Should Exercise Be Considered a First-line Treatment for Mental Health Conditions?

A reader asks:

I saw an article the other day that said exercise should be considered the first line treatment for mental health conditions because research has shown that it’s as least as effective as therapy or medication. Do you agree? Or is that an oversimplification?

It’s definitely an oversimplification.

For one thing, there are many types of mental health struggles where exercise is just obviously not a good idea as a first-line treatment. If someone’s just a had a psychotic break and is actively hallucinating, for example, putting them on a treadmill is unlikely to be the best things for them at that moment. Or if someone has a severe eating disorder, while exercise might be helpful to that person, I doubt it should be the first-line treatment (it could even be dangerous in this case).

Most of the research on the effectiveness of exercise as a treatment for mental health struggles is in mild to moderate anxiety and depression. And while those make up the vast majority of mental health struggles, it’s dangerous to conflate those with mental health struggles broadly speaking.

Another point I’d make is that this whole line of thinking where we look for a single best treatment—whether that’s drugs, talk therapy, or exercise—for a mental health struggle is a little silly. Most mental health struggles are complex phenomena which are maintained by many variables on a variety of levels from the neurochemical to the social. If you struggle with anxiety, for example, it’s very likely that your patterns of thinking and self-talk play a large role. But everything from your genetics to your diet to the quality of your primary relationships are likely playing important roles as well. Consequently, the idea that one intervention (like exercise, for example) is sufficient to address that struggle in a meaningful and lasting way seems unlikely bordering on naive.

There are no silver bullets.

That said, I do think exercise is a highly underrated tool in helping people address many mental health struggles. In fact, I make it habit that before I talk about any psychological technique for addressing an emotional problem I remind people that if you’re not doing at least a minimum to take care of your body—especially sleep, diet, and movement—it’s unlikely that even the best psychological approach will work well.

The brain is part of the body, and if you’re not taking care of your body, you can’t expect your brain to take care of you.