Effects of exercise and physical activity on depression



Depression is a very prevalent mental disorder affecting 340 million people globally and is projected to become the leading cause of disability and the second leading contributor to the global burden of disease by the year 2020.


In this paper, we review the evidence published to date in order to determine whether exercise and physical activity can be used as therapeutic means for acute and chronic depression. Topics covered include the definition, classification criteria and treatment of depression, the link between β-endorphin and exercise, the efficacy of exercise and physical activity as treatments for depression, properties of exercise stimuli used in intervention programs, as well as the efficacy of exercise and physical activity for treating depression in diseased individuals.


The presented evidence suggests that exercise and physical activity have beneficial effects on depression symptoms that are comparable to those of antidepressant treatments.

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  1. 1.

    Murray CJL, Lopez AD (1996) The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Harvard University Press, Cambridge, MA

    Google Scholar 

  2. 2.

    Kruijshaar ME, Hoeymans N, Spijker J, Stouthard ME, Essink-Bot ML (2005) Has the burden of depression been overestimated? Bull World Health Org 83(6):443–448

    PubMed  Google Scholar 

  3. 3.

    Lewinsohn PM, Rohde P, Seeley JR, Fischer SA (1993) Age-cohort changes in the lifetime occurrence of depression and other mental disorders. J Abnorm Psychol 102(1):110–120

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Escribá QR, Maestre MC, Amores LP, Pastor TA, Miralles ME, Escobar RF (2005) Depression prevalence in adolescents. Actas Esp Psiquiatr 33:298–302

    Google Scholar 

  5. 5.

    Möller HJ, Henkel V (2005) What are the most effective diagnostic and therapeutic strategies for the management of depression in specialist care? Health Evidence Network report. WHO Regional Office for Europe, Copenhagen. http://www.euro.who.int/Document/E86602.pdf, accessed 1/5/09

  6. 6.

    Babyak M, Blumenthal JA, Herman S et al (2000) Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med 62(5):633–638

    PubMed  CAS  Google Scholar 

  7. 7.

    Blumenthal JA, Babyak MA, Doraiswamy PM et al (2007) Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med 69(7):587–596

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. 4th edn. American Psychiatric Association, Washington

  9. 9.

    World Health Organization (1992) The ICD-10 Classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Royal College of Psychiatrists, London

    Google Scholar 

  10. 10.

    Powers RH, Kniesner TJ, Croghan TW (2002) Psychotherapy and pharmacotherapy in depression. J Ment Health Policy Econ 5(4):153–161

    PubMed  Google Scholar 

  11. 11.

    Klinkman MS (1997) Competing demands in psychosocial care. A model for the identification and treatment of depressive disorders in primary care. Gen Hosp Psychiatry 19(2):98–111

    Google Scholar 

  12. 12.

    Gilbody S, House A, Sheldon T (2002) Improving the recognition and management of depression in primary care. Effective Health Care 7(5):1–12

    Google Scholar 

  13. 13.

    Williams JW, Noël PH, Cordes JA (2002) Is this patient clinically depressed? J Am Med Assoc 287(9):1160–1170

    Article  Google Scholar 

  14. 14.

    Von Korff M, Katon W, Bush T et al (1998) Treatment costs, cost offset, and cost-effectiveness of collaborative management of depression. Psychosom Med 60(2):143–149

    Google Scholar 

  15. 15.

    Oxman TE, Dietrich AJ, Schulberg HC (2003) The depression care manager and mental health specialist as collaborators within primary care. Am J Geriatr Psychiatry 11(5):507–516

    PubMed  Google Scholar 

  16. 16.

    Fichna J, Janecka A, Costentin J, Do Rego JC (2007) The endomorphin system and its evolving neurophysiological role. Pharmacol Rev 59(1):88–123

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Cox RH (2002) Sport psychology: concepts and applications. McGraw-Hill Publishers, St. Louis, MO

    Google Scholar 

  18. 18.

    Navines R, Martin-Santos R, Gomez-Gil E, Martinez de Osaba MJ, Gasto C (2008) Interaction between serotonin 5-HT1A receptors and beta-endorphins modulates antidepressant response. Prog Neuropsychopharmacol Biol Psychiatry 32(8):1804–1809

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Stein DJ, van Honk J, Ipser J, Solms M, Panksepp J (2007) Opioids: from physical pain to the pain of social isolation. CNS Spectr 12 (9):669–670, 672–664

    Google Scholar 

  20. 20.

    Castilla-Cortazar I, Castilla A, Gurpegui M (1998) Opioid peptides and immunodysfunction in patients with major depression and anxiety disorders. J Physiol Biochem 54(4):203–215

    PubMed  CAS  Google Scholar 

  21. 21.

    Djurovic D, Milic-Askrabic J, Majkic-Singh N (1998) Effect of fluvoxamine on the level of beta-endorphin in the sera and nervous tissue of rats. Pharmazie 53(2):143–144

    PubMed  CAS  Google Scholar 

  22. 22.

    Mead GE, Morley W, Campbell P, Greig CA, McMurdo M, Lawlor DA (2009) Exercise for depression. Cochrane Database Syst Rev 3:CD004366

  23. 23.

    Vaccarino AL, Olson GA, Olson RD, Kastin AJ (1999) Endogenous opiates: 1998. Peptides 20(12):1527–1574

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Grisel JE, Bartels JL, Allen SA, Turgeon VL (2008) Influence of beta-endorphin on anxious behavior in mice: interaction with EtOH. Psychopharmacology (Berl) 200(1):105–115

    Article  CAS  Google Scholar 

  25. 25.

    Disham KR, O’Connor JP (2009) Lessons in exercise neurobiology: the case of endorphins. Ment Health Phys Activity (in press)

  26. 26.

    Boecker H, Sprenger T, Spilker ME et al (2008) The runner’s high: opioidergic mechanisms in the human brain. Cereb Cortex 18(11):2523–2531

    PubMed  Article  Google Scholar 

  27. 27.

    Wester HJ, Willoch F, Tolle TR et al (2000) 6-O-(2-[18F]Fluoroethyl)-6-O-desmethyldiprenorphine ([18F]DPN): synthesis, biologic evaluation, and comparison with [11C]DPN in humans. J Nucl Med 41(7):1279–1286

    PubMed  CAS  Google Scholar 

  28. 28.

    Stern RA, Arruba JE, Hooper CR, Wolfner GW, Morey CE (1997) Visual analogue mood scales to measure internal mood state in aphasic patients: description and initial validity evidence. Aphasiology 11:59–71

    Article  Google Scholar 

  29. 29.

    Finley JP, Bonet JF, Waxman MB (1979) Autonomic pathways responsible for bradycardia on facial immersion. J Appl Physiol 47(6):1218–1222

    PubMed  CAS  Google Scholar 

  30. 30.

    Goldfarb AH, Jamurtas AZ (1997) Beta-endorphin response to exercise. An update. Sports Med 24(1):8–16

    Google Scholar 

  31. 31.

    Lindstrom LH, Widerlov E, Gunne LM, Wahlstrom A, Terenius L (1978) Endorphins in human cerebrospinal fluid: clinical correlations to some psychotic states. Acta Psychiatr Scand 57:153–164

    Google Scholar 

  32. 32.

    Gross-Isseroff R, Dillon KA, Israeli M, Biegon A (1990) Regionally selective increases in μ-opioid receptor density in the brains of suicide victims. Brain Res 530:312–316

    Google Scholar 

  33. 33.

    Scarone S, Gambini O, Calabrese G et al (1990) Asymmetrical distribution of β-endorphin in cerebral hemispheres of suicides: preliminary data. Psychiatry Res 32:159–166

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Darko DF, Risch SC, Gillin JC, Golshan S (1992) Association of β-endorphin with specific clinical symptoms of depression. Am J Psychiatry 149:1162–1167

    PubMed  CAS  Google Scholar 

  35. 35.

    Gabilondo AM, Meana JJ, Garcia-Sevilla JA (1995) Increased density of μ-opioid receptors in the postmortem brain of suicide victims. Brain Res 682:245–250

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Kline NS, Li CH, Lehman HL, Lajta A, Laski E, Cooper T (1977) β-Endorphin-induced changes in schizophrenics and depressed patients. Arch Gen Psychiatry 34:1111–1113

    Google Scholar 

  37. 37.

    Jamurtas ZA, Fatouros JI (2004) The effects of exercise on the levels of beta-endorphin in blood. Inq Sport Phys Educ 2(1):93–102

    Google Scholar 

  38. 38.

    Hung HF, Kao PF, Lin YS et al (2007) Changes of serum beta-endorphin by programmed exercise training are correlated with improvement of clinical symptoms and quality of life in female mitral valve prolapse syndrome. Cardiology 108(4):252–257

    PubMed  Article  Google Scholar 

  39. 39.

    Bender T, Nagy G, Barna I, Tefner I, Kadas E, Geher P (2007) The effect of physical therapy on beta-endorphin levels. Eur J Appl Physiol 100(4):371–382

    PubMed  Article  Google Scholar 

  40. 40.

    Legrand F, Heuze JP (2007) Antidepressant effects associated with different exercise conditions in participants with depression: a pilot study. J Sport Exerc Psychol 29(3):348–364

    PubMed  Google Scholar 

  41. 41.

    Paffenbarger RS Jr, Lee IM, Leung R (1994) Physical activity and personal characteristics associated with depression and suicide in American college men. Acta Psychiatr Scand Suppl 377:16–22

    PubMed  Article  Google Scholar 

  42. 42.

    Goodwin DR (2003) Association between physical activity and mental disorders among adults in the United States. Prev Med 36(6):698–703

    PubMed  Article  Google Scholar 

  43. 43.

    Larun L, Nordheim LV, Ekeland E, Hagen KB, Heian F (2006) Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane Database Syst Rev 3:CD004691

  44. 44.

    Giacobbi RP, Hausenblas AH, Frye N (2005) A naturalistic assessment of the relationship between personality, daily life events, leisure time exercise, and mood. Psychol Sport Exerc 6:67–81

    Article  Google Scholar 

  45. 45.

    Hoffman DM, Hoffman RD (2008) Exercisers achieve greater acute exercise-induced mood enhancement the no exercisers. Arch Phys Med Rehabil 89:358–363

    PubMed  Article  Google Scholar 

  46. 46.

    McNeil JK, LeBlanc EM, Joyner M (1991) The effect of exercise on depressive symptoms in the moderately depressed elderly. Psychol Aging 6(3):487–488

    PubMed  Article  CAS  Google Scholar 

  47. 47.

    Harris AH, Cronkite R, Moos R (2006) Physical activity, exercise coping, and depression in a 10-year cohort study of depressed patients. J Affect Disord 93(1–3):79–85

    PubMed  Article  Google Scholar 

  48. 48.

    Lampinen P, Heikkinen RL, Ruoppila I (2000) Changes in intensity of physical exercise as predictors of depressive symptoms among older adults: an eight-year follow-up. Prev Med 30(5):371–380

    PubMed  Article  CAS  Google Scholar 

  49. 49.

    Herman S, Blumenthal JA, Babyak M et al (2002) Exercise therapy for depression in middle-aged and older adults: predictors of early dropout and treatment failure. Health Psychol 21(6):553–563

    PubMed  Article  Google Scholar 

  50. 50.

    Hoffman MB, Babyak AM, Sherwood A et al (2009) Effects of aerobic exercise on sexual functioning in depressed adults. Ment Health Phys Activity (in press)

  51. 51.

    Carta MG, Hardoy MC, Pilu A et al (2008) Improving physical quality of life with group physical activity in the adjunctive treatment of major depressive disorder. Clin Pract Epidemol Ment Health 4:1

    Article  Google Scholar 

  52. 52.

    Hassmen P, Koivula N, Uutela A (2000) Physical exercise and psychological well-being: a population study in Finland. Prev Med 30(1):17–25

    PubMed  Article  CAS  Google Scholar 

  53. 53.

    Beniamini Y, Rubenstein JJ, Zaichkowsky LD, Crim MC (1997) Effects of high-intensity strength training on quality-of-life parameters in cardiac rehabilitation patients. Am J Cardiol 80(7):841–846

    PubMed  Article  CAS  Google Scholar 

  54. 54.

    Dunn AL, Trivedi MH, Kampert JB, Clark CG, Chambliss HO (2002) The DOSE study: a clinical trial to examine efficacy and dose response of exercise as treatment for depression. Control Clin Trials 23(5):584–603

    PubMed  Article  Google Scholar 

  55. 55.

    Singh NA, Stavrinos TM, Scarbek Y, Galambos G, Liber C, Fiatarone Singh MA (2005) A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults. J Gerontol A Biol Sci Med Sci 60(6):768–776

    PubMed  Google Scholar 

  56. 56.

    National Institute for Health and Clinical Excellence (2007) Management of depression in primary and secondary care. http://www.nice.org.uk/nicemedia/pdf/CG023fullguideline.pdf. Accessed October 21 2009

  57. 57.

    Stanton JM, Arroll B (1996) The effect of moderate exercise on mood in mildly hypertensive volunteers: a randomized controlled trial. J Psychosom Res 40(6):637–642

    PubMed  Article  CAS  Google Scholar 

  58. 58.

    Krawczynski M, Olszewski H (2000) Psychological well-being associated with a physical activity programme for persons over 60 years old. Psychol Sport Exerc 1(1):57–63

    Article  Google Scholar 

  59. 59.

    Smith PJ, Blumenthal JA, Babyak MA, Georgiades A, Hinderliter A, Sherwood A (2007) Effects of exercise and weight loss on depressive symptoms among men and women with hypertension. J Psychosom Res 63(5):463–469

    PubMed  Article  Google Scholar 

  60. 60.

    Milani RV, Lavie CJ, Cassidy MM (1996) Effects of cardiac rehabilitation and exercise training programs on depression in patients after major coronary events. Am Heart J 132(4):726–732

    PubMed  Article  CAS  Google Scholar 

  61. 61.

    Fuchs R (2001) Physical activity and health. In: Smelser NJ, Baltes PB (eds) International encyclopaedia of the social and behavioural sciences, vol 17. Elsevier, New York, pp 11411–11415

  62. 62.

    Berkman LF, Blumenthal J, Burg M et al (2003) Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA 289(23):3106–3116. doi:10.1001/jama.289.23.3106

    PubMed  Article  Google Scholar 

  63. 63.

    van Melle JP, de Jonge P, Honig A et al (2007) Effects of antidepressant treatment following myocardial infarction. Br J Psychiatry 190:460–466. doi:10.1192/bjp.bp.106.028647

    PubMed  Article  Google Scholar 

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This work was supported in part by funding from the European Union 7th Framework Program (FP7-PEOPLE-IRG-2008 grant no. 239521).

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Correspondence to P. C. Dinas.

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Dinas, P.C., Koutedakis, Y. & Flouris, A.D. Effects of exercise and physical activity on depression. Ir J Med Sci 180, 319–325 (2011). https://doi.org/10.1007/s11845-010-0633-9

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  • Exercise
  • Depression
  • Physical activity
  • Mood
  • β-Endorphin