by ONEt True Mind + Body, a mental health clinic in Northbrook, Illinois, therapy goes far beyond the couch. Adult clients can book “walk-and-talk” sessions with a therapist, working through issues while strolling in the fresh air (or on a treadmill, if inclement weather warrants). Or they can sign up for in-house yoga classes that promote mindfulness and are followed by group discussions. Children and teenagers, meanwhile, can get therapy appointments while shooting hoops, traversing an obstacle course or playing soccer in one of the clinic’s exercise rooms.
The idea behind this holistic approach, says co-founder and licensed clinical social worker Melissa Novack, is to supplement traditional mental health treatment with the healing power of movement, which has been shown in numerous studies to improve both psychological and physical health.
“Science tells us we’re one workout away from a good mood,” says Novack. Combining that workout with therapy is especially beneficial, she says, because clients can gain a “sense of productivity or purpose when they move.” People who feel nervous in traditional therapy sessions – especially children – can also feel at ease when they are active.
The idea of mixing movement with mental health is not entirely new. Wilderness therapy programs that combine behavioral support and outdoor adventure have been around for decades, and many clinics have adopted the walk-and-talk model to get clients moving. Other therapists integrate nature into their appointments, either by hiking, gardening or forest bathing.
Although not all of these approaches have been formally studied, some research suggests they are onto something. Several recent studies have concluded that mental health treatments are more effective when combined with physical activity programs, supporting the idea that therapy can be about much more than just talking.
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The combination of exercise and therapy does not necessarily have to be at the same time to be beneficial, says Jennifer Thomas, a health and wellness researcher at Britain’s Swansea University who has studied the benefits of combining exercise and therapy. Some of the studies she analyzed for a 2020 research review involved programs that blended exercise directly into therapy sessions, while others staggered the timing of treatment and exercise. As long as people received both mental health treatment and followed a specific physical activity plan during the same time period, she says, the benefits tended to build on each other.
“Regardless of what type of exercise you do or what you add to it, it’s most likely going to benefit the patients,” says Jacqueline Lee, a graduate student in neuroscience at the University of British Columbia and co-author of a 2021 research review on the benefits of combined exercise and mental health treatment.
Why does exercise have such a strong effect on mental health? It’s a question scientists are still studying, but there seem to be several paths. Studies have long shown that exercise releases feel-good endorphins, and animal research suggests that it can also increase the brain’s supply of neurotransmitters, which can improve mood and reduce stress, anxiety and depression. Exercise has also been shown to increase blood flow to and stimulate nerve growth in the brain, which can improve cognitive health and function, potentially leading to psychological benefits including preventing or improving depressive symptoms. Physical activity is also linked to better sleep, which in itself is beneficial for mental health.
These effects can be powerful. A report by the World Health Organization published on 17 February estimates that if everyone in the EU got at least 150 minutes of weekly physical activity, there would be 3.5 million fewer new cases of depression there by 2050 – a reduction that represents about 10% of the number of EU- residents who are currently estimated to have depression.
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Depression appears to be a particularly strong target for combined exercise and mental health treatment regimens. A 2020 research review found that behavioral therapy combined with exercise alleviated depressive symptoms—but not symptoms of anxiety—better than therapy alone. The review Lee co-authored also found that patients had fewer depressive symptoms when they combined their usual treatment – either pharmaceutical or therapeutic – with physical activity, rather than following the usual treatment plan alone. Exercise may even make patients more likely to adhere to their other treatment programs, her research suggests.
There’s no single “best” form of exercise for mental health, says Thomas, nor is there a set amount someone needs to do to feel better. While US public health guidelines recommend getting at least 150 minutes of moderate or 75 minutes of vigorous activity per week, studies suggest that almost any amount of movement can improve mental and physical health.
Still, while any style of exercise can be beneficial, Thomas’ research suggests that physical activity has the greatest impact on mental well-being when it fulfills certain psychological needs, including feeling competent, connecting with others, and mastering tasks or skills. The most effective exercise programs, she says, are tailored to the person’s preferences, include a social element and plenty of encouragement, and are neither too challenging nor too easy—a sweet spot that provides the satisfaction of completing a difficult task without becoming overly daunting. . When done correctly, any form of exercise can fulfill these values, says Thomas.
While researchers are still determining exactly why physical activity has such a strong psychological effect, Lee says there is already more than enough evidence to support the idea of adding exercise to mental health treatment.
“There’s really almost no disease or illness where exercise doesn’t help patient outcomes,” says Lee. “There are no downsides and so many upsides.”
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