In the immortal words of Elle Woods in Legally Blonde, “Exercise gives you endorphins. Endorphins make you happy.” She was right. Anyone who’s ever broken a sweat knows the power of that feel-better energy after a head-clearing run or a sweaty group fitness class. And scientific research backs this up.
Seventy-eight percent of people said in a recent US survey that their mental and emotional well-being was their number one reason for exercising. And in another survey, 44 percent of people rated mental health as their top health concern in 2023. Yet the conversation around utilizing physical activity as an Rx of sorts remains a complicated one, experts agree.
Exercise is often more accessible and affordable than traditional treatment methods, so it’s no wonder that hashtags like #runningismytherapy (which has been used nearly 1.3 million times on Instagram) or #movementismedicine (used 1.7 million times) are all over social media feeds.
The sticking point is that conflating exercise with therapy may be a large oversimplification. And even suggesting it’s as powerful as therapy or medication, or that it can replace them, could stigmatize the use of crucial mainstream interventions, says Angel Brutus, PsyD, lead psychological services provider on the United States Olympic and Paralympic Committee and a fellow at the Association for Applied Sport Psychology.
As science and the numbers show, working out is a valuable tool in dealing with mental health disorders—but it’s not always a solution on its own. You can use it healthily and in conjunction with other proven ways of improving mental health, but it’s important to be aware of how you use exercise as an outlet. Let’s unpack, shall we?
How Exercise Affects Your Brain
When you work out, your body boosts the release of neurotransmitters like endorphins (which act as natural pain relievers) and dopamine (which plays a role in pleasure and motivation). It also triggers the release of oxytocin, a hormone that increases your pain threshold and has an antianxiety effect, as well as serotonin, a chemical that helps stabilize your mood and sense of well-being. Obviously, “all of those things can support our mental health,” says Brutus.
But the longer-term effects could be what make the *real* difference. “Exercise can increase the level of brain-derived neurotrophic factor, a molecule that helps us produce new neurons in the part of the brain involved in emotional regulation,” says Arash Javanbakht, MD, director of the Stress, Trauma, and Anxiety Research Clinic at Wayne State University and author of Afraid: Understanding the Purpose of Fear and Harnessing the Power of Anxiety. There’s also research that suggests a link between inflammation and depression and anxiety, “and exercise is known to have an anti-inflammatory effect,” adds Dr. Javanbakht.
The mood-boosting effects of movement have made headlines recently, with researchers suggesting physical activity be viewed as a first-choice treatment for people with mental health issues. Exercise was also declared to be more beneficial for conditions such as anxiety and depression than standard psychotherapy or medications, in one meta-analysis published in the British Journal of Sports Medicine. Similarly, running had effects comparable to antidepressant medication on the physical health of 141 subjects in a new study in the Journal of Affective Disorders.
It’s not just cardio that seems to help either. Another recent meta-analysis, published in Frontiers in Psychiatry, found, in looking at 58 different studies, that 30 to 60 minutes of resistance exercise done three to four times a week for more than six weeks was the most effective type of training to improve depression and anxiety in youths. Whew!
So Where’s the Rx?
Here’s the rub: What exercise is really targeting in these studies are the symptoms of anxiety, depression, and psychological distress. “Symptoms of a mental health condition are like an engine light that turns on in your car,” says Chris Sherman, LPC, a counselor and personal trainer in Washington, D.C. Sometimes a quick fix is enough to address the issue. “But oftentimes those symptoms are sending us an important signal that there are deeper needs to address. In that case, exercise may be like driving with your hand over the check-engine light for a few hours so you don’t have to see the reality of what’s not working.”
Movement is not yet an approved prescription because “treatment is something that has a clear mechanism of how it changes the pathology,” says Dr. Javanbakht. If a doctor prescribes an antidepressant or antianxiety med, they know how it works in the brain and what effect if will have on that specific disorder; if a therapist uses a specific psychotherapy approach with a patient, it’s because that tool has been proven to resolve mental or emotional issues.
Ultimately, a lot more research is needed to understand the type, duration, and frequency of exercise that might work for different people, and also to consider through a cultural lens all the underpinnings that impact access, “if exercise is to ever be used as a stand-alone approach,” Brutus says. “It’s prudent for governing bodies and organizations like the World Health Organization [WHO] to not outright declare that exercise is a go-to prescription but that it can be adjunct or additive. That helps people understand not everyone is the same or will respond with the same treatment outcomes.”
Instead, movement is suggested as a second-line option for the treatment of depression—following recommended psychotherapy and antidepressants—in the American Psychological Association’s clinical guidelines, last updated in 2019.
Why Therapeutic Doesn’t Equal Therapy
Exercise can be a powerful coping mechanism or a strategy used under stress to help manage difficult emotions—and that might be enough for some people.
But it’s important to understand the difference between something that is therapeutic and actual therapy. The latter “is steeped in science,” says Brutus. “It’s a structured, formalized treatment approach.” A therapist’s role is to help someone gain awareness of unhelpful thought or behavior patterns and help them challenge and change those patterns, says Sherman.
Let’s say exercise helps you calm down after an argument. That’s great, except you can’t always exercise right after an argument! And sometimes a squabble might make you so mad that no amount of sweat can calm you down. In therapy, you learn other interventions—like deep breathing, mindfulness, and conflict resolution skills—that allow you to calm your nervous system and handle big emotions.
A Dream Combination
For now, despite its myriad benefits, exercise currently falls more squarely in that therapeutic category. “Exercise is not a treatment. It’s a lifestyle change,” says Dr. Javanbakht. In fact, it’s a foundational part of healthy functioning and self-care, along with sleep, diet, and social connection.
It doesn’t replace proven fixes and protocols for mental health issues. When exercise was combined with standard treatments, it led to significantly greater antidepressant effects over standard treatment alone, a recent scientific review in the Journal of Affective Disorders determined. “People are going to have different needs, brain chemistry, and abilities to adhere to certain things,” says Sherman. “The more effective tools you have in your tool kit to handle life situations, the better off you’ll be.”
Hear this: *No one* is saying you shouldn’t use exercise to help stress or sadness. “It might offer perspective and space so that your brain has the clarity to problem-solve and alleviate feelings of anxiety, fear, distress, or sorrow,” says Sherman. “But anxiety and depression are broad categories, and an exercise ‘prescription’ minimizes the reality of these complex conditions.” Read: Movement is magic, but mind mending is multifaceted.
This story originally appeared on Women’s Health U.S.
