HIIT workouts are a great way to complete a high-intensity exercise routine (Photo by Jacob Lund on Shutterstock)
In A Nutshell
- New research highlights that the link between exercise and mental health is more complex than widely believed.
- Leisure-time activities like sports or gym workouts are consistently linked to lower depression and anxiety, but work-related or household chores may not provide the same benefit, and can sometimes correlate with worse outcomes for some groups.
- Placebo effects and contextual factors, like group settings or supportive programs, play a huge role in whether exercise helps.
- The authors argue that while exercise can help, it won’t fix the broader social and economic drivers of mental health issues on its own.
ATHENS, Ga. — For decades, the prescription has been simple: feeling down? Hit the gym. Stressed? Go for a run. Depression got you down? Start lifting weights. But new research from top universities is turning this conventional wisdom on its head, revealing that the relationship between exercise and mental health is far more complicated than anyone imagined.
A major study published in Medicine & Science in Sports & Exercise found that while exercise does benefit mental health, the effects are often smaller than expected and may be largely due to placebo responses. Even more surprising: certain types of physical activity, such household chores or work-related movement, might not provide the same mental health benefits, and in some cases may even be linked to worse outcomes for certain groups.
The research team noted that “mental health benefits of exercise may be partially a placebo response or result from contextual factors surrounding exercise programs.” This revelation comes as America grapples with a mental health crisis, with 10% of adults and 20% of teens experiencing depression annually.
“For example, if a soccer player runs down the field and kicks the game-winning ball, their mental health is fantastic,” said co-author Patrick O’Connor, of the University of Georgia, in a statement. “In contrast, if you do the exact same exercise but miss the goal and people are blaming you, you likely feel very differently. Anecdotes such as these show how context matters even when people are performing a similar exercise dose.”
Playing sports has long been linked to better mental health outcomes; but researchers say that a poor performance or causing a team to lose can have the opposite effect on athletes. (© ALAIN VERMEULEN – stock.adobe.com)
The Exercise Equity Gap Nobody Talks About
The study revealed a troubling disparity in who actually benefits from physical activity. Large-scale population studies consistently show that people who engage in recreational exercise — sports, hiking, gym workouts — report lower rates of depression and anxiety. But this advantage doesn’t extend to other forms of movement.
Latino adults in the United States have the highest overall physical activity levels when measured by fitness trackers, but most of it comes from manual labor jobs rather than leisure activities. Despite being the most physically active group, they have the lowest rates of recreational exercise among all ethnicities.
This creates what researchers describe as a potential equity problem. People who lack time, money, or safe access to recreational facilities are told to exercise more while receiving little psychological benefit from their existing physical activity.
The Placebo Effect Problem
Clinical trials present an even more complex picture. While hundreds of studies show exercise can improve mental health symptoms, they suffer from a fundamental flaw: participants always know whether they’re exercising or sitting still.
Unlike drug studies where patients receive identical-looking pills, it’s impossible to hide whether someone is running on a treadmill or doing nothing. This creates what researchers call “outcome expectations,” which is when people expect exercise to help because that’s what they’ve been told their entire lives.
In one analysis examining ADHD symptoms in children, researchers estimated that roughly half of exercise’s benefits came from the activity itself, while the other half stemmed from contextual factors like behavior management programs. When researchers compared exercise programs to equally engaging activities like arts and crafts, the mental health advantages of exercise often disappeared or shrank dramatically.
Most exercise studies also fall short of medical research standards, lasting less than six months with fewer than 100 participants, while FDA guidelines recommend following 100–300 people for up to two years.
Outcome expectations can “trick” people into believing that exercise will boost their mental health. (Credit: Unsplash+ in collaboration with Getty Images)
Context Matters More Than Cardio
Perhaps the most eye-opening discovery involves how, where, and with whom people exercise. Studies of children with ADHD found that physical activity programs only worked after researchers added psychological interventions like behavior management and reward systems — treatments that reduce ADHD symptoms on their own.
College students participating in group sports showed better mental health than solo exercisers, regardless of how much they actually moved. After-school programs with better-trained staff produced superior mental health outcomes in children, independent of the physical activities involved.
Several studies also revealed a “U-shaped” relationship between exercise and mental health: some activity beats none, but extremely high levels can actually worsen psychological outcomes. This pattern appeared across depression, anxiety, and other mental health measures.
Rethinking Exercise as Mental Health Medicine
The research team argues that treating exercise as a mental health cure-all distracts from addressing America’s real psychological wellness crisis. Social factors like economic stability, housing security, and healthcare access likely matter much more than individual exercise habits.
As the researchers put it: “Just as physical inactivity did not cause a mental health crisis of this magnitude, neither will physical activity solve our mental health crisis.”
Mental health professionals routinely prescribe exercise, insurance companies promote gym memberships as wellness benefits, and public health campaigns encourage physical activity as a psychological solution. But if household chores, work movement, and commuting don’t provide the same benefits as leisure exercise, these recommendations may miss the mark entirely.
The authors suggest recognizing that context matters enormously when it comes to exercise; not all physical activity provides equal benefits, and exercise works best as part of comprehensive mental health strategies rather than a standalone fix. Rather than abandoning exercise entirely, understanding its limitations may be key to unlocking its true potential for psychological wellness.
Disclaimer: This article summarizes findings from peer-reviewed research. It is not medical advice. Always consult a qualified healthcare professional for diagnosis or treatment of mental health conditions. The study’s conclusions highlight trends in population-level data and should not be interpreted as universal for every individual.
Paper Summary
Methodology
Researchers conducted a comprehensive review examining physical activity and mental health from three angles. They analyzed published studies and searched three major databases (MEDLINE, CINAHL, and PsycINFO) from 2018-2023, reviewing 710 abstracts. The team examined different types of physical activity (leisure, work, transportation, household) and evaluated existing research on exercise interventions and contextual factors that influence mental health outcomes.
Results
Leisure-time physical activity consistently linked to reduced depression, anxiety, and dementia risk in large population studies. However, evidence for mental health benefits from work, transportation, or household physical activity was limited or mixed. Clinical trials supported exercise benefits but showed small effect sizes, especially in healthy populations. Approximately half of exercise’s mental health benefits may be due to placebo effects. Contextual factors like social environment and program quality significantly influenced outcomes independent of physical activity levels.
Limitations
Most exercise studies were too small (under 100 participants) and short (under 6 months) for reliable conclusions. Participants can’t be blinded to exercise interventions, creating bias from expectations. Publication bias favors positive results. Research primarily focused on white, higher-income populations, limiting broader applicability. Studies often failed to account for contextual factors beyond physical activity.
Funding and Disclosures
No authors received funding for this work. They reported no financial relationships with companies that would benefit from the research. One author previously worked for the Centers for Disease Control and Prevention, but findings represent only the authors’ views.
Publication Information
Published as “Up for Debate: Does Regular Physical Activity Really Improve Mental Health?” by Eduardo E. Bustamante, Angelique G. Brellenthin, David R. Brown, and Patrick J. O’Connor in Medicine & Science in Sports & Exercise, Volume 57, Number 5, pages 1056-1066, 2025. Based on a 2023 American College of Sports Medicine colloquium in Denver, Colorado.