Exercise works for depression. Almost nobody prescribes it.

When psychiatrist Dr. Nicholas Fabiano fractured his humerus bone in an arm-wrestling match and briefly stopped exercising, his mental health quickly deteriorated. His regular exercise habit had helped him manage his mental health his entire life, and now, with that option no longer available, he realized that medication and therapy were the most popular tools left for healing.

Depression is among the most common mental disorders worldwide, frequently co-occurring with obesity, diabetes and heart disease. Yet standard care — medication, therapy or both — leaves 30 to 50% of patients without meaningful improvement and does nothing for the physical burdens. Knowing how effective consistent movement can be in relieving the symptoms of conditions like depression and anxiety, why isn’t exercise regularly prescribed as a treatment? Writing for Big Think, Dr. Fabiano turns that personal experience into a bigger question — why isn’t exercise treated like real medicine?

The evidence is clear. Hundreds of trials show exercise reduces depressive symptoms, roughly on par with medication or therapy in mild to moderate cases, and is likely additive when used in combination with them. Moreover, for those without the condition, exercising just half the recommended amount for maintaining sound physical health is linked to an 18% lower risk of depression.

That’s because exercise boosts brain neuroplasticity by raising brain-derived neurotrophic factor) levels, sparking new neuron growth, reducing chronic inflammation, promoting a better-regulated stress response and providing the plain psychological lift of self-efficacy, a belief in one’s capacity to achieve one’s goals. Altogether, these shifts make depression harder to develop and less likely to persist.

The thing is, treatment guidelines already name exercise as a first-line option for mild depression, but it just doesn’t make it into the therapy room. A recent survey found that 92% of mental health professionals received no training in how to recommend exercise, and 41% said they never recommend it at all. When it does come up, Fabiano notes, it tends to arrive as “just go work out” — a prescription with no drug, no dose and no duration.

But simply telling patients that exercise works isn’t enough, Fabiano says. Clinicians need training that starts in medical school and continues through residency, along with practical guidance on how to actually prescribe exercise. They also need direct referral pathways to qualified exercise professionals and insurance coverage that makes supervised programs and gym memberships accessible and easy to integrate into care as medication. No further research is needed. What’s left is treating exercise like the medical intervention it already is.