Effectiveness of Physical Exercise in Older Adults With Mild to Moderate Depression

Ann Fam Med. 2021 Jul-Aug;19(4):302-309. doi: 10.1370/afm.2670.


Purpose: We sought to compare the effectiveness of physical exercise with that of treatment with antidepressant drugs routinely used in clinical practice, in terms of decreasing depressive symptomatology in patients aged ≥65 years who present with clinical criteria of a depressive episode.

Methods: We conducted a randomized clinical trial in a primary care setting. A total of 347 patients aged ≥65 years with a clinically significant depressive episode were randomized to participation in a supervised physical exercise program or to receive antidepressant treatment by their general practitioners.

Results: Intention-to-treat analysis showed that the cumulative incidence of improvement in depressive symptomatology (Montgomery-Åsberg Depression Rating Scale score <10) in the physical activity (PA) group after 1 month was not significantly different from that in the antidepressant treatment (AT) group. However, the proportion of those who showed improvement was significantly greater (P <.01) in the AT group (60.6% and 49.7%) compared to the PA group (45.6% and 32.9%) at the end of 3 and 6 months, respectively. The number of withdrawals was greater in the PA group (39.2% and 58.2%) compared to the AT group (22.6% and 40.0%) at 3 and 6 months, respectively, yet the proportion of participants with adverse side effects was greater in the AT group (8.9% vs 22.5%; P = .007).

Conclusion: Although improvement was initially similar in both treatment groups, AT was superior in the medium term, despite giving rise to a greater number of adverse effects.

Trial registration: ClinicalTrials.gov NCT03358433.

Keywords: antidepressant agents; depression; elderly; exercise; primary health care.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antidepressive Agents / therapeutic use
  • Depression / therapy*
  • Exercise Therapy / methods
  • Exercise Therapy / psychology*
  • Exercise* / physiology
  • Exercise* / psychology
  • Female
  • Humans
  • Intention to Treat Analysis
  • Male
  • Primary Health Care / methods*
  • Treatment Outcome


  • Antidepressive Agents

Associated data

  • ClinicalTrials.gov/NCT03358433