Most people seeking treatment for depression
    or anxiety face two choices: medication or psychotherapy. But there's a
    third choice that is rarely prescribed, though it comes with few side
    effects, low costs and a list of added benefits, advocates say.

    The treatment: exercise.

    "It's become clear that this is a good
    intervention, particularly for mild to moderate depression," says
    Jasper Smits, a psychologist at Southern Methodist University in Dallas. Exercise as an anxiety treatment is less well-studied but looks helpful, he says.

    It's no secret that exercise often boosts mood:
    The runner's high is legendary, and walkers, bikers, dancers and
    swimmers report their share of bliss.

    Now, data pooled from many small studies suggest
    that in people diagnosed with depression or anxiety, the immediate mood
    boost is followed by longer-term relief, similar to that offered by
    medication and talk therapy, says Daniel Landers, a professor emeritus
    in the department of kinesiology at Arizona State University.

    And exercise seems to work better than relaxation, meditation, stress education and music therapy, Landers says.

    "Most physicians and therapists are aware of the
    effects," says Chad Rethorst, a researcher at the University of Texas
    Southwestern Medical Center in Dallas. "But they may not be comfortable
    prescribing it."

    Smits and another researcher, Michael Otto of Boston University,
    are on a mission to change that. The two have written a guidebook for
    mental-health professionals and are working on guides for primary care
    physicians and consumers.

    Ideally, Smits says, depressed or anxious people
    would get written exercise prescriptions, complete with suggested
    "doses" and strategies for getting started and sticking with the

    One thing that helps people keep up this
    therapy, he says, is the immediate boost that many report. The same
    can't be said of taking pills, he says.

    Questions still to be answered

    But Smits and other exercise-as-treatment
    enthusiasts are quick to say that medications and psychotherapy are
    good treatments, too, and can be combined with exercise. "They work
    well," Smits says. "But too few people get them, and few get them in
    the doses that are needed."

    Many people who start talk therapy or
    medications soon stop using them because of costs, side effects,
    inconvenience or other factors. In short-term studies, at least as many
    people stick with exercise as with drugs, Rethorst says. Not known, he
    says, is "how this will translate into the real world."

    Other remaining questions:

    --What kind of exercise works? Most studies have
    focused on aerobic exercise, such as running and walking, but have not
    ruled out strength training or other regimens.

    --How much is needed? At least one study shows
    results from the amount recommended for physical health: 150 minutes of
    moderate exercise (such as brisk walking) or 75 minutes of vigorous
    exercise (such as running) each week.

    --How does it help? Does it boost certain brain
    chemicals? Induce deeper sleep? Give patients a sense of action and

    --Can it prevent initial bouts or recurrences of depression and anxiety?

    That seems likely, says Michelle Riba, a
    psychiatrist who works with cancer patients and others at the
    University of Michigan. She prescribes exercise to depressed patients
    as part of a long-term plan for healthier living that includes sleep,
    eating and, in many cases, weight loss. Exercise can be especially
    important, she says, for patients taking antidepressant medications
    that cause weight gain.

    "I don't' think exercise will ever be the only
    treatment, but it may be a major part of preventing recurrences," she
    says. "It should be part of everybody's plan of health."

    News release courtesy of