustained commitment. Exercise sits above both. It's a lifestyle intervention, which has its own grammar: identity shift (seeing yourself as someone who runs), environmental redesign (running shoes by the door), momentum sustainment (not missing twice in a row).
FITT specifies dosage variables, but the compliance problem isn't dosage precision. It's the mismatch between prescription grammar and what exercise actually requires. Training clinicians in the wrong grammar won't fully close that gap.
Yes, the right exercise for the right person at the right time. Depression is a downward spiral, taking the pills are easier than putting on the gym kit. I agree the GP’s need one voice to guide someone into their exercise starting point as where the patient is today, can evolve into many different layers and seasons of movement. Get some supervision, and just start slow. Create the desire to take care of yourself- rewrite any negativity around yourself and your body. Try the meds with the exercise to get started. Move well! Annette
percy's point about exercise needing its own "grammar" (identity shift, environmental redesign) is the sharpest thing here. but there's a specific failure mode worth naming for people who already exercise: turning movement into one more thing to optimize, tracked and judged by output, exactly the same performance logic that's driving the depression in the first place. the mechanism you describe (more bdnf, lower cortisol reactivity) partly depends on the exercise actually functioning as regulation, not as another achievement to hit.
fitt is useful, but for that population the missing variable isn't frequency or intensity, it's whether the activity still feels like something being done to them or something they're doing for themselves.
Exercise is certainly a good treatment for depression. However, it seems that Most people whether it’s doctors and patients do what feels best for themselves. Doctors who themselves enjoy the benefit of exercise stress that to their patients. However, patients don’t always do what doctor says. If exercise is not within there their concept of helping themselves, they may not do it also those who find it difficult to exercise may not do it. The other issue is that when people are depressed some Most often find it hard to get out of bed so exercise works though when people are able to able to feel a little bit better.
Because the American Health System is for-profit only. Because, there is no profit to be gained by healthcare professionals, they will not recommend exercise nor natural remedies.
It doesn't even take a lot of exertion. "Solvitur ambulando," as the old saying goes ("It is solved by walking."). Just getting up and moving around has benefits.
I think those who understand the best the power of exercise are the ones who actually practice it. Many doctors are sedentary themselves and lead chaotic lives. Also, some of them prefer to stick to conventional, well-established treatments that have delivered results over time.
At the very least, exercise should be recommended as an adjunct therapy.
As someone who is diagnosed bipolar 1, I really cannot overstate how much exercise has saved my life.
I do dance therapy, because it doesn't even FEEL like working out, but rather a joyous celebration of life and rhythm.
Therapy never did a damn thing for me personally, and antipsychotics have terrifying side effects (no more hallucinations, but congrats! You have kidney failure).
When I'm manic I dance vigorously for 3-6 hours a day, and that burns off that crazy Superman on meth energy so I can sleep and not take out my nervous energy on others.
When I'm depressed it's obviously far less, but I still force myself to do yoga or swim (I just learned that being submerged in water decreases blood pressure in mammals) and boogie as much as I can.
So thank you so much for advocating for an excellent treatment for those of us with mental illnesses. You're doing good work here!!
I would simply qualify this article by saying "focused exercise" is helpful, as opposed to random exercise. My wife for instance has a social group at the gym where they do their classes which she enjoys very much. For my part, I prefer solitary exercise with the emphasis on personal attainment.
The experience of exercise is so varied across individuals. You and I could try the same workout routine and love it or hate it. The liberating thing for me was realizing I could go to the gym and just... do whatever I felt like. I didn't need to follow a regimen or strict routine. And you can even broaden that to classes, sports, outdoorsing, whatever. The benefits are undeniable. Its about finding what clicks for an individual that keeps them coming back.
I am a perfect example. If I don’t get to the gym(power lifting), I notice it, could just stay in bed. I am keen to let others know just how much of a difference it can make. It can make ALL the difference. I want to yell it out! Move! Move! Move! So kudos to you for this.
This is an important point. The real question isn't whether exercise *works* for depression—the evidence is overwhelming that it does. The question is why we still treat it as optional rather than as a legitimate part of care.
That doesn't mean replacing therapy or medication. It means recognizing exercise as another evidence-based treatment that should be prescribed, supported, and personalized—not just suggested as "try to be more active."
I was eye-ball deep in research articles for a presentation I’m giving to mental health professionals on this exact topic when this landed in my inbox! What a lit review shows is almost all prescribing practitioners across the board understand the effectiveness of exercise, and practically nobody thinks it will make a condition worse.
Reasons for not prescribing are as you’d imagine, e.g. they don’t have any training in ExRx, there’s no referral pathway to existing exercise pros, they’re already tight on time. Contrary to what you might think, one’s personal exercise habit didn’t influence whether or not they prescribed. That being said, saving a better personal relationship to movement did increase their knowledge of it, allowing them to offer more refined advice. The most common ExRx is “aerobic exercise,” 20–30 minutes, moderate intensity.
The tricky thing is that, while “movement is medicine” is a catchy phrase, it’s not quite accurate. Medicine typically doesn’t require a fundamental shift in your habits, environment, or identity. Movement is nutrition. So, the training component isn’t just covering how to figure out the right dose (which we’ve made great headway on); it’s about understanding the practical and psychological barriers that make adopting new behaviors so difficult—even when we genuinely want the outcomes those behaviors are associated with. Oh, and then it’s trying to deliver all that information in a way the individual in front of you can hear it, in a couple minutes.
P.S. If you were drawn to this article because deep down you think getting off the computer and out on a 10-minute walk would make you feel better, YOU ARE RIGHT. What are you waiting for? Shut it down and let's go.
Those that say it's to do with mindset, it's not. Mindset is an end product, but what gets you there is your thinking. Actually, what we all need to focus on is our thinking and perception.
We all intellectually know that exercise helps us both physically and mentally, but it takes a certain type of person to actually adopt it into their actions. Remember this: your thoughts are your actions, your thoughts are your behaviours, your thoughts are your ideas. Your thoughts are your decisions. If you do not invest in your qualitative thinking, you cannot achieve the output of the action.
The framing "treat like medication" runs into a category problem. FITT is a real improvement over "just go work out." But medication succeeds because the threshold is low — swallow a pill. Therapy is higher — sustained commitment. Exercise sits above both. It's a lifestyle intervention, which has its own grammar: identity shift (seeing yourself as someone who runs), environmental redesign (running shoes by the door), momentum sustainment (not missing twice in a row).
FITT specifies dosage variables, but the compliance problem isn't dosage precision. It's the mismatch between prescription grammar and what exercise actually requires. Training clinicians in the wrong grammar won't fully close that gap.
Yes, the right exercise for the right person at the right time. Depression is a downward spiral, taking the pills are easier than putting on the gym kit. I agree the GP’s need one voice to guide someone into their exercise starting point as where the patient is today, can evolve into many different layers and seasons of movement. Get some supervision, and just start slow. Create the desire to take care of yourself- rewrite any negativity around yourself and your body. Try the meds with the exercise to get started. Move well! Annette
When all you have is a script, all of your patients need a script
percy's point about exercise needing its own "grammar" (identity shift, environmental redesign) is the sharpest thing here. but there's a specific failure mode worth naming for people who already exercise: turning movement into one more thing to optimize, tracked and judged by output, exactly the same performance logic that's driving the depression in the first place. the mechanism you describe (more bdnf, lower cortisol reactivity) partly depends on the exercise actually functioning as regulation, not as another achievement to hit.
fitt is useful, but for that population the missing variable isn't frequency or intensity, it's whether the activity still feels like something being done to them or something they're doing for themselves.
really well argued piece, thanks for writing it 🙏
Exercise is certainly a good treatment for depression. However, it seems that Most people whether it’s doctors and patients do what feels best for themselves. Doctors who themselves enjoy the benefit of exercise stress that to their patients. However, patients don’t always do what doctor says. If exercise is not within there their concept of helping themselves, they may not do it also those who find it difficult to exercise may not do it. The other issue is that when people are depressed some Most often find it hard to get out of bed so exercise works though when people are able to able to feel a little bit better.
Big Pharma wants us reliant on THEM, not autonomously healthy.
Because the American Health System is for-profit only. Because, there is no profit to be gained by healthcare professionals, they will not recommend exercise nor natural remedies.
It doesn't even take a lot of exertion. "Solvitur ambulando," as the old saying goes ("It is solved by walking."). Just getting up and moving around has benefits.