Patients' views of physical activity as treatment for depression: a qualitative study
Open accessAbstract
BACKGROUND: Clinical guidance recommends physical activity to manage patients with persistent subthreshold depressive symptoms or mild-to-moderate depression. However, little is known regarding the acceptability of physical activity as a treatment for depression from patients' perspective. AIM: To explore patients' views of physical activity for the treatment of depression in the context of primary care. DESIGN OF STUDY: In-depth interviews were held with 33 participants taking part in a randomised controlled trial assessing the effectiveness of physical activity for the management of depression. SETTING: Primary care. RESULTS: Most participants perceived physical activity to be an acceptable treatment for depression. The mechanisms by which physical activity could enhance mood were attributed to a number of subjective benefits including biochemical pathways, providing a source of distraction from negative thoughts, and a sense of purpose. Participants who expressed a belief that their depression was caused by biochemical mechanisms reported activity that 'raised the heartbeat' as most beneficial, while those who believed depression was situational in origin tended to state the benefits of less-aerobic activities, such as walking. Many participants reported low motivation and a lack of confidence as barriers to undertaking physical activity. These patients suggested that medication could be helpful for initiating and maintaining activity. CONCLUSION: Patients view physical activity as an effective treatment for depression. However, they vary in their views about how physical activity might impact on depression, what intensity and form of activity is necessary to enhance mood, and the barriers to undertaking activity. This variation suggests the need for GPs to elicit patients' views on physical activity as a treatment, and offer interventions that are tailored to the needs and expectations of individual patients.
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GP-prescribed exercise is acceptable to patients with mild to moderate depression.
“recent evidence points to the acceptability of GP-prescribed exercise by patients with mild to moderate depression (Searle et al. 2011).”
From A call to action: Exercise as treatment for patients with mental illness (2015) · cites this paper as Searle et al. 2011
The Clinical implications section says patients and GPs view physical activity as an acceptable treatment option, citing Searle et al. (2011). The Introduction discusses physical activity in guidelines for mild to moderate depression, but the acceptability statement does not establish that finding specifically for patients with mild to moderate depression or for GP-prescribed exercise. (LLM, conf=0.79)
Experimental — accuracy not yet measuredPatients find exercise acceptable.
“This is despite patient acceptability for exercise.”
From A call to action: Exercise as treatment for patients with mental illness (2015) · cites this paper as Searle et al. 2011
The supplied passages and additional indexed passages are labeled as a different paper, “Participants’ experiences of facilitated physical activity for the management of depression in primary care.” Its Clinical implications section says patients view physical activity as an acceptable treatment and cites Searle et al. (2011), but it is not the cited Searle paper itself. The available copy therefore does not allow verification of what the cited paper says. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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“Research examining barriers to physical activity in those with mental health conditions suggests that individuals with high symptom severity and low self-efficacy may be particularly disinclined to pursue physical activity–based interventions [174,175].”
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“Specific items from the measure of treatment attitudes showed that around 40% of the young people in our study reported a preference for psychological treatment over PA and a third preferred medication, which is consistent with findings in adults with depression who thought it would be easier to take medication than t…”
ResultClegg, A. J., Hill, J. E., Mullin, D. S., Harris, C., Smith, C. J., Lightbody, C. E., Dwan, K., Cooney, G. M., Mead, G. E., & Watkins, C. L. (2026) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004366.pub7 · Cited by 12 · see citing works
Cody, R., Christensen, M., Kreppke, J.-N., Faude, O., Gerber, M., & Nicca, D. (2022) · Mental health and physical activity · doi:10.1016/j.mhpa.2022.100464 · Cited by 14 · see citing works
Pritchett, R., Jolly, K., Daley, A., Turner, K., & Bradbury-Jones, C. (2020) · Journal of Health Psychology · doi:10.1177/1359105317726590 · Cited by 12 · see citing works
“Many of the psychological barriers to exercise found among general populations were also reported by mothers in our study, such as lack of confidence, low motivation (Searle et al., 2011) and comorbid anxiety (Farr et al., 2013).”
BackgroundInfluentialSelf-citationHempler, N. F., Pals, R., Pedersbæk, L., & Costa, P. D. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1924-3 · Cited by 11 · see citing works
Percival, J., Donovan, J., Kessler, D., & Turner, K. (2016) · Health Expectations · doi:10.1111/hex.12436 · Cited by 11 · see citing works
Self-citationExercise as antidepressant treatment: Time for the transition from trials to clinic?
Ekkekakis, P., & Murri, M. B. (2017) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2017.04.008 · Cited by 10 · see citing works
RetractedA Review of the Importance of Physical Fitness to Company Performance and Productivity
Etemadi, M., Shameli, K., Hassan, N. A., Zakaria, Z., Khairudin, N., & Hara, H. (2016) · American Journal of Applied Sciences · doi:10.3844/ajassp.2016.1104.1118 · Cited by 10 · see citing works
Dubash, S. (2024) · Mental Health and Physical Activity · doi:10.1016/j.mhpa.2024.100599 · Cited by 9 · see citing works
Gómez-Cambronero, Á., Casteleyn, S., Bretón-López, J., García-Palacios, A., & Mira, A. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100624 · Cited by 9 · see citing works
“PA has been shown to be effective for depression Cooney et al. (2013); Ekkekakis (2015); Rebar et al. (2015); Mammen and Faulkner (2013), and it is cited by patients as their elected treatment Searle et al. (2011); Ussher et al. (2007).”
BackgroundDanielsen, K. K., Øydna, M. H., Strömmer, S., & Haugjord, K. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph181910516 · Cited by 9 · see citing works
Grabovac, I., Štefanac, S., Smith, L., Haider, S., Cao, C., Jackson, S., Dorner, T., Waldhoer, T., Rieder, A., & Yang, L. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.11.023 · Cited by 9 · see citing works
“In fact, qualitative research has revealed that patients with depressive symptoms generally see PA as an acceptable form of treatment that helps to enhance their mood, yet lack of motivation was a considerable barrier (Searle et al., 2011).”
BackgroundGerber, M., Ehrbar, J., Brand, R., Antoniewicz, F., Brand, S., Colledge, F., Donath, L., Egger, S., Hatzinger, M., Holsboer-trachsler, E., et al. (2018) · Mental Health and Physical Activity · doi:10.1016/j.mhpa.2018.08.001 · Cited by 9 · see citing works
Sanches, A., Guzzoni, V., Miranda, V. C. D. R., Peressim, L., Rocha, S., de Lima, P. O., Marcondes, F., Tanno, A., & Cunha, T. (2020) · Health Care for Women International · doi:10.1080/07399332.2020.1821689 · Cited by 8 · see citing works
“…(single-leg stand, hopping, hopscotch, static and dynamic balance) and object-control skills (dodgeball, throwing and catching overhand and underhand), and strategies of diversion as essential factors of motivation and enhancement of social contact (Nied & Franklin, 2002; Searle et al., 2011).”
BackgroundMcPherson, K., Bronars, C. A., Patten, C., Decker, P., Hughes, C. A., Levine, J., Vickers-Douglas, K., Williams, M. D., & Ussher, M. (2014) · Mental health and physical activity · doi:10.1016/j.mhpa.2014.05.001 · Cited by 8 · see citing works
Connolly, M. L., Bowden, S., Pascoe, M., & Dam, N. V. V. (2023) · Sports Medicine - Open · doi:10.1186/s40798-023-00555-x · Cited by 7 · see citing works
Kruisdijk, F., Hendriksen, I., Tak, E., Beekman, A., & Hopman-Rock, M. (2018) · Annals of General Psychiatry · doi:10.1186/s12991-018-0181-7 · Cited by 7 · see citing works
“This is in line with recommendations based on a qualitative study of patients’ viewpoints in general practice involving 33 participants [28].”
Thylstrup, B., Hesse, M., Thomsen, M., & Heerwagen, L. (2015) · Drugs Education Prevention and Policy · doi:10.3109/09687637.2015.1036006 · Cited by 7 · see citing works
“Although recent programmes support an increase in treatment optimism regarding response and effect concerning this user group, there is still need to improve our understanding of how they experience these programmes (Searle et al., 2011; Thystrup, & Hesse, 2009).”
BackgroundSpearing, R., & Bailey, J. (2012) · International Journal of Therapy and Rehabilitation · doi:10.12968/ijtr.2012.19.7.394 · Cited by 7 · see citing works
Yegüez, C. E., Ogle, R. R., Jusko, M. L., Melendez, R., & Sibley, M. H. (2022) · Journal of Child and Family Studies · doi:10.1007/s10826-022-02384-0 · Cited by 6 · see citing works
“Qualitative interviewing methods to examine changes as a result of psychosocial treatment have been instrumental in identifying key outcome variables and hypothesis generating of perceived mediators of these outcomes (Bendelin et al., 2011; Searle et al., 2011).”
MethodChen, J.-P., & Wu, C.-G. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.900287 · Cited by 6 · see citing works
Baniya, M., Kitrungrote, L., & Damkliang, J. (2022) · Belitung Nursing Journal · doi:10.33546/bnj.1991 · Cited by 6 · see citing works
Sakai, Y., Chen, C., Toyomaki, A., Hashimoto, N., Kitagawa, K., Inoue, T., Sato, A., Makihara, K., Kameyama, R., Wakatsuki, Y., et al. (2021) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2021.787688 · Cited by 8 · see citing works
Sinnott, C., Quigley, F., & Morris, M. (2014) · European Journal of General Practice · doi:10.3109/13814788.2013.819849 · Cited by 6 · see citing works
Mortazavi, R., Lalouni, M., Andersson, R., Serlachius, E., Sundberg, C., Norrbom, J., Larsson, I., Haglund, E., Ivarsson, A., Lenhard, F., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-060159 · Cited by 5 · see citing works
“36 The subjective approach with interviews describing how the intervention is perceived has shown acceptability for exercising not only in adults, 37 38 but also, in adolescents.”
Hemmis, L., de Vries, H., Vandelanotte, C., Short, C., Duncan, M., Burton, N., & Rebar, A. (2015) · Mental health and physical activity · doi:10.1016/j.mhpa.2015.08.001 · Cited by 5 · see citing works
Liu, L., Wang, D.-Q., Wu, W., Xiang, M., Li, X., Zhao, Y., Wang, J.-Y., & Wang, A. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e33818 · Cited by 4 · see citing works
“Some research suggests that physical activity may facilitate positive cognitive changes, such as redirecting attention away from negative thoughts, thereby fostering a sense of purpose and alleviating depressive symptoms [38].”
BackgroundTrust in management, change resistance and work engagement on startup employees in Indonesia
Aziza, D. F., & Nadia, F. N. D. (2023) · Jurnal Ilmiah Psikologi Terapan · doi:10.22219/jipt.v11i2.26074 · Cited by 4 · see citing works
Griffiths, C., Walker, K., Willis, A., & Pollard, L. (2022) · Mental Health Review Journal · doi:10.1108/mhrj-04-2021-0036 · Cited by 4 · see citing works
Ein neuer Weg in der Behandlung depressiver Symptome
Book, S., & Luttenberger, K. (2015) · DNP - Der Neurologe und Psychiater · doi:10.1007/s15202-015-0964-5 · Cited by 4 · see citing works
“Nicht zuletzt bewerten auch Patienten selbst Bewegung als eine wirksame und akzeptable Behandlungsoption bei Depression [18].”
BackgroundTranslating theory and evidence into practice: What is the role of health professionals?
Faulkner, G., & Taylor, A. H. (2012) · Mental health and physical activity · doi:10.1016/j.mhpa.2012.04.002 · Cited by 4 · see citing works
Self-citationLambert, J. D., Dean, S., Terry, R., Charles, N., Greaves, C. J., Campbell, J., & Taylor, A. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-080472 · Cited by 3 · see citing works
Self-citationXu, L.-G., Yang, Y., Wang, S., & Lu, B.-C. (2026) · BMC Psychology · doi:10.1186/s40359-026-04158-5 · Cited by 2 · see citing works
“…was positively associated with positive affect, which was positively associated with cognitive flexibility; cognitive flexibility, in turn, was negatively associated with repetitive negative thinking (physical activity → positive affect → cognitive flexibility → repetitive negative thinking).”
Cui, R., Zhai, H.-T., Wang, R., Hua, S., Zhang, J., & Li, S. (2025) · Annals of Tourism Research · doi:10.1016/j.annals.2025.103995 · Cited by 2 · see citing works
Cooper, J., Wort, G., Gillison, F., & Lambert, J. (2025) · Mental Health and Physical Activity · doi:10.1016/j.mhpa.2025.100674 · Cited by 2 · see citing works
Gilbert, C., Earleywine, M., & Altman, B. R. (2023) · Journal of American College Health · doi:10.1080/07448481.2023.2185461 · Cited by 2 · see citing works
“7 25 Consumers frequently wonder if exercise’s impact might exceed the effect of psychotherapy of various forms as well as how these approaches might interact.”
Uebelacker, L., Epstein-Lubow, G., Sillice, M., O’Keeffe, B., Kraines, M. A., Battle, C., Anderson, B., Miller, I., & Abrantes, A. M. (2023) · Mental Health and Physical Activity · doi:10.1016/j.mhpa.2023.100508 · Cited by 2 · see citing works
Björkman, M., & Danielsson, L. (2023) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2023.2251051 · Cited by 1 · see citing works
“Searle et al. (2011) found that patients consider physical activity an acceptable treatment with possibilities to influence their illness from a longer-term perspective, although difficult to initiate.”
Busch, A. M., Louie, M. E., SantaBarbara, N. J., Ajayi, A. A., Gleason, N., Dunsiger, S., Carey, M., & Ciccolo, J. (2019) · Mental Health and Physical Activity · doi:10.1016/j.mhpa.2019.100299 · Cited by 1 · see citing works
“exercise adherence (Searle et al., 2011; Seime & Vickers, 2006) by: (a) providing structured, graded goal setting for at-home RT goals, (b) actively problemsolving idiographic barriers to RT session attendance and completion of at-home RT goals, and (c) promoting maintenance of RT during follow-up.”
Applying health promotion theories to improve depressive symptoms through exercise
Abelman, D., & Hanna, A. (2017) · University of Western Ontario Medical Journal · doi:10.5206/uwomj.v86i2.1952 · Cited by 1 · see citing works
Glowacki, K. (2020) · doi:10.14288/1.0394047 · Cited by 1
“Searle et al. (2011) reported a mean Beck Depression Index score of 29.6 (Range: 15–57), while Searle et al. (2014) reported the number of participants in mild, moderate, and severe ranges of the Clinical Interview Schedule Revised, with the majority in the moderate range.”
BackgroundMethodInfluentialHuang, K.-X., Song, L., Sáenz, A. A., He, R., Jiao, Y.-L., Jia, Y., & Chen, L. (2026) · JMIR Serious Games · doi:10.2196/80937
“However, traditional exercise programs often face challenges related to low motivation and poor long-term adherence, particularly among individuals experiencing depressive symptoms [41].”
Shields-Zeeman, L., Schmitter, M., Vilé, J., van Geffen, A., van Doesum, T. J., Wijnen, B., Oostelbos, P., Smits, J. A. J., Spijker, J., & Vrijsen, J. (2026) · Mental Health and Physical Activity · doi:10.1016/j.mhpa.2025.100742
Danielsen, K. K., Rexha, D., & Sveaas, S. H. (2025) · Journal of Physical Activity and Health · doi:10.1123/jpah.2024-0582
Physical Exercise and Geriatric Depression: An Opinion
Machado, S. A. S., Monteiro, D., Moutão, J., Murillo-Rodríguez, E., Yamamoto, T., Paes, F., Cid, L., & Lima, J. L. M. D. (2020) · Revista Psicologia e Saúde · doi:10.20435/pssa.v12i1.807
“In addition, exercise may promote other cognitive mechanisms related to subjective well-being, such as negative thinking drift and sense of purpose (Hardoy et al., 2011; Searle et al., 2011).”
BackgroundLambert, J., Greaves, C., Farrand, P., Price, L., Haase, A. M., & Taylor, A. (2018) · Explore Bristol Research · doi:10.2196/101
“Physical activity (PA) has been shown to be effective in treating [6-8] and preventing [9] depression and is often cited by patients as their preferred treatment option [10,11].”
BackgroundSelf-citationEine alternative Pflegeintervention für Menschen mit Depressionen?
Hegedüs, A., Kunz, S., Glavanovits, K., & Kozel, B. (2013) · Psych Pflege · doi:10.1055/s-0033-1351364
Effects of Physical Exercise on Patients with Depression
Lindeman, D., Hober, C., & Null, N. (2020) · John Heinrichs Scholarly & Creative Activities Day · doi:10.58809/rgob7585
Shubair, M. M., Chongo, M., & Reschny, J. (2014) · Universal Journal of Public Health · doi:10.13189/ujph.2014.020601
- Authors
- Searle, A., Calnan, M., Lewis, G., Campbell, J., Taylor, A., & Turner, K.
- Affiliations
- University of Bristol (GB)
- University of Kent (GB)
- Venue
- British Journal of General Practice
- Published
- 2011-04-01
- Volume
- 61
- Issue
- 585
- Pages
- e149-e156
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC3063043
- OpenAlex
- W2099055399
- Cited by
- 115
- References
- 0
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 5 · 2023: 9 · 2022: 9 · 2021: 6 · 2020: 8 · 2019: 4 · 2018: 8 · 2017: 11 · 2016: 8 · 2015: 13 · 2014: 8 · 2013: 8 · 2012: 8
- FWCI
- 5.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion)
- PEARL (University of Plymouth) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (03/45/07)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- physical activity, depression, patient acceptability, primary care, barriers to exercise, walking, exercise motivation, mood improvement, antidepressants, personalized interventions
- MeSH terms
- Adult, Aged, Attitude to Health, Depressive Disorder, Exercise Therapy, Humans, Middle Aged, Patient Satisfaction, Young Adult
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