There is increasing evidence to suggest that regular physical exercise has psychological benefits, with more active people illustrating lower levels of depression than sedentary people [1133–1135]; and, conversely, more physical inactivity found among people who are depressed [1136]. As mentioned previously, exercise is relatively low-risk, associated with a wide range of physical health benefits, and research has demonstrated exercise to be as effective in reducing depressive symptoms as psychotherapy and antidepressants [272, 1137]. A Cochrane review examining the effect of exercise on depressive symptoms concluded that physical activity (defined as aerobic, mixed, or resistance) was moderately more effective than control interventions for treating depression, with exercise equally as effective as psychotherapy or pharmacotherapy [1138]. The UK NICE Guidelines for mild to moderate depression recommend 45 minutes to 1 hour duration of structured, supervised physical activity programs, three times a week over 10 to 14 weeks [1139].
A number of systematic and meta-analytic reviews have examined the effects of physical exercise on elevated symptoms of depression and/or diagnosed depressive disorders among people with AOD use disorders. A systematic review by Giménez-Meseguer and colleages [306] found that both physical fitness and body-mind interventions have positive effects on depression, quality-of-life, and cravings among people with an alcohol use or other drug use disorder. Similarly, a meta-analysis of 22 studies examining the use of physical exercise of varied intensity (from light to vigorous, aerobic-based activities, mind-body practices such as Tai chi, qigong) as a treatment for AOD use disorders found improvements in abstinence rates, withdrawal symptoms, and depression [305]. However, some reviews have pointed toward differential effects depending on the type of activity. Specifically, among people with alcohol use disorders, aerobic exercise or strength training has been found to result in reduced depressive symptoms but not a reduction in daily alcohol consumption, compared to control conditions [1140]. Among people with AOD use disorders more broadly, another review found highly mixed outcomes in relation to depression and AOD use with anaerobic exercise (i.e., high intensity, interval training) [1141].