Exercise should no longer be treated as an optional add-on in mental health care-it should be prescribed as a standard part of treatment for depression, argues Dr. Nicholas Fabiano, a psychiatry resident at the University of Ottawa. In a compelling editorial published in the British Journal of Sports Medicine, Dr. Fabiano calls for a shift in the way psychiatrists and mental health professionals approach the treatment of depression, emphasizing that physical activity must be taken as seriously as medication or psychotherapy.
Dr. Fabiano's editorial critiques the current standard of care, where physical activity is often sidelined or mentioned as a vague recommendation. “Ignoring exercise as a treatment for depression isn’t just a missed opportunity. It might even cross the line into negligence,” he writes. Citing growing research, he stresses that the antidepressant effects of exercise are well-documented, and the medical field can no longer afford to treat it as an afterthought.
The key, according to Dr. Fabiano, is not simply telling patients to “go for a walk,” but prescribing exercise in a structured and personalized way. He advocates for using the FITT principle—Frequency, Intensity, Time, and Type—to tailor exercise prescriptions to each patient’s specific condition, goals, and lifestyle limitations.
Beyond clinical settings, Dr. Fabiano is urging systemic changes. These include integrating exercise prescription training into medical education, incorporating physical activity into official clinical guidelines for depression, ensuring insurance coverage for related services, and making referrals to certified exercise professionals more accessible. He also highlights the role of technology, encouraging the use of fitness trackers and apps for monitoring progress and encouraging adherence.
“If we don’t hesitate to prescribe a pill, why do we hesitate with exercise?” Dr. Fabiano concludes. His message is clear: it’s time to reframe how we think about treating depression. With a strong evidence base and numerous physical and mental health benefits, exercise deserves a permanent seat at the table in modern mental health care.
Reference: Fabiano N, Puder D, Stubbs B, Could not prescribing exercise for depression be psychiatric malpractice?
British Journal of Sports Medicine Published Online First: 09 September 2025. doi: 10.1136/bjsports-2025-110405.
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