Effective Prescription of Exercise for the Treatment of Depression and Anxiety

There are few interventions in psychiatry that have received more recommendations than “exercise,” and yet fewer interventions that have been less clearly defined in terms of prescription. Many clinicians tell their patients to “get more physically active,” but those recommendations are usually made in a nonspecific manner (eg, “just get moving”), and there is typically little structural support for that goal. That lack of structural support is reminiscent of how many other evidence-based treatments have evolved over time, and that similarity raises a very good question: Are we prescribing exercise in a way that reflects the evidence?

Research

While many studies suggest a preventive effect of regular physical activity for both major depression and anxiety disorders, they also provide evidence for a treatment effect. Several large prospective studies indicate that even modest amounts of physical activity can reduce the risk of developing depression, with the largest reductions observed among individuals who were sedentary prior to engaging in some form of activity.^1,2 The findings of these studies are especially pertinent to clinicians because they illustrate that meaningful changes do not necessarily require high levels of organized or intensive physical activity. For example, becoming more active could be a first step toward a greater positive impact for many patients.

Further supporting the treatment effects of exercise, numerous meta-analyses of randomized controlled trials examining various forms of physical activity among different populations, including individuals with chronic medical illnesses, have demonstrated statistically significant improvements in both depressive and anxiety symptoms.^3-5 Physical activities examined include walking, resistance training, and various mind-body activities (eg, yoga).^3,4 While the literature indicates that higher-intensity physical activity may confer additional benefits for some patients, the breadth of effective modalities underscores the importance of patient preferences and perceived ability to sustain an exercise regimen in the formulation of recommendations.

How to Effectively Prescribe Exercise as an Adjunct

Despite the substantial evidence base supporting the use of physical activity as a treatment option for depression and anxiety disorders, it is infrequently prescribed with the same clarity as medication or psychotherapy. Patients are generally provided with only broad recommendations, without specific guidance on frequency or progression. This lack of structure likely contributes to low adherence, particularly among patients with depression, who experience low motivation, fatigue, and anhedonia. Additionally, individuals with anxiety may interpret the physiological responses to exercise as frightening or aversive, further limiting engagement.

Improved clinical outcomes are achieved when exercise is prescribed in a simple, tailored manner that integrates into each individual’s daily routine. Rather than providing recommendations based on idealized regimens, clinicians may find greater success by focusing on feasibility. Encouraging patients to begin with short periods of activity, such as walking several times per week, may be more effective than recommending complex programs that feel overwhelming or unattainable. Follow-up after providing an exercise prescription is similarly crucial to reinforce that physical activity is an integral part of treatment.

It is essential to recognize that exercise does not replace pharmacological therapy or psychotherapy. Studies have demonstrated that while exercise produces comparable outcomes to traditional treatments for mild to moderate depression, it is not superior.⁶ Instead, exercise is best viewed as an adjunctive treatment that enhances overall response, particularly for individuals whose symptoms remain partially responsive to established therapies.

Practical Strategies for Prescribing Physical Activity

A mental health clinician can prescribe physical activity similarly to prescribing medications. The clinician can provide the patient with specific, individualized prescriptions for physical activity rather than general suggestions. Here are some examples:

• Begin slowly. For example, recommend 10-15 minutes walks 3 times weekly, and incrementally increase the time and frequency.
• Set SMART goals. For example, help the patient specify what they want to accomplish (eg, walk after dinner every Monday, Wednesday, and Friday), rather than their intent (eg, "I will try to walk").
• Focus on regularity rather than intensity. Individuals are more likely to maintain their current level of moderate activity than to try an intense program.
• Specify the type of activity. There are many options, such as walking, cycling, swimming, resistance training, yoga, etc, that individuals may find enjoyable and therefore adhere to.
• Evaluate the effectiveness of the prescribed physical activity during follow-up appointments. Inquire about the patient's ability to complete the prescribed physical activity as you would inquire about whether they have taken their medications as directed. Celebrate their successes and collaborate to overcome any obstacles when they experience difficulty meeting the prescribed amount of physical activity. For example, I recommend that you walk briskly for 15 minutes after dinner on Monday, Wednesday, and Friday for 2 weeks. If you tolerate this schedule, we can increase the duration of time spent walking to 20 to 30 minutes daily.

Concluding Thoughts

In addition to providing symptomatic relief, regular exercise offers clinically meaningful benefits for overall physical health. Individuals with severe mental illness have elevated cardiovascular risk and metabolic comorbidity compared with the general population. Incorporating exercise into psychiatric treatment plans provides an opportunity to address both mental and physical health simultaneously and reinforces its role as a key component of comprehensive care.

Dr Gait is a PGY-1 psychiatry resident at St. Catherine of Siena Hospital in Smithtown, New York.

References

1. Harvey SB, Øverland S, Hatch SL, et al. Exercise and the prevention of depression: results of the HUNT cohort study. Am J Psychiatry. 2018;175(1):28-36.

2. Pearce M, Garcia L, Abbas A, et al. Association between physical activity and risk of depression: a systematic review and meta-analysis. JAMA Psychiatry. 2022;79(6):550-559.

3. Singh B, Olds T, Curtis R, et al. Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. Br J Sports Med. 2023;57(18):1203-1209.

4. Noetel M, Sanders T, Gallardo-Gómez D, et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2024;384:e075847.

5. Soong RY, Low CE, Ong V, et al. Exercise interventions for depression, anxiety, and quality of life in older adults with cancer: a systematic review and meta-analysis. JAMA Netw Open. 2025;8(2):e2457859.

6. Fabiano N, Puder D, Stubbs B. The evidence is clear: exercise is not better than antidepressants or therapy: it is crucial to communicate science honestly. J Phys Act Health. 2025;22(2):161-162.