Study details and key findings

For the study, researchers recruited 141 patients from depression and anxiety outpatient clinics in the Netherlands. All patients either had major depressive disorder or an anxiety disorder, including social phobia and generalized anxiety disorder. The mean age of the patients was 38.2 years, and 58.2% were women.  

The researchers gave patients the option to either be randomized into two treatment groups (antidepressants or running therapy) or to choose which treatment group they wanted to be in. A minority of participants was randomized, and more patients chose the running therapy. In total, 45 patients received antidepressant medications, and 96 underwent running therapy.

Patients in the antidepressant group received escitalopram, an SSRI, with an initial dosage of 10 mg per day. A psychiatrist provided medication management at the study onset and at different points during the study period. Patients in the running group aimed to participate in two to three "closely supervised" 45-minute running sessions per week. The researchers followed both groups for 16 weeks.

Overall, around 44% of participants in both groups showed improvements for both depression and anxiety at the end of the study period. The running group also had additional improvements to their physical health, such as weight, waist circumference, blood pressure, and heart function, while those in the antidepressant group had slight declines in these metabolic markers.

"Antidepressants generally had worse impact on body weight, heart rate variability and blood pressure, whereas running therapy led to improved effect on general fitness and heart rate for instance," said Brenda Penninx, a researcher at Vrije University in Amsterdam and one of the study's authors.

However, adherence to treatment was much lower in the running group. Only 52% of patients in the running group completed the treatment compared to 82% of the antidepressant group.

"The study shows that lots of people like the idea of exercising, but it can be difficult to carry this through, even though the benefits are significant," Penninx said. "Telling patients to go run is not enough. Changing physical activity behavior will require adequate supervision and encouragement as we did by implementing exercise therapy in a mental health care institution."

Commentary

Other studies have suggested that exercise could be more effective as a treatment for depressive or anxiety disorders than antidepressants. For example, a study published in the British Journal of Sports Medicine in February found that exercise effectively treated depression and depressive symptoms and should be offered to patients as a potential treatment option.

Separately, Michael Craig Miller, a professor of psychiatry at Harvard Medical School, said that exercise can work "as well" as antidepressants as a treatment for depression, but "exercise alone isn't enough for someone with severe depression."

According to Penninx, "[w]e know that not treating depression at all leads to worse outcomes; so antidepressants are generally a good choice," but "we need to extend our treatment arsenal as not all patients respond to antidepressants or are willing to take them."

The study gave "anxious and depressed people a real-life choice" about their treatment, Penninx said. And "[o]ur results suggest that implementing exercise therapy is something we should take much more seriously, as it could be a good – and maybe even better – choice for some of our patients."

"It is important to say that there is room for both therapies in care for depression," she added. (Diaz, New York Post, 10/6; Roush, Forbes, 10/6; Verhoeven et al., Journal of Affective Disorders, 5/15; European College of Neuropsychopharmacology, EurekAlert!, 10/6)

Unmet behavioral health needs are pushing the health care system to a breaking point. Most mental health and substance use needs are worse than ever — especially for patients who are high-acuity, low-income, and/or people of color. Read on to learn  how different stakeholders can advance long-term, equitable change in behavioral health.