Psychiatrist Advocates Exercise as Primary Depression Treatment Amidst Low Prescription Rates

Ottawa, ON – Dr. Nicholas Fabiano, a psychiatry resident at the University of Ottawa, is challenging conventional approaches to depression treatment, advocating for exercise to be recognized as a first-line therapy. His call comes as a significant portion of physicians reportedly overlook physical activity in patient care. Dr. Fabiano recently discussed his views on CBC News, emphasizing the robust evidence supporting exercise's efficacy.

In an editorial published in the British Journal of Sports Medicine, Dr. Fabiano argued that "ignoring exercise as a treatment for depression isn’t just a missed opportunity. It might even cross the line into negligence." He highlighted a concerning trend, stating in his tweet, "Yet 41% never prescribe exercise to their patients." He proposes that tailored, structured exercise plans, adhering to the FITT (Frequency, Intensity, Time, Type) principle, should become as routine as antidepressant prescriptions.

Scientific research increasingly supports this stance. A comprehensive 2024 systematic review and network meta-analysis published in the BMJ concluded that exercise is an effective treatment for major depressive disorder, showing comparable benefits to psychotherapy and antidepressants. Specific modalities like walking, jogging, yoga, and strength training were found to be particularly impactful, especially when performed at higher intensities. Another study indicated that running therapy yielded similar mental health outcomes to antidepressants while also improving physical health.

Despite this growing body of evidence, a significant disconnect persists in clinical practice. Dr. Fabiano questioned, "If we don’t hesitate to prescribe a pill, why do we hesitate with exercise?" He points to barriers such as a lack of confidence among healthcare providers in prescribing exercise and insufficient practical training in medical education.

To bridge this gap, Dr. Fabiano urges the medical community to integrate exercise into clinical guidelines, medical school curricula, and insurance coverage. He also suggests facilitating patient access to exercise professionals through direct referrals and offering incentives like reduced gym memberships or fitness trackers. This proactive approach aims to leverage exercise as a core component of mental health care, not merely an adjunct.