FPIN's Clinical Inquiries

Physical Activity and the Prevention of Depression


Am Fam Physician. 2021 Aug ;104(2):204-205.

Clinical Question

Can physical activity prevent the development of depression?

Evidence-Based Answer

Yes. Physical activity appears to be associated with a lower risk of developing depression and depressive symptoms. (Strength of Recommendation: B, based on a systematic review of cohort trials and individual randomized controlled trials [RCTs] and cohort trials.)

Evidence Summary

A 2018 meta-analysis of 49 prospective cohort studies (N = 266,939) examined whether physical activity decreases the risk of developing depression.1 Study participants did not have depression at baseline. Most of the studies enrolled adults, although some also enrolled children and older adults. Physical activity was self-reported and was defined as any bodily movements requiring energy expenditure. Depression was diagnosed using defined cutoffs from a variety of depression screening instruments. Trials were one year or longer. Compared with patients who had low levels of physical activity, those engaged in high levels of physical activity (definition varied by study; included groups with greater frequency, intensity, and volume of physical activity) had a lower risk of developing depression (36 trials; odds ratio [OR] = 0.83; 95% CI, 0.79 to 0.88; I2 = 0). The included studies were conducted in diverse geographic regions, and this meta-analysis found a range of ORs among different areas (0.65 to 0.84); however, in each region, physical activity was found to be protective against developing depression. The protective effect of physical activity against depression was similar among the different age groups (two trials; OR = 0.90; 95% CI, 0.83 to 0.98 for children; eight trials; OR = 0.78; 95% CI, 0.70 to 0.87 for adults; and nine trials; OR = 0.79; 95% CI, 0.72 to 0.86 for older adults).

A 2018 prospective cohort study, with 33,908 healthy adults living in a rural area of Norway, examined whether exercise was protective against new-onset depression.2 Patients were followed for an average of 11 years (range =

Address correspondence to Corey Lyon, DO, at corey.lyon@anschutz.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


1. Schuch FB, Vancampfort D, Firth J, et al. Physical activity and incident depression: a meta-analysis of prospective cohort studies. Am J Psychiatry. 2018;175(7):631–648.

2. Harvey SB, Øverland S, Hatch SL, et al. Exercise and the prevention of depression: results of the HUNT cohort study. Am J Psychiatry. 2018;175(1):28–36.

3. Paolucci EM, Loukov D, Bowdish DME, et al. Exercise reduces depression and inflammation but intensity matters. Biol Psychol. 2018;133:79–84.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.



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