For centuries, we鈥檝e known anecdotally that movement can improve your mood. Joggers often describe a euphoric runner鈥檚 high, while swimmers recall an inner calm that lasts long after they leave the pool. In April, researchers published the to date showing that physical activity does more than induce these temporary feel-good effects; It can actually improve depression as effectively as medication or psychotherapy. The findings build on previous studies showing exercise can reduce , , , and symptoms.

This mounting evidence doesn鈥檛 suggest you should toss out your medication or skip your next therapy appointment in favor of exercise alone. But it does indicate physical activity could be a powerful first-line treatment for mental health disorders, especially when combined with other therapies.

Based on the data, some see exercise as a safe, cheap antidepressant that could help the estimated of adults with mental illness who do not receive adequate treatment. And some clinicians are putting this concept into practice, doling out 鈥渆xercise prescriptions鈥� for mental health. These scripts give patients step-by-step instructions for physical activity recommendations, much like they would with antidepressants or behavioral therapy. But providers say that on the whole, the field has been slow to embrace exercise as medicine for mental illness, and 鈥渆xercise prescriptions鈥� remain the exception in clinical care, not the norm.

鈥淓xercise is a good, underutilized tool to help with mental health conditions,鈥� Ivan Escobar Roldan, a psychiatrist in Florida who regularly writes 鈥渆xercise prescriptions” for his patients and studies the use of exercise in clinical practice, says. He co-authored a published in the Journal of Psychiatric Practice in 2021 showing that while many providers generally encourage patients to be active, they don鈥檛 often give specific instructions due to a lack of training, education, or standardized clinical guidelines.

鈥淓veryone says you should exercise more,鈥� Seattle-based clinical psychologist says. 鈥淏ut patients always ask: What does that mean? Do I need to take an extra lap around the grocery store, or does that mean I have to go to a gym for three hours every day?鈥�

Currently, mental health providers don鈥檛 give the clearest answers to these questions.

A Mind in Movement

Exercise is as close to a miracle drug as we鈥檝e got. Research shows it works as effectively as some prescription drugs in preventing and treating more than .

When you start a workout, your pulse quickens and breathing deepens as your heart pumps oxygen-rich blood to your brain and muscles. Within a few minutes, you likely notice a lift in your mood as your brain releases 鈥渉appy chemicals鈥� like endorphins, dopamine, and serotonin (the same neurotransmitter targeted by antidepressants). The fleeting bliss of a results from a spike of in the bloodstream鈥攃annabis-like signaling molecules that are naturally produced in your body and induce feelings of calm.

After your strength or conditioning session wraps up, the positive effects don鈥檛 stop. Over time, physical activity can increase levels of a protein called (BDNF), which leads to the creation of new neurons. More BDNF is correlated with reduced anxiety and depression, better focus, improved cognition, and sharper memory as you age.

When people exercise regularly, the brain鈥檚 hippocampus鈥攖he area linked to memory and learning鈥� to increase in volume. That鈥檚 not all. With a regular workout routine, people often feel better, sleep better, eat better, and report improved relationships and work satisfaction. Exercising can burn off anxious energy as well as increase resilience to future stress. Eventually, it can even help people taper off medication and cut down on doctor鈥檚 visits or medical treatments. People who start to exercise before or during middle age between $824 to $1,874 annually on their health care costs after retirement.

鈥淲hile medications may take a few weeks to work, you see benefits right away with exercise,鈥� Escobar Roldan says. 鈥淚t’s not only going to help with anxiety, depression, and many other mental health conditions, but also with patients鈥� overall health and other chronic conditions.鈥�

Getting moving can be tough initially. Despite the upsides, of U.S. adults do enough aerobic exercise or strength training to meet the national physical activity guidelines. But once people get going, exercise鈥檚 instant gratification often kicks off a beneficial feedback loop, Vieselmeyer says.

鈥淲hen we’re making healthy choices, that ends up affecting how we think about ourselves, our self-confidence, and our energy levels鈥攖hings affect our emotions positively and lead to behavior change,鈥� she says. Working out isn鈥檛 just about quelling anxiety, depression, or negative emotions, but fostering positive ones too.

Matthew Ellison, a late-twenties investment banker based in New York City, has experienced these benefits firsthand. Ellison has a history of anxiety and recently dealt with a bout of depression tied to work stress. With the support of his therapist, Ellison made going to the gym a daily priority. He says the routine pulled him through this period and has become a non-negotiable practice to maintain his mental health.

鈥淏eing able to clear my mind, in the morning or late at night, has honestly been the greatest thing for my mental health,鈥� Ellison says. 鈥淚t鈥檚 the foundation for my mental well-being.鈥�

Barriers to Entry

For more than 20 years, Vieselmeyer has been interested in exercise as medicine, and says that amid recent studies, she is seeing more acceptance of the topic across the field. But even with a robust body of evidence, providers still struggle to convert these research breakthroughs into targeted exercise prescriptions.

That鈥檚 because there鈥檚 little formal training or education on the topic. Some clinicians are concerned about their patients鈥� health status and worry that exercise might lead to injury or cause a heart attack. Others simply don鈥檛 have the time to discuss exercise in depth.

Many providers recommend (or 2.5 hours) of physical activity per week鈥攇uidelines from the U.S. Department of Health and Human Services鈥攂ut are hesitant to give concrete instructions beyond that. The American Psychological Association鈥檚 most recent on depression don’t mention exercise as treatment.

In his own practice, Escobar Roldan uses resources like this created by , a global initiative coordinated by the American College of Sports Medicine. The organization also provides a handy to help providers prescribe the right 鈥渄ose鈥� of physical activity for more than 40 chronic conditions, including mental health disorders. Exercise is Medicine maintains a for health professionals to connect patients with qualified exercise professionals. Some insurance companies also training programs or gym memberships, or even reimburse health and fitness expenses. But these programs aren鈥檛 yet commonly used in the mental health arena. 鈥淵ou need a lot of mounting evidence to see a paradigm shift or clinical practice change,鈥� says Escobar Roldan. 鈥淲ith more awareness, we’re moving towards that, but we aren鈥檛 there yet.鈥�

To get patients moving, Vieselmeyer and , a clinical psychologist based in New York, don鈥檛 use strict 鈥減rescriptions.鈥� Instead, they draw on techniques from , one of the most evidence-based forms of therapy. The psychologists use motivational interviewing to explore the root causes of behavior and barriers to exercise. They also target behavioral activation, which uses behavioral shifts like physical activity to influence people鈥檚 emotional state.

鈥淚f clients are severely depressed and unable to do their laundry, I鈥檓 not going to suggest running two miles,鈥� England, who helps patients set 鈥淪MART鈥� goals that are specific, measurable, achievable, relevant, and time-bound, says. 鈥淲e have to behaviorally activate them first, in smaller steps, like walking around the block.鈥�

A Happiness Workout

Ellison managed to establish a regular workout routine with only vague encouragement from his therapist. But for many others dealing with mental health issues, symptoms like fatigue or lack of motivation preclude their ability to exercise regularly.

鈥淲hen somebody is really depressed, it’s hard to put the running shoes on and get out the door, even if they know that’s going to make them feel a whole lot better,鈥� Vieselmeyer says. Sometimes the easiest entry point might be medication or seeing a therapist, and then progressing to exercise, she says.

Much of the evidence behind the antidepressant and anti-anxiety effects of exercise is based on people with mild to moderate cases of mental illness. A few suggest that structured workout treatments can help patients with serious mental illness in inpatient settings. But on its own, exercise is unlikely to alleviate serious mental illness, experts say.

A major reason why mental health providers have been slow to embrace exercise as treatment is because researchers haven鈥檛 nailed down the exact 鈥渄ose and effect鈥� like they would with a prescription drug. More research is needed to determine which type of exercise works best, how much is needed, and who it can benefit mentally.

Based on what we know so far, the most effective exercise prescription includes physical activity that is:

Moderate to Vigorous

Escobar Roldan suggests people bring their heart rate up to the point where they are a little bit out of breath. Gardening, walking, dancing, hiking, running, or cycling can all ease symptoms of anxiety and depression.

Enjoyable

Most studies point to aerobic exercise as a way to boost your mood, but evidence shows strength or resistance training works too. It’s more about getting people moving doing something they enjoy, rather than finding the 鈥減erfect鈥� exercise, Vieselmeyer says.

Social

Group exercise sessions, from bootcamp to yoga, can be especially effective. People appear to gain more benefit when supervised by trained health and exercise professionals. There鈥檚 also the extra opportunity to connect with others, which pays dividends on our mental health.

Doable

Vieselmeyer recommends starting small. No triathlon or two-a-days involved. It鈥檚 more about working out consistently, not calculating the perfect ratio of Crossfit to Pilates.

鈥淲hatever prescriptions are made going forward need to fit with people’s lives, or they’re just not going to do them,鈥� Vieselmeyer says. 鈥淭here are already enough barriers for people to exercise.鈥�

Ultimately, physical activity isn鈥檛 a silver bullet for mental health鈥攁nd more intense movement isn鈥檛 always the best strategy, especially for fitness fanatics who already train hard. 鈥淎 good long run is not enough to process through your history of trauma,鈥� Vieselmeyer says. If exercise alone was the panacea to our mental health crisis, we wouldn’t see any mental health difficulties in professional athletes, England notes.

The right exercise prescription comes down to each person鈥檚 level of physical and mental fitness. 鈥淚 certainly hope no one is hesitating to prescribe exercise on top of other evidence-based treatments,鈥� Vieselmeyer says. 鈥淚 would rather give patients more tools than fewer, and then see where their interest lies.鈥�

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If you鈥檙e looking to reboot your health this year, you might sign up for your first triathlon, kickstart a meditation habit, or cut down on ultra-processed foods. But the latest science suggests the best way to improve long-term health isn鈥檛 physical, it鈥檚 social: connection.

Strengthening relationship ties by exercising what experts call 鈥渟ocial fitness鈥� is the most influential brain and body hack. Like weight training staves off as you age, social fitness counters the downstream effects of .

鈥淣ot exercising your social fitness is hazardous to your health,鈥� says Robert Waldinger, a psychiatrist and psychoanalyst at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School.

Waldinger directs the , the longest scientific study of happiness ever conducted. According to the psychiatrist, who recently summed up eighty-plus years of data in his book (January 2023, Simon & Schuster), the formula for health and happiness hinges on positive relationships.

鈥淚f you regularly feel isolated and lonely, it can be as dangerous as smoking half a pack of cigarettes a day or being obese,鈥� Waldinger cautions.

But even though humans are wired to connect, exercising social fitness can be tricky. There鈥檚 no clear roadmap for building鈥攐r maintaining鈥攁 solid social life.

鈥淟ike unused muscles, neglected relationships atrophy,鈥� Waldinger says.

Luckily, Waldinger鈥檚 data points to actionable exercises we can all use to supercharge our social fitness.

Studying the Good Life

In 1938, amid the worst economic depression in American history, researchers rounded up 268 Harvard sophomores to better understand how early psychosocial and biological factors influence life outcomes. For over eighty years, a team鈥攏ow led by Waldinger鈥攈as tracked the students and their families, following them through marriages, careers, births, diseases, and deaths. In the 1970s, 456 Boston inner-city residents who were part of another focused on juvenile delinquency and resilience were incorporated into the Harvard study.

The researchers check in with participants every two years, posing thousands of questions on topics like mood and life satisfaction. Every five years, they take physiological measurements including brain scans and blood work. As of 2023, the ongoing study is still tracking all living members of the original participant set and over 500 members of their offspring. The trove of data provides an unparalleled window into what makes up a good life.

When Waldinger first joined the study as a young psychiatrist at Harvard, he had an inkling that conventional measures of success like achievement, status, and awards were mere distractions on the path to real happiness. As he delved deeper in the data, hundreds of subjects confirmed this suspicion. Across the study, neither wealth nor social class were correlated with happiness levels or longevity. Positive relationships, on the other hand, were consistently linked to happier, longer lives.

Other large-scale data reinforces this link between connection and longevity. One systematic from 2010, including over 300,000 participants, suggests people with strong social ties are 50 percent more likely to survive over a given period than those with weak ties.聽 Loneliness and social isolation are associated with and may even spike the risk of heart attack or stroke by an estimated . To help prevent these negative health outcomes, it鈥檚 essential to foster social fitness.

What Is Social Fitness?

Scientists have been studying humans鈥� social psychology in formal labs and universities for over a century, but the idea of flexing your 鈥渟ocial muscle,鈥� like you would a bicep or quad, didn鈥檛 emerge until 2011. That鈥檚 when social neuroscientists John and Stephanie Cacioppo shared from testing a 10-hour social fitness training program with the U.S. military. The team found that social fitness exercises such as doing someone a favor or practicing conflict resolution reduced loneliness and boosted well-being in soldiers.

While scientists and philosophers had linked positive relationships and optimal health for decades, the Cacioppos and their research team were among the first to suggest positive relationships could be analogous to physical fitness. And just like you can鈥檛 remain physically fit without exercising, social fitness鈥攖he ability to cultivate and maintain positive relationships鈥� withers without consistent effort.

Social Fitness and the Loneliness Epidemic

When the first Harvard study subjects were in their 80s, Waldinger and his team asked them to look back on their lives and share what they were proudest of. Nearly everyone talked about relationships.

鈥淎lmost all said: I was a good parent or a good mentor. I had a good marriage or I was a good friend,鈥� Waldinger recalls. 鈥淎lmost nobody said: I made a lot of money, I won these awards, or I got to be the chief executive of my organization.鈥�

The team went on to ask subjects: Who could you call in the middle of the night, if you were sick or scared? Some people rattled off a long list. Others couldn鈥檛 list anyone.

鈥淭hat’s real loneliness鈥攖his sense that nobody in the world has my back,鈥� Waldinger says. 鈥淭he costs of that are huge. It makes us feel unloved and unsafe, and eventually breaks down our health.鈥�

In 2023, at the most technologically connected moment in human history, people report feeling farther apart than ever. of older adults in the U.S. report chronic loneliness. Add in pandemic-related lockdowns and loneliness has hit record highs, culminating in what Vivek Murthy, physician, and former United States surgeon general classifies as a loneliness epidemic.

鈥淲hen you lose emotional and social fitness, you lose everything,鈥� says Emily Anhalt, a clinical psychologist, co-founder of Coa, a gym for mental health, and expert on emotional fitness who is not involved in the Harvard Study. 鈥淓verything in life is going to feel better if you feel connected to other people to get through the tough things and enjoy the good things.鈥�

Like prescribing a dose of time outside, some physicians go as far to say that encouraging social interactions has the potential to have a healing effect on patients. Emerging suggests cancer patients have higher chances of survival if they feel satisfied by their levels of social support. Some experts even liken social connection to a vital sign鈥攖hat measuring people鈥檚 loneliness levels hints at general health as accurately as blood pressure or pulse.

A Social Cure

To combat widespread loneliness and reap the positive benefits of social connection, it may seem like we’re all supposed to be extroverts or party animals. That鈥檚 a common misconception.

Humans are social creatures, but we鈥檙e not all social butterflies. Loneliness is a subjective experience. It鈥檚 not about the quantity of friends or family you have, but how fulfilling those relationships feel. The antidote to loneliness for some may entail a vast social network, while a few close relationships work for others.

Anhalt says people should treat social fitness proactively. Rather than wait until they feel isolated, people should regularly nurture their social life, which elevates mental well-being by default.

鈥淥ur culture鈥檚 way of thinking about mental health is very reactive鈥攚e make people feel like they have to wait until things are falling apart to get support.鈥� To Anhalt, that’s like waiting until you have early signs of heart disease to do cardio. 鈥淚 want to help people think about working on their mental health more like going to the gym and less like going to the doctor.鈥�

To exercise your social fitness, try this training plan outlined by Waldinger in his new book, The Good Life:

Map Your Social Universe

To kickstart social fitness, start with self-reflection. Like completing a basic strength training circuit to pinpoint weak muscle groups, the following mental exercises can reveal your shaky social muscles. First, in a journal or notes app, outline how you are devoting your time weekly, and to who. Then ask yourself: What am I giving and what am I receiving? Am I having enough fun with loved ones? Am I getting enough emotional support? Waldinger suggests taking this comprehensive social evaluation annually, maybe every new year or birthday.

Strengthen Keystones of Support

Rather than aim for a total social rehaul, focus on improving the valued relationships you already have. An easy way to do this is by asking loved ones: Is there anything I can do better in our relationship? Can I communicate differently, or should we spend more time together? Based on their answers, tailor your communication or quality time to benefit your inner circle.

Build Routine

A great way to level up鈥攁nd maintain鈥攈ealthy relationships is by scheduling regular contact, virtual or in-person. Pencil in a weekly coffee date with a mentor or plan a monthly Zoom call with high school friends. Remove some of the logistical barriers that make connecting feel like a chore. There鈥檚 no exact rep of weekly social interactions to hit. For some, one or two a week will suffice, while others may want to schedule daily opportunities for connection. Reflecting on how these interactions make you feel鈥攅nergized or drained鈥攃an help you find your sweet spot.

Create New Connections

One exercise to keep your social muscles in good shape is by expanding your network. But making friends in adulthood isn鈥檛 as easy as it once was on the playground or soccer pitch. A surefire way to connect with someone new? Get involved in something you care about. If you love cross country skiing in winter, join a local club. If you enjoy getting your hands dirty outside, volunteer at a local community garden. These activities provide an immediate conversation starter with those who have similar interests. If you鈥檙e worried that no one would enjoy your company, volunteer your time to those who may be lonely like the elderly. Forging new connections at an older age may feel impossible鈥� like running a marathon after years spent jogging 5Ks鈥� but the effort leads to major benefits. Friendship shapes mental health and in turn, our physical well-being.

Do Emotional Push-Ups

And here鈥檚 a bonus tip from Anhalt: Do 鈥渆motional push-ups.鈥� These include striking up conversations with strangers, saying thank you, or accepting compliments without deflection. Start small鈥擯ractice one or two emotional push-ups weekly. While there鈥檚 no shortcut to social fitness, regularly flexing your social muscles will add up to stronger relationships over time.

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