Exercise for Depression and Anxiety: Which Workouts Work Best? - Dr. Michael Ruscio, DC

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Exercise for Depression and Anxiety: Which Workouts Work Best?

Adopting Smart Fitness Habits Can Have a Profound Effect on Your Mood

Key Takeaways:

  • Exercise can be one of the most effective ways to ease depression and anxiety symptoms.
  • Moderate and higher intensity exercise seems to work best, but any type of activity helps.
  • The optimal mood-lifting regime includes aerobic and strength exercises, and working out 4–5 times a week for 30–60 minutes.
  • Try to exercise outside in nature as often as you can for enhanced psychological benefits.
  • There are no strict rules: the best sort of exercise is what you can stick to.
  • If exercising is a bit much right now, that’s OK too. Just be sure to get help if you are overwhelmed.

A solid, sweaty workout is one of the absolute best ways to boost mood.

In fact, exercise can even beat antidepressant medications and psychotherapy for effectiveness, and is great for your physical health too. Let’s dig into the evidence and come up with a practical guide on exercise for depression and anxiety.

What The Research Tells Us About Exercise for Depression

The mental health benefits of exercise include [1] : 

  • Enhancing your overall mood and feelings of emotional well-being 
  • Increasing your energy level
  • Improving sleep

A recent umbrella review, pooling data from over 1000 trials and more than 128,000 participants, found that exercise had similar or slightly greater positive effects on depression and anxiety compared to talking therapies and drugs. It also unearthed some helpful recommendations on the type, duration, and frequency of exercise that works best for mental health. I give this review a more detailed look in this video [2].

The topline finding was that all forms of physical activity led to reductions in symptoms of depression, anxiety, and psychological distress. 

The forms of exercise studied were:

  • Aerobic workouts
  • Strength workouts
  • Mixed (aerobic + strength together)
  • Mind-body (yoga, tai chi, qi gong, dance, stretching)

The greatest benefits of exercise for depression were observed in people with mild-to-moderate clinical depression, pregnant women and new mothers, apparently healthy people, and people diagnosed with HIV or kidney disease [2].

Aim for 4–5 Weekly Sessions 

A useful thing this umbrella review tells us is that there’s a sweet spot when it comes to the amount of exercise for the treatment of depression. The results showed that:

  • Exercising for up to 150 minutes (two and a half hours) each week had a larger positive effect on both depression and anxiety than exercising for longer periods. 
  • Exercising 4–5 days per week also had a larger benefit than exercising more or less frequently.
  • Sessions that lasted between 30–60 minutes were optimal.

Putting these findings together supports a general recommendation to exercise for depression at a level of around 5 times a week for 30 minutes a session.

That’s not to say that a different exercise schedule won’t be beneficial, as any sort of activity is better than none.

Moderate to High-Intensity Exercise Seems Best

While any level of exertion was good, the effects of exercise on mental well-being and mental disorders were better with medium to high-intensity exercise than with lower intensity exercise. Breaking it down a little bit more [2]:

  • Low-intensity exercise had a small effect on depression and a small effect on anxiety.
  • Moderate-intensity exercise had a moderate effect on depression and a small–moderate effect on anxiety.
  • High-intensity exercise had a moderate–large effect on depression and a small–moderate effect on anxiety.

An accurate way of finding whether you are exercising in the medium or high-intensity range involves using a heart rate monitor while you perform a hard effort to discover your current max heart rate. Once you have this figure, you can work out your moderate-intensity heart rate and high-intensity heart rate range using simple math:

Exercise for Depression

If you are not used to exercise, a test to find out your max heart rate may be too grueling. You may find it easier to go with RPE or “rated perceived exertion” (this is how hard the exercise feels to you on a 1 to 10 scale). 

Medium-intensity exercise should feel like a 6 or 7 out of 10, and hard-intensity exercise should feel like 8 out of 10 or more. You can also use the “talk test”: if you’re working at medium intensity (zone two or zone three training), conversation starts to become difficult, and you’ll only be able to speak in short sentences; at high intensity (zone 4) you’ll only be able to say the odd word or two.

Strength Exercise May Be Particularly Good for Depression

A final thing we can pull out from this umbrella review is the exercise types that had the most benefit.

People often assume that aerobic exercise (the sort that makes you out of breath and stresses the cardiovascular system in a healthy way is the best for lifting mood, but the results here were somewhat different:

  • For depression, the largest positive came from strength (resistance) exercise
  • For anxiety it was the mind-body exercises that had the most effect, for example, yoga tai chi, stretching

Here’s an example of a medium-intensity strength training session you can do using the machines at a gym. It will take about 30 minutes if you do two rounds [3]

Do two repeats of the 4 sets for one approx. 30-minute strength session

Set 1:

  • Lat pulldown, 10 repeats at 70% of 1-rep max*
  • Rest 30 seconds
  • Lat pulldown, 10 reps
  • Rest 30 seconds
  • Lat pulldown, 10 reps
  • Rest 2 minutes

Set 2: Leg extension, same as set 1

Set 3: Shoulder press, same as sets 1 & 2

Set 4: Lunges, same as sets 1–3 

*70% of 1-rep max is 70% of the most you can lift at one time.

If you haven’t maintained a regular workout routine before or haven’t exercised in a while, you probably will want to gradually work up to this regimen over a few weeks or even months. And if you have a diagnosed medical condition, you should consult with your local doctor before working out, especially with moderate- or high-intensity exercises.

Do What Works for You

In practice, it’s a good idea to mix things up with any exercise routine, and other research has shown that all types of exercise you include in an exercise for depression program can be beneficial.

For example, a large meta-analysis of 69 randomized controlled studies found that aerobic, resistance, and mind-body exercises were similarly effective at treating depression in older adults aged 65 and over [4]. 

This emphasizes that it’s important to avoid pigeonholing yourself too much into one type of exercise. Instead, you can do the kinds of exercise you most enjoy, and you’ll still feel the benefits!

Go Outdoors for an Extra Boost

If you get the chance to do your exercise in the forest, at the park, near a lake, or on the beach, so much the better.

Two meta-analyses found that spending time in nature is good for helping to improve mental health. 

The first meta-analysis assessed the effects of “forest bathing” (immersion in the green forest environment while sitting, meditating, walking, or exercising). The research looked at 36 clinical trials involving over 3500 participants and found that [5]:

  • Forest bathing had a medium–large positive effect on depression and a large positive effect on anxiety.

The second, more recent, meta-analysis evaluated 28 clinical trials (11 of which were randomized controlled trials) to determine how time in nature affected various health outcomes, including depression and anxiety [6]:

  • Spending time near or in forests, parks, lakes, or beaches had a large beneficial effect on anxiety and a medium beneficial effect on depression.

How Exercise for Depression Works

There’s still work to be done to figure out exactly how exercise improves mental health conditions. 

One theory is that exercise might improve depression by increasing the expression of brain-derived neurotrophic factor (BDNF). Higher BDNF is thought to improve depression by promoting cell growth and creating new blood vessels. This can lead to better connectivity between neurons and increases in the neurotransmitters serotonin and dopamine that help manage mood [2, 7, 8].

However, while some studies are in support of the BDNF/ depression theory [9, 10], others don’t support it [11, 12].

Some researchers have proposed that exercise helps depression and anxiety by acting as hormetic or “good” stress, that challenges the body to adapt and grow stronger. Specifically, high-intensity training may help to fine-tune the hypothalamic-pituitary-adrenal (HPA) axis (the body’s main stress response system), and/or to adjust to higher levels of the stress hormone cortisol [8].

A final theory is that exercise may help depressive disorder through improving the balance of inflammatory markers in the body, but again this is not a confirmed theory and needs a lot more research [2, 10].

The bottom line is that a lot more research is needed. But there’s little doubt that exercise is a really helpful antidepressant, whatever the mechanisms.

A Practical Exercise Prescription

To help simplify things, we can pull together all the above research strands and distill them into one simple 5-point exercise for depression plan: 

  1. Combine strength exercises (e.g. weights), with aerobic exercises (e.g. dancing, biking, jogging)
  2. Do them at a moderate to high-intensity level
  3. Carry out 4–5 times per week
  4. Work out for 30–60 minutes per session
  5. Do your exercise in nature whenever possible

However, I wouldn’t just recommend this exercise plan for depression and mental illness; it is a good exercise blueprint for health problems in general.

Be Kind to Yourself!

If you can’t reach this full exercise prescription, you should still invite whatever movement you can reasonably fit into your life and feel confident that you’re doing something that will improve your quality of life and self-esteem.

  • If you can only exercise at low intensity right now, don’t sweat it — even this level of activity can be an effective moot boost
  • If you like to exercise more than 4–5 days a week, or can only manage a couple of days this is OK too! While moderate exercise is the sweet spot for mental health, what you can do will vary, depending on your life, schedule, and physical health.
  • If you don’t live near any natural areas don’t stress. Exercising in nature is an added bonus, but if you can’t access it most of the time, it’s ok. Just try to find a park or forest whenever you can.

Some Final Words of Self Care

If you’d like to try replacing your depression medication with exercise, please talk with your prescribing doctor first. 

Quitting psychiatric medications abruptly can result in serious withdrawal symptoms, and your provider can help you wean off your medications safely over time to avoid or minimize painful or otherwise disruptive side effects. Until you talk to your healthcare provider, keep your medications at your normal dose and start (or continue) exercising. There’s no rush. After you’ve safely weaned off your medications, you’ll be able to see more clearly whether exercise is a good substitute for the meds.

If you find that an exercise program doesn’t help alleviate your depression and/or you’re too depressed to get started with regular exercise in the first place, please reach out to a health professional you trust.

Movement Boosts Mood

Whether you can manage a lot of exercise or only a little, increasing the physical activity you do can have a significant impact on your mood and can help alleviate feelings of depression, anxiety, and stress.

The ideal is to team aerobic and resistance exercise, but just doing what you can manage, particularly if it’s enjoyable activities in the open air, is a good start.At the Ruscio Institute for Functional Health, we have a team of highly qualified functional health practitioners who can help you with a range of health issues, including depression and anxiety. We use mostly dietary and lifestyle approaches with a big focus on gut health. If this is something you are interested in working on with us, please reach out.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References
  1. Mental Health Benefits of Exercise and Physical Activity | National Institute on Aging [Internet]. [cited 2023 Aug 22]. Available from: https://www.nia.nih.gov/health/infographics/mental-health-benefits-exercise-and-physical-activity
  2. Singh B, Olds T, Curtis R, Dumuid D, Virgara R, Watson A, et al. Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. Br J Sports Med. 2023 Feb 16; DOI: 10.1136/bjsports-2022-106195. PMID: 36796860.
  3. Bharti N, Hrubeniuk T, Mayo A, Sénéchal M, Bouchard DR. Resistance training contribute to the aerobic components of an exercise session in adults but not as much in older adults. Int J Exerc Sci. 2017 May 1;10(3):406–16. PMID: 28515837. PMCID: PMC5421976.
  4. Miller KJ, Areerob P, Hennessy D, Gonçalves-Bradley DC, Mesagno C, Grace F. 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. F1000Res. 2020 Nov 13;9:1325. DOI: 10.12688/f1000research.27123.2. PMID: 34158928. PMCID: PMC8191520.
  5. Siah CJR, Goh YS, Lee J, Poon SN, Ow Yong JQY, Tam W-SW. The effects of forest bathing on psychological well-being: A systematic review and meta-analysis. Int J Ment Health Nurs. 2023 Aug;32(4):1038–54. DOI: 10.1111/inm.13131. PMID: 36864583.
  6. Nguyen P-Y, Astell-Burt T, Rahimi-Ardabili H, Feng X. Effect of nature prescriptions on cardiometabolic and mental health, and physical activity: a systematic review. Lancet Planet Health. 2023 Apr;7(4):e313–28. DOI: 10.1016/S2542-5196(23)00025-6. PMID: 37019572.
  7. Gujral S, Aizenstein H, Reynolds CF, Butters MA, Erickson KI. Exercise effects on depression: Possible neural mechanisms. Gen Hosp Psychiatry. 2017 Nov;49:2–10. DOI: 10.1016/j.genhosppsych.2017.04.012. PMID: 29122145. PMCID: PMC6437683.
  8. Sarbadhikari SN, Saha AK. Moderate exercise and chronic stress produce counteractive effects on different areas of the brain by acting through various neurotransmitter receptor subtypes: a hypothesis. Theor Biol Med Model. 2006 Sep 23;3:33. DOI: 10.1186/1742-4682-3-33. PMID: 16995950. PMCID: PMC1592480.
  9. Wang Y-H, Zhou H-H, Luo Q, Cui S. The effect of physical exercise on circulating brain-derived neurotrophic factor in healthy subjects: A meta-analysis of randomized controlled trials. Brain Behav. 2022 Apr;12(4):e2544. DOI: 10.1002/brb3.2544. PMID: 35274832. PMCID: PMC9014996.
  10. da Cunha LL, Feter N, Alt R, Rombaldi AJ. Effects of exercise training on inflammatory, neurotrophic and immunological markers and neurotransmitters in people with depression: A systematic review and meta-analysis. J Affect Disord. 2023 Apr 1;326:73–82. DOI: 10.1016/j.jad.2023.01.086. PMID: 36709828.
  11. Schuch FB, Deslandes AC, Stubbs B, Gosmann NP, Silva CTB da, Fleck MP de A. Neurobiological effects of exercise on major depressive disorder: A systematic review. Neurosci Biobehav Rev. 2016 Feb;61:1–11. DOI: 10.1016/j.neubiorev.2015.11.012. PMID: 26657969.
  12. Morgan JA, Olagunju AT, Corrigan F, Baune BT. Does ceasing exercise induce depressive symptoms? A systematic review of experimental trials including immunological and neurogenic markers. J Affect Disord. 2018 Jul;234:180–92. DOI: 10.1016/j.jad.2018.02.058. PMID: 29529552.

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