The psychiatrist reaches for his prescription pad—not to prescribe an antidepressant, but a walk.
“Ten minutes a day,” he says. “No copay. No waitlist. No warning labels.”
The fact that this scene still feels like fantasy is precisely the problem we face today, according to Dr. Nicholas Fabiano, lead author of a recent editorial in the British Journal of Sports Medicine and a psychiatry resident at the University of Ottawa.
“We still separate physical and mental health in ways that don’t make clinical sense,” he told The Epoch Times.
The separation began in the 17th century, with philosopher René Descartes arguing that the mind is distinct from the body. Modern medicine absorbed that divide, and it continues to shape how we diagnose, treat, and heal.
But depression doesn’t respect that boundary.
Fabiano argues that exercise should be prescribed as a first-line treatment for depression, not offered as an afterthought—and the evidence backs him up.
How Strong Is the Evidence for Exercise?
“Across studies, [exercise’s] effect size is at least as good as an SSRI, and it may have a longer-lasting tail,” Dr. Charles Raison, professor of psychiatry at the University of Wisconsin, where his lab studies novel mechanisms in depression treatment, told The Epoch Times. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed type of antidepressant.
A newly published Cochrane review of 73 randomized trials—one of the most rigorous analyses to date—found that exercise is effective in treating depression and is on par with antidepressants and talk therapy.
In a clinical trial, researchers from Duke University Medical Center assigned depression patients to one of three treatments: an exercise program, exercise combined with antidepressant medication, or antidepressant treatment alone. More than 60 percent of participants achieved remission after the treatment program, regardless of the treatment regimen.
However, six months after treatment, those in the exercise program had the highest rates of continued recovery and less relapse. Regular exercise after treatment may explain why some patients recover better.
The effects of antidepressants often fade once the medication stops, Raison notes, meaning many patients require ongoing drugs or additional support.
The evidence keeps growing. A 2023 umbrella review in the British Journal of Sports Medicine—drawing on more than 1,000 clinical trials—found that physical activity has a “large and significant” effect on depression, anxiety, and distress across ages and health conditions.
For Fabiano, the science became personal when he had nerve damage for months, distressing him mentally. This made the mind-body link impossible to ignore—and helped shape Fabiano’s view that physical movement can also influence the mind.
How Movement Resets the Body
Think of exercise as a biological reset button—one that helps your whole system find its balance again.
Anyone who’s felt a mood shift after a walk on a bad day knows that change isn’t just mental. Shoulders loosen. Breathing deepens. Everything starts to ease.
“Exercise acts as an adaptive stressor—a short, controlled dose of stress that prompts the body to recalibrate,” Raison said. “You don’t get stronger while you’re lifting; you get stronger when your body rebuilds after. Exercise works the same way [for mood].”
Even a short walk can start this process. As your heart rate and core temperature rise, your body cools itself through two simple mechanisms: sweating and widening blood vessels near the skin. Those temperature changes might seem minor, but they ripple through your immune system—calming down inflammation.
Many people living with depression have slightly elevated body temperatures and chronic low-grade inflammation. The rebound from exercise is part of why many people instinctively go for a walk to feel clearer.
How Movement Rewires the Brain
Movement doesn’t just affect the body—it helps restore the brain, too.
Regular exercise boosts chemical messengers that help nerve cells grow and connect in ways that support mood and thinking. This particularly benefits the hippocampus, a brain region that handles memory, which is affected in depression.
Exercise also activates the body’s endocannabinoid system, which lifts and stabilizes mood, while calming the stress-response system that tends to stay overactive in depression. Brain imaging studies show it can quiet areas linked to rumination and self-critical thought—two mental loops that can trap people in depressive states.
The real benefit, however, goes beyond a quick lift in mood.
Over weeks and months, these physiological and neurological changes help the brain and body regulate stress more effectively, reduce inflammation, and therefore lower the risk of relapse.
And it doesn’t require a marathon. Just a few minutes of movement, done consistently, can start this positive chain reaction.
“People often assume exercise has to mean going to the gym for an hour,” Ana Abrantes, professor of psychiatry and human behavior at Brown University and co-director of Behavioral Medicine & Addictions Research at Butler Hospital, told The Epoch Times. But research shows even five or 10 minutes of movement a day can help shift mood.
Yet, for many patients, even the small shift of exercise remains frustratingly out of reach.
Why Care Doesn’t Match the Science
The science on exercise and depression is clear. But the U.S. mental health system isn’t designed to act on it. The problem runs deeper than individual doctors—it’s built into how medicine is taught, practiced, and paid for.
A recent U.S. survey backs this up: 92 percent of mental health professionals never learned how to prescribe exercise during their training.
As Abrantes noted, many clinicians simply don’t know how to move beyond vague encouragement. “Most don’t really know how much more to say to patients beyond ‘You should exercise because it’ll help you feel better,” she said.
Even when clinicians believe in the evidence, many feel unprepared to assess fitness levels or tailor movement plans. Fewer than one in three medical practitioners give exercise recommendations to patients in line with national guidelines.
The system doesn’t make it easy. Unlike pills and therapy, movement isn’t built into the treatment guidelines, billing systems, or referral pathways. If a psychiatrist wants to prescribe a medication, it takes seconds—the pharmacy fills it and insurance covers it.
However, there’s no billing code for exercise and no insurance coverage for structured movement programs. Even when clinicians want to recommend it, patients usually have to sort out the details themselves—deciding what to do, how to do it, and how to pay for it, whether that means a gym membership, fitness classes, or a personal trainer.
If exercise is framed as a real treatment and people have a place to go and someone expecting them, they’re much more likely to do it, Raison says.
But even with better systems, there’s another problem: Depression itself can make taking those first steps feel impossible.
Why ‘Just Go for a Walk’ Isn’t That Simple
On paper, “10 minutes a day” seems simple. In real life, it’s anything but.
“We have to be realistic about what depression feels like,” Fabiano said. “Getting out of bed, let alone going for a run, can feel impossible.”
On the hardest days, depression itself actively works against the very behaviors that would help ease it. And “just get outside” can sound less like encouragement and more like blame.
The resistance to exercise isn’t just in the mind; it’s a deep biological one. Raison noted that the inflammation from depression can trigger “sickness behavior,” an ancient survival response that once helped people conserve energy and not spread infection.
“It’s not laziness,” Raison said. “It’s biology.”
Many people with depression also live with other health issues—chronic pain, obesity, diabetes, cardiovascular disease, or sleep disorders—that make movement even harder. More than half of patients cite this mix of emotional and physical barriers as a key reason why they struggle to stay active.
What Exercise Prescriptions Could Look Like
To make exercise a real clinical tool, Fabiano and others argue, it needs the same structure and follow-through as any other treatment.
“With medication, patients know what they’re taking, how often, and what to expect,” Fabiano said. “With exercise, the advice is usually something vague like ‘go for a run.’ That’s the equivalent of saying ‘take a pill’ without any details.”
One practical framework is FITT, which breaks a plan into four parts: frequency (how often), intensity (how hard), time (how long), and type (what kind of activity).
Using FITT, a psychiatrist can tailor activity to a person’s fitness, symptoms, and goals. For some, that might mean gentle walking three times a week. For others, it might mean supervised group sessions.
And just like any treatment, prescribing exercise isn’t a one-time conversation. It works best with monitoring, follow-up, and adjustments over time. Psychiatrists don’t just hand out medication and walk away—they check in to see if and how it’s working.
But for that to happen, the system has to make it possible.
For patients with low energy, fatigue, and hopelessness, supported exercise, such as with a coach, joining a group, or regular check-ins, creates accountability that improves follow-through.
Trials in the updated Cochrane review echo this, with many of the most effective interventions delivered as structured, supervised programs, often in groups, rather than as “be more active” advice. When motivation is low, accountability gives people the social support to show up and lets motivation catch up later.
“People tend to show up when someone’s expecting them,” Raison said. “That kind of positive peer pressure can make a huge difference.”
What’s Already Working
Other countries have already shown what a system built to use science can look like.
In the UK, national guidelines prescribe supervised group exercise—45 to 60 minutes, three times a week, for 10 to 14 weeks—for mild to moderate depression. Group exercise is accepted as a first-line option alongside medication and psychotherapy in these guidelines.
Australia goes further. Its guidelines recognize regular exercise—whether aerobic, strength, or a mix—as a frontline treatment on par with medication or psychotherapy.
One U.S. health system is following suit. In Colorado’s Vail Valley, Vail Health’s Healthspan program builds movement, sleep, and nutrition into treatment from day one. Patients enrolled in the multi-month, lifestyle-first program receive baseline fitness testing, including VO2 max, strength assessments, and body-composition scans, along with personalized exercise plans and regular check-ins with coaches, nutritionists, and functional-medicine clinicians.
Walk into the outpatient clinic and the emphasis is immediately visible: The front room is filled with exercise machines.
“All of our psychiatric providers look at root cause and whole-person health,” psychiatrist Dr. Elaine Sandler, director of outpatient psychiatry at Vail Health Behavioral Health, told The Epoch Times.
Medication and therapy may still be part of treatment, she said, but Vail Health also focuses on “the fundamentals—movement, sleep, and nutrition.”
Policy nationwide may be starting to shift. The Society of Behavioral Medicine and patient advocacy groups have urged Medicare, Medicaid, and private insurers to cover evidence-based exercise programs for people with serious mental illness.
After piloting the program with its own employees in 2025, Healthspan is now open to patients across its system, inviting anyone in its care to enroll.
In a country where exercise is still rarely written into the treatment plan, programs such as Healthspan offer a blueprint of what U.S. care could look like. Prescribing movement for depression is one way to start stitching the mind and body back together, centuries after Descartes split them apart.
“Movement is medicine,” Sandler said.