David Rakel

“Exercise as Medicine More than 1000 trials have examined the relationship between exercise and depression, and most have demonstrated an inverse relationship between them.13,14 Physical activity may also prevent the initial onset of depression.15,16 Regularly performed exercise is as effective an antidepressant as psychotherapy or pharmaceutical approaches.13,17–21 Well-designed studies also support that exercise combined with pharmacologic treatment is superior to either alone, but exercise appears to be superior in maintaining therapeutic benefit and preventing recurrence of depression.22–26 Evidence provides some support for the use of exercise. A recent Cochrane review (updated from 2009) included 32 studies (n=1858) involving exercise for the treatment of researcher-defined depression. From these studies, 28 randomized controlled trials (RCTs) (n=1101) were included in a meta-analysis revealing a moderate to large effect in favor of exercise over standard treatment or control. However, only four trials (n=326) with adequate allocation concealment, blinding, and ITT analysis were found, resulting in a more modest effect size in favor of exercise. Pooled data from seven trials (n=373) with long-term follow-up data also found a small clinical effect in favor of exercise.28 The additional benefits that may be attained by patients who exercise, including increased self-esteem, increased level of fitness, and reduced risk of relapse, make exercise an ideal intervention for patients suffering from depression. Both aerobic and anaerobic activities are effective.19,23,33,34 Regardless of the type of exercise, the total energy expenditure appears more important than the number of times a week a person exercises, and high-energy exercises are superior to low-energy exercises.”
― David Rakel, Integrative Medicine - E-Book