A large review of studies suggests that exercise can ease depression about as effectively as psychological therapy. Compared with antidepressants, exercise showed similar benefits, though the evidence…
Regular physical activity may ease symptoms of depression about as effectively as psychological therapy, according to an updated Cochrane review. When researchers compared exercise with antidepressant medication, they found similar benefits, although the certainty of that evidence was lower.
Depression remains a major global health challenge, affecting more than 280 million people worldwide and contributing significantly to disability. Exercise stands out as a low cost and widely accessible option that also improves physical health, making it appealing to both patients and healthcare professionals.
Inside the Cochrane Review
The analysis was led by researchers at the University of Lancashire and drew on data from 73 randomized controlled trials involving nearly 5,000 adults diagnosed with depression. These studies examined how exercise compared with no treatment or control conditions, as well as with psychological therapies and antidepressant drugs.
Overall, the findings showed that exercise led to moderate reductions in depressive symptoms compared with no treatment. When measured against psychological therapy, exercise produced similar improvements, based on moderate certainty evidence from ten trials. Comparisons with antidepressant medication also suggested comparable effects, but the supporting evidence was limited and considered low certainty. Few studies tracked participants after treatment ended, leaving the long-term impact unclear.
Safety and Side Effects
Reported side effects were uncommon. People in exercise programs occasionally experienced muscle or joint injuries, while those taking antidepressants reported typical medication-related issues such as fatigue and gastrointestinal problems.
"Our findings suggest that exercise appears to be a safe and accessible option for helping to manage symptoms of depression," said Professor Andrew Clegg, lead author of the review. "This suggests that exercise works well for some people, but not for everyone, and finding approaches that individuals are willing and able to maintain is important."
What Kind of Exercise Works Best
The review found that light to moderate intensity activity may be more helpful than vigorous workouts. Greater improvements in depressive symptoms were linked to completing between 13 and 36 exercise sessions.
No single form of exercise clearly outperformed others. However, programs that combined different types of activity and resistance training appeared more effective than aerobic exercise alone. Some activities, including yoga, qigong and stretching, were not evaluated in this analysis and remain areas for future study. As with other findings, long-term benefits are still uncertain due to limited follow-up.
Why Conclusions Remain Cautious
This update added 35 new trials to earlier versions of the review published in 2008 and 2013. Even with the expanded evidence base, the main conclusions changed little. Many of the included studies were small, often involving fewer than 100 participants, which makes it harder to draw firm conclusions.
"Although we've added more trials in this update, the findings are similar," said Professor Clegg. "Exercise can help people with depression, but if we want to find which types work best, for who and whether the benefits last over time, we still need larger, high-quality studies. One large, well-conducted trial is much better than numerous poor quality small trials with limited numbers of participants in each."
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Comments
This is a finding that keeps coming up, and I've certainly found it true in my life, but there's a significant chicken-and-egg problem in that depression frequently precludes the motivation to exercise, and if you don't already have a deeply-disciplined routine to overcome the lack of motivation, people won't do it.
Exhortation to develop those good habits in the good times, I suppose.
By yomismoaqui 2026-01-0921:1319 reply Motivation is fleeting but routine persists.
When there is something that you want to do regularly (exercise, doing the final boring part of some sideproject, cleaning the house...) you remove willpower from the equation and set a day and a time.
For example, everyday from 18 to 19 I work on my sideprojects, or saturdays from 16 to 18 is house cleaning time. There is no question if I want to do it, it is set at that time and I have to do it, period.
The nice thing about routine is that the first times it is hard, but after some repetitions your mind (and body) begin to get used and it transforms into a routine and then it's like it's written in stone. That time period of that day X is for Y and it is what it is.
Routine can be used for bad things but also for good things.
> There is no question if I want to do it, it is set at that time and I have to do it, period.
Gosh it must be nice to have at least an ordinary amount of executive function skills. Is it really this easy for neurotypical people to build routines? That's really all it takes?
I don't see how this removes willpower at all. It just determines what time you have to use it.
By bluerooibos 2026-01-0921:586 reply All you need to do is go to sleep before 12 every single night and wake up at 7am without fail, hit the gym and crank out a few sets of squats, hit the pool and the sauna, read a chapter of that book, and then cook yourself an amazing breakfast, all before 9am.
If you're a real go-getter, though, you'd wake up at 6am and do some vibe coding for an hour on that side hustle.
Super simple.
It still requires willpower, but to use a metaphor, it's much easier to travel down a well-trod path than it is to cut a new path through the jungle. Repetition and consistency establishes the path, so the willpower required to travel down it the next day is reduced over time. Establishing a pre-set time and committing to that time ahead of time removes the "will I or won't I" decision at "go time", when you're most likely to falter.
By byproxy 2026-01-100:32 What makes this “neurotypical?” I don’t necessarily consider myself as such, but I’ve made it a point to have some routine in my life. In fact, I think being highly regimented and sticking to a routine can be very neuroatypical. I would never go so far as to say I’m autistic, but there are markers on that spectrum, like becoming upset when a routine is disrupted. I certainly am perturbed when I’ve set some routine for myself and something interrupts it.
By worldsayshi 2026-01-0923:10 I'm not claiming this works for everyone but what sometimes work for me to form a routine is to do the thing but without committing effort to it. I.e. go to the gym but you only promise yourself to go there, not actually spend effort there. Any actual exercise you then do is a bonus, not a "payment on your promise".
I think it can be generalized as:
Find the thing to do that doesn't require much effort but puts you in the context of doing the effortful thing. Do that thing. See if you "want" to do the effortful thing. Otherwise go home.
Cleaning? Put the vacuum in your hands and see if something happens.
At least I think that's how it works for me.
The points when it's hardest to make it work is when there's lots of distractions. Like when you try to get into a routine of doing work at a computer.
By safety1st 2026-01-107:14 The parent comment's point is that you can reduce the amount of executive function required to do the correct thing. Doing something at the same time every day will indeed make it more automatic, requiring less willpower to do it again tomorrow. This effect applies whether you're neurotypical or not and is grounded in behavioral research.
There are better examples in my opinion than just doing something at 18:00 every day. There's a technique called habit stacking where you identify all the habits you already have at a given time (like when you first wake up), and then you add one more at the end. It's easier to introduce a new habit this way, and it becomes ingrained more quickly, resulting in less need to use executive function.
There are still more techniques. An example from my personal life: in my whole adult life, I've never gone to the gym... unless I sign up for a gym that's right across the street from my workplace. Then it happens like clockwork. If all I need to do is walk across the street, I end up in the gym, and inevitably, I work out. If I need to drive 20 minutes though, well my willpower just ain't that great, so it basically never happens.
The best book I've read on this topic is Atomic Habits by James Clear. He goes deep down the rabbit hole of these techniques you can employ and touches on the research it's all based on. The brain's not a computer so I mean it's not all just going to come together automatically, but in my experience this stuff does work.
Willpower is what you use when you’re allowed choice and know you should make the good choice but actually feel like choosing the bad choice. The trick to good discipline is to never allow it to be a choice. There are no excuses. There is no negotiation. It just is the same way the sun rises or the tax man comes. Good discipline is a skill you develop and it is far easier than trying to live via something as temperamental as willpower.
I have utterly horrible executive function. Diagnosed and everything. Sitting here on HN right now avoiding boring spreadsheet work to finish my day out.
It’s not easy for anyone to develop these style of habits and routines. It’s just hard mode and takes much more effort for folks with executive dysfunction.
The first rule is choose one thing and stick to it. With realistic goals. Mine was: I am going to walk at least 6,000 steps a day. No matter what. Zero excuses.
Since schedules are insanely difficult for me I set none. If I remembered I still needed to walk and I could do it in the moment I simply prioritized it. It’s surprisingly easy to fit in 10 minutes of walk in throughout your day, even when working a desk job. It could simply mean pacing while on conference calls.
Another rule was “if I fail to achieve it one day, I must achieve it the next” to avoid the “all or nothing” mental trap.
This was to the level of getting into bed, checking step counter, and if I was under target literally getting out of bed, putting clothes back on, and walking until I hit it. I had all sorts of technical widgets to enforce this and help remind me.
It totally sucked for the first couple months. Then it started to just become a thing. Then I ramped it up to 12k/day until I hit a weight goal.
It’s the best thing I ever did for my mental health since it started a snowball in other areas of my life. I was able to swap out a few days of steps for an hour workout (beginning with a personal trainer to force me to show up 2 days a week minimum). I was and still am constantly 10 minutes late to my session but no matter what I show up to them.
The weeks I miss them due to schedule conflicts or travel I feel much worse mentally. And it’s easy to give into the anxiety and panic over not having enough time in the day to fit it in after procrastinating on other items. You also start to realize that those other items are probably not as important as you thought.
I find routine and habits over schedule and calendaring are hyper-important for my dysfunction and have leaned into that. It’s more of a “this thing before that thing” sort of deal vs “at 3pm I do the thing” since the latter would go off the rails immediately.
It’s possible. Just the hardest thing I’ve maybe ever accomplished in life so far.
Gonna be different for everyone and you probably need that one moment of clarity to get the initial motivation. The motivation will go away, but the habits and discipline will probably stick around.
Been using this same method to build habits and routine into other areas of my life now as well.
By singpolyma3 2026-01-100:23 Your daily reminder that neurotypical people do not exist.
By fatata123 2026-01-107:02 [dead]
I found this to be true, and that it perfectly dovetailed with TFA.
When I was at my absolute depth (so far…) back in 2013, I would see my counsellor at 1130 on a Saturday. I’d be able to recount the darkness of the previous 7 days in stark vivid detail, yet cheerfully and not feeling at all depressed in the moment. The counsellor asked what I did on Saturday morning except the session and my answer was, well I do Parkrun[0] of course. I always do Parkrun. It’s in my calendar, it’s not really negotiable. It might have been the only time I managed to get out of bed all week, but, I mean, how can I possibly skip Parkrun?
I never actually linked the exercise to the boost in my mental health until I had it pointed out to me at that moment. I go for a run and I feel better because of the run. I would spend the whole 5km stewing and ruminating and maybe in tears but half hour after getting home I could function! it’s stuck with me ever since, and I’ve never (yet) been so down again.
Tomorrow will be my 429th Parkrun :)
By cheald 2026-01-0922:49 That's amazing! I'm so glad for you that you found something that works and which can keep you going!
This reads like an ad. Why would you capitalize it like a product name and then even link to the website?
I still have no idea what it really is. From the name I'd think you're going for a run at a local park. The website calls it a "5k and 2k community event", what that's supposed to mean I have no clue. It insists you either "join" or "volunteer", all while being as non-specific as possible why I should even care
2/5k what? people? distance? currency? number of events? It almost reads like in-group speak of a cult I don't partake in.
-- Rant over --
By shevy-java 2026-01-0922:00 > saturdays from 16 to 18 is house cleaning time.
> Routine can be used for bad things but also for good things.
So your willpower causes such routines to work. Not everyone works that way. And not everyone not working that way has depression. I don't think one can generalise this to "routines will fix your depression".
> but after some repetitions your mind (and body) begin to get used
I also don't buy into that. A good counter-example is tobacco smokers. Some manage to quit the moment they decide they want to quit, with no substitutes. Others try with substitute and interestingly for many who try, that also works, but for some it does not. And some can barely ever quit smoking. And a lot of this has to do with how their brain works.
Matthew Perry spoke about that with regard to his alcohol addiction. People are different. I personally never started with smoking, for instance, because I never trusted myself to be able to (want to) quit again - so at the least I was consistent in this regard (plus also, because in our youth, so many others started to smoke suddenly, and I always felt it was a very stupid reason to smoke merely because others would do so, even at an early age. Their rationales would not be mine and I failed to see the point in adopting their positions and make them my position).
By jjtheblunt 2026-01-0921:233 reply I bet simply having a dog needing walking tips the scales into an exercise routine at some level.
By multiplegeorges 2026-01-0921:291 reply It did for me. You have to be truly heartless to see a dog being sad about not going outside. So you take it for a walk, then another and another. Soon enough you're researching hiking trails in your region and getting healthier.
Dogs are the best.
By specproc 2026-01-0922:05 God yeah. So much healthier and happier in my forties than my thirties, and it's all down to my executive assistant.
By greenie_beans 2026-01-102:371 reply yes and then dog dies so you go back into a depression :(
By WalterBright 2026-01-0922:17 > Motivation is fleeting but routine persists.
Ahnold Schwarzenegger said that the gains in an exercise program happen when you really don't want to do it, but do it anyway.
By mancerayder 2026-01-102:40 >Motivation is fleeting but routine persists. When there is something that you want to do regularly (exercise, doing the final boring part of some sideproject, cleaning the house...) you remove willpower from the equation and set a day and a time.
Absolutely!! Don't wait to Feel Like It, or Be Motivated... and especially do not depend on another person/trainer/weather to motivate you!
Fitness is a to-do, like laundry or grocery shopping or going to work. Now where the nuance comes in is finding what you enjoy. But a nuance of this nuance is, you don't know what you like until you have done it for a while, at least one month. Don't do boot camps or hacky gimmicky things people try to trick themselves into doing.
For a while I was deep into photography and writing. In both, I read and listened to people who were experts - successful writers and photographers. I learned this - they don't wait for inspiration. They commit X time per day to doing their craft, as habit.
I write this after coming from the gym, on a chilly night, after a relatively annoying day, and I feel 80 percent better.
Now the joint soreness and constant tightness are a problem, cuz I'm getting older. But it must be done.
By parpfish 2026-01-0922:27 An easier routine for me to manage house cleaning is to set up a calendar with one little chore each day.
List out what needs to be done every week, every month, every season, and set them up to repeat.
Every day you do your little two minute task (clean the bathroom mirrors; vacuum a single room), so you get a little win. And they’re each so small that it never feels like you need to switch into a long “cleaning binge” that you need to dread.
The key I found was to avoid self flagellation.
Try your hardest to do each session, but if you miss a session don't try to make it up. Just get on and do a normal session the next time it falls due. You're in it for the long term, so long term it doesn't matter if you were intermittent when building the habit, or the occasional session gets missed for a reason.
By Ostrogoth 2026-01-118:30 I’m on this journey myself; learning to become more emotionally well-regulated, and kinder to myself. For years I had depression, and I used self-flagellation and self-loathing as drivers to motivate myself to do better. In work, hobbies, fitness, relationships…everything. I would unfairly criticize, disdain, and lash out in anger at myself, in ways I would never treat another person. My baseline emotional state skewed negative, and I’ve realized I was suppressing or dissociating from emotions entirely. It took a while to realize I wasn’t coping well. I made improvements over many years time, but sometimes still fall back into old default patterns. I finally hired a therapist to work through stuff and develop better emotional health and cognitive strategies. Started with just checking-in and recognizing emotions, and being more fair and kind to myself, which in turn helps to respond to everyday circumstances more objectively. It has helped immensely, and I don’t think I could have made the same progress without a neutral third party. I highly encourage anyone in a similar place to hire a therapist; it can be hard to find someone you meld with, but it’s worth it.
This, plus start small. Just do those 5 or 10 minutes of karate exercises per day, at a fixed time, or 5 new flashcards per day.
By mnky9800n 2026-01-0923:58 thats right. a year ago i decided, fuck this going to the gym randomly and not having a plan and only kind of committing. im going to do it. so i got a trainer, committed to 4 days a week, and so far ive kept that up for a year. and now, if i find myself running out of time in the day i make time for the gym. it is such a part of my routine that i simply do it without much questioning. because i know if i dont go i will no longer be able to do the things in the gym the way i do them today. i enjoy that feeling and wish to continue. i think the point of life, at least partially, is to figure out things that you enjoy that don't take from you and do them consistently.
It is really easy to have a routine when you are single and healthy in your 20s. It stops working so well later on. If you have friends, partner, kids, parents, pets, work, health issues etc. the routine is going to be challenged. If that only happens once every few months no big deal, but now that I am in my late 30s with a partner, kid, 3 pets and elderly parents. I literally have something derail my day almost every single day. Carefully planning my week would be a recipe for misery.
I think really successful people are ones that just don't give a shit, like full on narcissism. Like my dream is X, I need to do Y today. The dog is sick? My kid needs a ride? My parents need help? Not my problem I am doing Y full stop.
By chaostheory 2026-01-0922:25 I’m in the same situation as you as well many other people who still workout. The trick is to remove as much friction as possible for working out and adding friction to activities that aren’t good for you. For example, if you don’t have time for the gym, make it easier to workout at home, make working out the very first thing you do when you wake up, etc…
By nradov 2026-01-104:25 Routines tend to get more and more derailed as the day goes on. Wake up early and get the important stuff done first.
As for narcissism, the optimal amount is not zero. If you want to continue being of value to your family over the long term then sometimes you have to take care of yourself first. Unless it's a life-or-death emergency, others can wait a bit for help.
By RickJWagner 2026-01-0921:461 reply I subscribe to Arnold Schwarzenegger’s newsletter, which has a surprising amount of great, well researched content.
Right after New Year’s Day, he said pretty much what you said. Discipline beats Herculean effort that’s sporadic.
By WalterBright 2026-01-0922:24 Scott Adams said it a different way - systems over goals.
By Terr_ 2026-01-0922:50 > Motivation is fleeting but routine persists.
That makes me think of a philosophical comic on quitting smoking. [0] Rather than cerebral willpower, a lot of value comes from indirectly shaping what your animal-brain does or doesn't encounter/expect every day.
By jimnotgym 2026-01-108:50 I'm not even back from work at 18-19 every day, or even most days. It varies by hours. By the time I have had dinner I'm thinking about settling down to settle my mind so that I might sleep that night. I'm also mentally exhausted after a day in my job. How do I create a habit without a time gap?
By trueismywork 2026-01-0922:061 reply The same routine for good things can turn into being a bad thing. Brcause it can make you inflexible. So there's a trade off there.
For me, it was when I was in a situation where I had to work 80 hours a week to keep my job. I had to get rid of my routine for 8 months and I am happy I did it otherwise I would he poor today.
By exe34 2026-01-0922:08 Being inflexible is only a problem for other people! :P
By skywhopper 2026-01-0922:11 Glad that works for you, but please know if you are giving advice to individuals, that not everyone can work this way. In fact, for some people, this sort of artificial structure actually makes it harder to get the stuff done, and just makes things worse.
As someone that is unable to keep any sort of routine, I have objections here. :D Without some sort of obligating circumstance, it is incredibly easy to forego what would have otherwise been today's routine.
This 100x. I go to work because I don't want to have a long uncomfortable conversation with my boss, and because I hate interviewing, and not having income is even worse. Even at work, I often find reasons (like HN) to do actually DO work.
I've had routines at times in my life for months. And they disappear in a matter of days when I get stressed or my schedule changes or whatever.
By aiahs 2026-01-116:51 What worked for me was a thing I started with one of my best friends, where we're accountability buddies for each other. We both pick topics/habits we wanna foster and then talk once a week about how that went the last week. In my case I chose exercise (going a certain number of times per week), and there were quite a few moments already, where I'm sure I would've just skipped if I didn't have this construct. It basically created this social obligation to keep the habit. I can really really recommend it if you wanna try it out with someone.
By 46493168 2026-01-1015:23 > Motivation is fleeting but routine persists.
This is tautological: if the action doesnt persist, it isn’t routine.
By bicepjai 2026-01-0923:07 This is a great quote
>> Motivation is fleeting but routine persists.
By fastasucan 2026-01-1121:26 >Motivation is fleeting but routine persists
Dude, not when we are talking about mental health problems. A semi serious mental health problem can take you out of the routine of showering, eating and brushing yoir teeth.
>There is no question if I want to do it, it is set at that time and I have to do it, period.
Again we talk about mental health here. Getting out of bed before dinner can be an impossible task. There is no "I have to do it, period". That period can cease to exist, and all you are left with is "i have to do it" over and over again without the ability to actually do it.
We have a certain amount of "willpower" that can overcome motivational barriers. This willpower is limited, though. It's very helpful to have clear guidance on where to allocate this very limited resources, especially in situations where people are otherwise struggling.
All of which is to say -- these exhortations can play a useful role. :)
By ToucanLoucan 2026-01-0921:132 reply It's also worth noting that willpower in general is constantly being whittled down by how stressful and, for lack of better term, fucking annoying modern life is. I'm reminded of a quote from my favorite article from Ed Zitron:
> In plain terms, everybody is being fucked with constantly in tiny little ways by most apps and services, and I believe that billions of people being fucked with at once in all of these ways has profound psychological and social consequences that we’re not meaningfully discussing.
And I think one of those psycho-social consequences we're not discussing is everyone is just... fucking annoyed now, constantly, about shit that it doesn't feel right to really complain about. Like, you plus or minus live on your phone, and I'm very much including myself in that statement. Every time you get logged out of an app you use every day to, for example, board your morning train, or park your car, or have to reset a password to pay your power bill, just like, all of that? Every time your day is interrupted with stupid bullshit from Modern Life takes a tiny bit of that energy, and I dunno about everyone reading this, I have a quite well managed and streamlined life, and I still have just... dozens of these. Every single day. I can't fathom being one of the folks who ISN'T as well versed in tech as I am, existing for them must be utter HELL.
And that's the essentials, that's not even going into how most tech products now are constantly begging for your attention, for your engagement, trying to pluck the strings of your psyche into making you angry, or horny, or whatever. Engage with platforms, buy these products, watch 9 TV shows so you're not out of the loop, you've been added to an SMS spam group, and everyone is replying to it saying they're not interested, on and on and on.
Sorry this turned into more of a rant than I really envisioned but yeah. I can easily comprehend a day where I try and go to my gym, and the fucking app doesn't work right and I can't get in, and I just quit because I've already solved 20 fucking captchas today and I simply lack the energy to do another, to help train some goddamned AI, for a company I don't know, you know?
By smeej 2026-01-0921:31 > existing for them must be utter HELL.
You've certainly hit upon why they use the same password for every single thing.
I just got a new phone which meant I had to read-login and set up every app and account.
It was an intense deluge of SMS codes, flipping back and forth to the Authenticator, dismissing welcome popup modals, security email notifications.
I was frazzled by the multitasking and can only imagine how hard it would have been for some senior citizen that was badgered into updating their device.
AIUI, the whole "certain amount of willpower" was a misunderstanding / exaggeration / bullshit claim that's not really held to be true anymore.
By boplicity 2026-01-1015:13 Source? I'd love to learn more about this!
By LorenPechtel 2026-01-0920:467 reply Yup, which is why diets fail. People who are fat generally do not have enough available willpower to lose weight.
I wouldn’t phrase it that way. Relying on willpower is a recipe for failure. Humans generally don’t have enough willpower, it goes for most things, even when you don’t have strong physiological forces involved. The key to getting a diet to work is in figuring out how to not require willpower, which means thinking about it differently, forming new habits. Stress and social environment also need attention or they will steamroll your goals.
This has more to do with hunger requiring a tremendous amount of willpower to ignore rather than fat people having less willpower than people of average weight.
My suspicion as someone with lifelong weight struggles and having tried GLP-1 medication: overweight people require more willpower to lose or maintain weight relative to those of normal weight.
So the advise or admonishment of the normally weighted that losing weight "just requires willpower" is true but facile.
If we were to medically induce a constant feeling of hunger and insatiability into a person of normal weight, I'm sure they could keep the weight off, but would find that their willpower is highly depleted.
There are medications that cause increased appetite and weight gain (ex: some bipolar depression medications, prednisolone). This effect is so pronounced, that if a doctor sees the patient not gaining weight, they will suspect non-compliance and have to rule it out. Of course, some patients use extreme diet and exercise (willpower) to avoid these effects, but a normal person accustomed to expending a normal amount of willpower to maintain weight will find themselves gaining.
By 46Bit 2026-01-0921:10 Overeating is often a coping mechanism. It’s really hard to displace unless your life is going fantastic. Even with GLPs.
By smeej 2026-01-0921:32 To solve digestive problems, I managed to eat the exact same meal every single meal for 20 straight months. And it didn't help me lose weight.
So I dispute this statement with some enthusiasm.
By kayodelycaon 2026-01-0922:341 reply I seriously dispute this. I spent weeks not being able to eat enough. I hardly lost weight despite being close to the optimal calorie range to do so.
That may be true if you're severely depressed, but I think it can save you if you're starting to get depressed. That's what happened to me at one point, and an online comment saved me.
I was like 60% depressed but on my way there. I just took my first computer science class in college but I was overly ambitious when I participated in an undergrad CS research. The stress and imposter syndrome was shoving me to the downward spiral.
I posted some gloomy thoughts on an online forum. It was long ago, but I remember the post contained how I could kind of relate to the villain while watching the movie The Dark Knight Rises.
Some online person advised me "lift weights". I had never tried seriously lifting weights, but I was living in a student apartment 10 minutes away from the student gym, so I decided to give it a try. I can't forget the sensation when I did a set of bench press. After a period of amassing so much stress, each rep felt like I was reaching my hand into my brain, directly scooping out the waste and tossing it away.
I became much more active after that, and successfully finished the research and the degree.
It's like how homelessness is more reversible for people who became homeless less than a year ago, and why organizations focus on those groups.
By eudamoniac 2026-01-1017:02 If psychiatrists could mind control their depressive patients into doing 2-3 weeks of heavy compound lifts, I'm certain more than half would be cured.
By HauntingPin 2026-01-0919:209 reply I also question the universality of it. No amount of exercise changed my depression or made life any less miserable. Anti-depressants finally helped me get past the trauma I was unable to properly process otherwise.
By antonymoose 2026-01-0920:191 reply I don’t think depression is a universal root-cause diagnosis so I’m inclined to agree.
I’ve been diagnosed clinically several times in life with depression and the pills never did anything for me. Sometimes exercise worked, sometimes it was of little or no use.
With retrospect, all of my episodes of depression were a function of environment. As a child, growing up in a broken home situation and bad school environment, of course there is going to be depression. Life sucks. Further, no pill or weight lifting schedule is going to fix that either. Only breaking out of that situation will.
As an adult, I’ve absolutely had and broken out of a long episode of depression with exercise. Bad breakup, startup failure, then introduce chronic drinking and subsequent weight gain. Guess what, cutting back on drinking, bicycling to work 30 minutes each way, doing martial arts in the evenings, it was a great fix. It enhanced self image, added a new community of positive people, and broke a cycle of depression.
By LorenPechtel 2026-01-0920:52 I definitely agree, there are two fundamental forms of "depression"--internal and a reaction to a bad external situation. Very different causes, what works for one doesn't work for the other. And I don't even like the "depression" label for bad situations--as with the previous post about willpower. We have a limited ability to cope with bad, when it's exceeded (or our efforts are misapplied resulting in the same end) we get "depression". No, we get reality! That's why things like forcing rehab does nothing about addiction--it doesn't remove what drove the person to the drugs in the first place.
By abraxas 2026-01-0920:15 And I'm the counter anecdotal case of your anecdotal case.
I have a page long list of failed psychiatric regimens that included drugs alone and drugs combined with talk therapy. None of them effective.
I won't say that I'm cured of depression now or will ever be. But a strict and persistent exercise routine lessened it to the point where I can function day to day. This was never achieved with presrciption drugs or therapy (of which I have developed a dim opinion).
By 2muchcoffeeman 2026-01-0919:533 reply And you think the effects of drugs is universal?
Exercise is a side effect free treatment that works for some people so it’s worth a shot because it sometimes works.
By mrgoldenbrown 2026-01-0920:061 reply The poster you responded to didn't claim that drugs were universally helpful. I think the main point is that there is no universal that works for everyone. For some exercise works, for some drugs, for others therapy. And "works" isn't a yes/no, one might work a little for you, one might work super great.
I'd argue that depression kills and optimal therapy is: anti-depressants, exercise AND talking therapy and the time to start is NOW.
I wouldn't knock the effectiveness of any of them with the caveats that: (1) you can get anti-depressants from you primary care doc, the best practice is to start on something, ramp up your dose and try something different if it is not working or you don't like the sides. I really thought Vanlafaxine was a comfortable ride but it raised my blood pressure to the "go to the ER" range. Call on the phone and lean in about adjusting your meds. (2) Getting an appointment for talk therapy can take a while these days. (3) In a hard case you can get a more complex medication cocktail from a psychiatrist but the wait could be worse than the talk therapy. (4) People in the military do insane amounts of cardio because it helps dealing with insane amounts of stress. 2 hours a day of cardio helped me deal with a business development process that went on for years before ultimately failing.
By keeganpoppen 2026-01-0922:48 i think they are merely saying what worked for them. it is working for me too, despite my misgivings about “just taking a pill”. YMMV.
By cheald 2026-01-0920:29 Depression isn't monocausal so it'd be far too simple for it to have a single solution.
But in general, humans just work better when we're regularly putting our bodies under reasonable physical load.
By heavyset_go 2026-01-0921:053 reply I'm a non-competitive athlete, and yes exercise can help depression, but no, it will not be sufficient for anything but your mild to average case of it.
Exercise is a crucial part of dealing with it, but it is not a panacea.
By unparagoned 2026-01-1018:38 Depression is an umbrella term that covers lots of underlying biological conditions.
Exercise forms the foundation of a biologically healthy brain which is required for all conditions. For some conditions it’s all you need for others it’s not enough
By genghisjahn 2026-01-103:33 True. I ran my but off in 2025 but it was mainly holding my anxiety over finding a job at bay.
By burningChrome 2026-01-0921:181 reply >> I'm a non-competitive athlete
Honest question, but what do you mean by this?
I've played competitive team sports my whole life and have a very competitive drive. If its not team sports, its rock climbing where I feel like I'm competing against myself or my brain trying to solve a route. If I'm hiking, I'm competing against the clock or how far I can go. If I'm lifting weights, its about how many sets I can do and what weight in order to push myself.
So even in what most people deem "non-competitive" activities I'm still competing against a clock, or my body, or my brain.
I'm just curious what you meant is all.
EDIT: Typical HN. Ask a question and get downvoted. Logging off the day - thanks.
By skywhopper 2026-01-0922:18 Yeah, any of these studies that show “X works better than Y” are inevitably operating on averages. Not everyone will respond the same way. Not to mention that the very existence of the structure and human interaction required for these studies makes a huge difference in their outcomes.
By resumenext 2026-01-0922:101 reply I hesitate to ask but what is your gender? I think there may be very gender specific effects in this comparison. I would also be very curious the type and intensity of exercise and whether you had comorbidities that impact ability to train (obesity, low testosterone, etc).
By HauntingPin 2026-01-0922:241 reply I'm male. I've done everything from cycling to 5-10k running to heavy weightlifting. The only other thing I have is ADHD, no other comorbidities.
By Jtsummers 2026-01-0920:16 > I also question the universality of it.
The article doesn't claim exercise is a universally effective treatment, so whose statements are you questioning?
By marcosdumay 2026-01-0920:27 There's no universality on anything linked to mental health.
By javanissen 2026-01-0922:25 I think the real exhortation is to develop a multi-pronged strategy for managing depression. I didn't feel like my depressed life got durably better until I had both exercise and therapy, and there are still times where things aren't going well with no clear discernible reason. I suspect that adding a low dose of medication on top would help.
Every additional coping mechanism you add, that works well for you, provides defense in depth.
By 4fterd4rk 2026-01-0919:25 Well... sure. I've had trouble with anxiety and it's actually an incredibly anxiety provoking thing for me to go to therapy. But I read enough information telling me that therapy is good for anxiety so I finally went. I think there's people out there who need to know that exercise is helpful for depression, even if the depression makes it difficult.
By WackyFighter 2026-01-0919:151 reply Much like the sibling comment I started walking around the local park before spending more time hiking. I live semi rurally though and wouldn't want to walk in an urban environment.
I normally feel much better after walking and cycling. Also I think doing something repetitive like walking allows you to think, tune out of other things.
Everyone is different, so I say this not to tell you how to feel but just to offer a different perspective:
Walking in urban environments can be its own sort of joy. Cities (well, good ones anyway) are full of life and energy and humanity, have unexpected nooks and crannies, and a rich sense of dynamism and excitement. Even late at night (as long as you're safe), a quiet city can be a source of serenity and melancholic beauty. Writers like Baudelaire and Benjamin described at great lengths the pleasures of flânerie.
Nature is wonderful too, of course! I love a good hike through the forests and mountains...but I also love a good stroll downtown.
By WackyFighter 2026-01-1010:002 reply No. Urban environments suck to walk around. What you wrote is utter drivel.
If one needs to justify it by quoting authors, that suggests it isn't self evident and they are just trying to justify something that they know isn't good.
By zaptheimpaler 2026-01-0919:11 It doesn't have to take deep discipline. I started my routine by just going for short walk after dinner everyday and it built up from there. It's intimidating to have to start at gym for 60 minutes 3x/week. Just do whatever little you like - a few pushups, a walk, a dance and stop when its not enjoyable. It tends to naturally build up.
By refulgentis 2026-01-0919:573 reply This is 100% true, and what I'm about to describe isn't an attempt to falsify it: took me 11 years and 3 cities to figure it out.
You don't have to exercise so much as get moving.
I'm the best I've been in 37 years, and it's because in August I started forcing myself to just keep walking whenever I went out to have a cigarette. I was in Boston, and would end up ~nowhere and exhausted.
Then started doing random stuff: "might as well walk to Harvard Square instead of the bike path again" "might as well go to a bookstore instead of somewhere random" "I should use the skate park, I don't fit in*, but I miss rollerblading from middle school"
Then my dog died, 2 days later I severely sprained my ankle at the skate park and couldn't walk anywhere substantive for a couple weeks. By the time I'm able to do a sustained 10m+ walk it's winter.
Went to visit California as a not-tech-employee for the first time, so I saw San Luis Obispo and Los Angeles for the first time. And the same habit kicked in, in SLO I ended up hiking for the first time on what I find out later was not a real trail, end up hiking every day that week.
Get to LA and it's nothing like I would have thought. Egalitarian, tons of stuff to do, and Waymo is a godsend. Whenever I get antsy there's somewhere to go and a way to get there.
2 weeks later, I got an apartment in LA, moving away from Northeast for the first time in my life. I could see me just spending another 4 months decaying in Boston until its barely warm enough out to take a 30m walk, and I'm tired of that cycle..
All that to say, I'm fit, I had a great career in high school sports, I played basketball occasionally, but couldn't really get active consistently. Treadmill was never stimulating enough to keep my attention on anything other than being bored. In retrospect, I really wish I heard this old saw ~all of us know and heard it as "moving around" instead of exercise.
(n.b. this was all under active mental health care x medications spanning a decade+. It's not that the mental health care was useless, I don't think I could have done what I did without it. But it couldn't "fix" me on it's lonesome, only enable me to get moving.)
* in retrospect this was wrong, plenty of newbies, and one of the most welcoming social environments I've been in. just people out there all trying to do the same thing and supporting each other.
By cheald 2026-01-0919:59 That's a great way to think about it. "Get moving" is a lot less intimidating and feels more achievable than "exercise" which conjures images of marathons and four-plate squats.
By burningChrome 2026-01-0921:26 get moving is the key.
Some of my best friends are personal trainers and they say the same thing. When you tell people just moving essentially gives you what they refer to as "free exercise". The kind that doesn't make people feel like they have to get up off the couch, change their clothes, go to the gym, get on the treadmill, lift their weights, etc.
Just walking around the block. Just walking up a few flights of stairs. Just doing something that doesn't feel like you have to have a huge investment is sometimes the best way to start - then transition into more structured stuff like wight lifting or running or anything else. And you still get the benefits for almost nothing. Walk a few flights of stairs and your legs start to burn, your lungs open up, you increase your blood flow, and you release endorphins. And it didn't cost anything if you can just include it in your day-to-day activities.
Not sure how many times I make extra trips to my basement just to get in a few more stairs. lol
By LorenPechtel 2026-01-0920:581 reply Getting moving *is* exercise.
No way could I do a gym and these days most things in a gym would be just begging for joint pain. But the wilderness is a great gym (assuming you know what you're doing safety-wise, I see too many idiots out there.)
> Getting moving *is* exercise.
There's a difference between what something is and what something is perceived as. For whatever reasons they may have, many people have a strong negative emotional reaction to the idea of exercising, ask them to go for a two mile walk around the neighborhood with you and they'll balk. But then you take them to a city like Rome and they'll walk 20 miles in a day without even realizing it.
By broof 2026-01-0922:32 Also the bad times can be a great time to build good habits. I’ve tried and failed to develop an exercise routine many times, but it wasn’t until I was laid off for 6 months that it finally stuck. I had a friend who went to the gym every day in the middle of the day so I didn’t really have a reason not to go. 6 months was long enough for the habit to stick and fast forward years later and I still have the habit. It’s been so good that I regularly think about how good it was that I had the opportunity to be laid off.
By KellyCriterion 2026-01-0920:461 reply You can also have a "deeply-disciplined routine" and get thrown out of it and hit depression because exactly by that one impact.
Source: Myself.
By gloxkiqcza 2026-01-0921:152 reply I’m not sure if you need to hear this but in case you do: There’s only one way to get back to it and the sooner you do it, the easier it is. First week is hardest, then the positive feedback loop starts kicking in. Do not to think about it, just get it done.
By KellyCriterion 2026-01-0921:26 What most people without this "experience" never understand:
you just _cant_
If you've seen a distinct "low bar", its nearly impossible to get straight up above this bar
By _DeadFred_ 2026-01-1016:55 Fun fact, people suffering from loss of quality of life issues don't lack motivation. Lots of these people are in great pain, constantly, every day. My mother had a hip issue where the pain could instantly shoot up so bad she couldn't move (from just the normal, constant, almost in tears pain). She couldn't risk going somewhere to exercise, she would be stuck. She couldn't risk exercising on days where she needed to work the next day. Some days she would break down crying going to the grocery store because she had gotten stuck there the previous time she went.
A LOT of quiet unassuming people are INSPIRINGLY motivated to push through INCREDIBLE pain and obstacles, every day. Many that prevent them from 'just exercising until life gets better'. It is bullshit to say they lack motivation/character/willpower.
Nail on the head. I know that exercise will make me feel better, but during a period of depression/grief I could not even get out the house.
By AnthonBerg 2026-01-0920:161 reply To my surprise, it has been my experience that this turns out to be pulmonary. It was always the chicken-and-egg of... breathing.
Seems like this has been my story:
Severe prolonged stress floored me. Turns out that the autonomous control of bronchoconstriction and dilation had gone out of wack, into dysregulation. My lungs were basically clamped shut. (Muscular tension and sundry dysregulation from severe prolonged stress makes sense, right? Applies to the lungs too!)
Exercise worked when I could get myself to do it... because exercise forces lungs to open.
And the nervous system and brain, well it requires lots of oxygen. In order to learn. And unlearn.
—
edit: Also interesting: Ketamine therapy worked. And... ketamine is a bronchodilator!
By ambicapter 2026-01-0921:39 That's interesting. I've noticed when I go for a long-enough run and my body warms up to an optimal state, breathing feels easy and effective. I wish I could breathe like that all the time.
By heavyset_go 2026-01-0921:021 reply > Exhortation to develop those good habits in the good times, I suppose.
This is what medication for more severe cases of things like depression is supposed to offer: an opportunity to learn, usually through therapy, to cope with the condition in a healthy way.
By hu3 2026-01-0921:11 Yup!
Same thing for ADHD.
Medication helps having willpower/focus to develop better habits and realize you are not a useless dumb human. It's just that your brain is a little finicky to get going sometimes.
In fact the few diagnosed ADHD people I know are wicked smart. It's just that their brain overclocks to unproductive levels without medication.
By cultofmetatron 2026-01-0920:23 its amazing that we haven't found anyone dualwielding the skill of therapist and personal trainer. we already have things like sex surrogacy (https://www.webmd.com/sex/what-is-sexual-surrogacy) so its not like it would be that weird by comparison.
By hannob 2026-01-0921:26 True, but the same is true for therapy. Finding a good therapist isn't easy, and having depression certainly doesn't make it easier.
By singpolyma3 2026-01-100:22 One thing that worked well for me is I switched my transportation to almost exclusively bicycle. Do I always want to exercise? Do I always want to get on my bike when it's below zero in active weather? No, not always. But if I want to get where I'm going that's my option and I get the exercise in the process (and save a buttload of money too)
By baby 2026-01-101:12 I think we also approach exercise the wrong way. And IMO this is true with sleep too (which also impacts depression). We're using the wrong metrics.
The most important thing to get started with working out is just to start doing some exercise. You can start on one push up a day or something. It's all about creating momentum and habit.
Once you do it, then you can increase the time and the intensity and optimize exercise and all. But doing sport should be about doing one push up a day and thats it. About starting as slow as you can.
Sleep is the same in that we try to sleep as much as we can, and get as much REM and deep sleep, and these are not the right metrics for most people. The most important is just to go to bed and wake up at the same time everyday. That's it.
People are obsessed with trying to go to sleep at some point in time. Don't. Go to sleep when you're tired, wake up sleep deprived at the right time, the next evening it'll be easier to sleep at the right time
By darkhorse222 2026-01-100:15 My two cents on this topic is to create short term, superficial incentives to help create the practices that yield the long term incentives. For me this is paying extra for a gym with a hot tub, sauna, and cold plunge. Now I derive relaxation from the workout, but before that I also received a lot of support from the knowledge that the amenities afterwards were waiting for me.
I'm not a big believer in discipline.
By vlod 2026-01-103:58 “Action precedes motivation.” ― Robert McKain
This seems to work for me at least. If I start trying to reason with myself why I should get out of bed at 5am to go to the gym rather than excuse XYZ, I will talk myself out of it.
If I simply start "moving" and start doing "stuff" without engaging my brain, things happen and within a short space of time, I'm pumping iron and feeling great.
By lightbulbish 2026-01-0923:38 That is true. And motivation is not a fixed variable. It is possible to get increased motivation by a better plan, resulting in increased self efficacy.
From studies like this, maybe more awareness and perhaps funding to solutions providing smaller steps
Shameless plug, I am building one: Low friction mini games, social, squats/situps/pushups. Feelgoodcrew.com
By mustaphah 2026-01-0921:26 Once exercise becomes a habit, it's very easy to do even on days when your mood is terrible. A strict routine (initially) is the trick to making things easier forever.
You definitely want to build that habit when you're at your best.
By mnky9800n 2026-01-0923:56 i think what is missing from this narrative is not whether or not people have a routine, it is that exercise elevates your mood away from the depressed state, therapy encourages you to question your thoughts and decisions through out your day that might lead you away from a depressed state. to put it a different way, whats the point of exercising every day if you continue the thoughts and habits that are less than satisfactory to you without any self awareness?
By jimnotgym 2026-01-101:30 I always wondered if this kind of research was just finding that depressed people motivated to exercise are already in a recovery mindset
By iamacyborg 2026-01-0921:56 Motivation generally follows action, not the other way around.
By econ 2026-01-0923:12 I hear ice swimming also works.
If you are or you know some that is depressed one of the best things you can do is start exercising with someone.
By pinkmuffinere 2026-01-100:23 I really like this advice. When I'm sad I don't want to leave the house, and certainly won't have the motivation to do much exercise on my own. But having friends peer-pressure me into making good choices would (and has) helped a lot.
By NedF 2026-01-106:12 [dead]
By oldpersonintx 2026-01-0919:50 [dead]
This is only talking about therapy and not medication. The original study is a bit light on details https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
> For the 57 trials (2189 participants) comparing exercise with no treatment or a control intervention, the pooled SMD for depressive symptoms at the end of treatment was −0.67 (95% confidence interval (CI) −0.82 to −0.52; low‐certainty evidence), showing that exercise may result in a reduction in depressive symptoms. When we included only the seven trials (447 participants) with adequate allocation concealment, intention‐to‐treat analysis and blinded outcome assessment, the pooled SMD was smaller (SMD −0.46, 95% CI −0.88 to −0.04). Pooled data from the nine trials (405 participants) with long‐term follow‐up provided very uncertain evidence about the effect of exercise on depressive symptoms (SMD −0.53, 95% CI −1.11 to 0.06; very low certainty evidence).
Like, what does -0.67 really mean in this context. I read the study and it is not really explained. Maybe I'm too dumb to get it, though.
By unparagoned 2026-01-1018:341 reply Other metas show exercise is more effective than both therapy and drugs.
ssri don’t fix any underlying condition and barely work long term, that if they really work at all.
By fastasucan 2026-01-1122:03 What if medication helps people being able to exercise?
It's a standardized mean difference, which I believe can roughly be interpreted as: "treated groups had 0.67 stddev lower depression score than control groups."
That's a pretty substantial improvement - consider someone who's more depressed than 75% of the population becoming completely average. (Because the 75th percentile is about 0.67stddev above the median.)
You cannot say if this is a substantial change or not, because you need to know by how much the groups actually differ on average, i.e. you need the unstandardized effect size, expressed as a mean difference in the scale sum scores, or as an actual percentage of symptoms reduced, or etc. In general, there are monstrous issues with standardized mean differences, even setting aside the interpretability issues [1-3].
See also my response to GP.
[1] https://journals.plos.org/mentalhealth/article?id=10.1371/jo...
[2] https://bpspsychub.onlinelibrary.wiley.com/doi/abs/10.1348/0...).
[3] https://www.tandfonline.com/doi/abs/10.1080/00031305.2018.15...
By D-Machine 2026-01-0921:44 It means nothing, standardized effect sizes have no clinical meaning here, they are purely statistical. To measure if these kinds of changes matter, you need to determine the Minimal (Clinically) Important Difference [1-2]. I.e. can clinicians (or patients) even notice the observed statistical difference.
In practice, this is a change of about 3-5 points on most 20+ item rating scales, or a relative reduction of 20-30% of the total (sum) score of the scale [1-2]. Unfortunately, anti-depressants are under or just barely reach this threshold [3-4], and so should be widely to be considered ineffective or only borderline effective, on average. Of course this is complicated by the fact that some people get worse on these treatments, and some people experience dramatic improvements, but, still, the point is, depression is extremely hard to treat.
Unfortunately, this also means that if exercise is only nearly as effective as therapy for depression, it may mean that the benefits of exercise are not actually really clinically observable, if measured properly and not just based on arbitrary statistical significance.
EDIT: There is less data on MCIDs for therapy, but at least one review suggests therapy effects can be in the 10+ point range [5]. But the way the exercise study is presented, with standardized effect sizes, we have no idea if the results matter at all [6].
[1] Button, et al. (2015). Minimal clinically important difference on the Beck Depression Inventory - II according to the patient’s perspective. Psychological Medicine, 45(15), 3269–3279. https://doi.org/10.1017/S0033291715001270 [https://www.cambridge.org/core/journals/psychological-medici...]
[2] Masson, S. C., & Tejani, A. M. (2013). Minimum clinically important differences identified for commonly used depression rating scales. Journal of clinical epidemiology, 66(7), 805-807. [https://www.jclinepi.com/article/S0895-4356(13)00056-5/fullt...]
[3] Hengartner, M. P., & Plöderl, M. (2022). Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression. BMJ Evidence-Based Medicine, 27(2), 69-73. https://doi.org/10.1136/bmjebm-2020-111600 [https://ebm.bmj.com/content/27/2/69.abstract]
[4] Jakobsen, J. C., Gluud, C., & Kirsch, I. (2020). Should antidepressants be used for major depressive disorder?. BMJ evidence-based medicine, 25(4), 130-130. https://doi.org/10.1136/bmjebm-2019-111238 [https://ebm.bmj.com/content/25/4/130.abstract]
[5] Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & van Straten, A. (2014). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis. Journal of affective disorders, 159, 118–126. https://doi.org/10.1016/j.jad.2014.02.026 [https://pubmed.ncbi.nlm.nih.gov/24679399/]
[6] Pogrow, S. (2019). How Effect Size (Practical Significance) Misleads Clinical Practice: The Case for Switching to Practical Benefit to Assess Applied Research Findings. The American Statistician, 73(sup1), 223–234. https://doi.org/10.1080/00031305.2018.1549101
Exercise is great, just make sure to take sometime to evaluate where you are at mentally. I was running about 40 miles and doing 5 hours of lifting per week to try and stay a head of my depression, and when I finally burnt out everything came crashing down all at once.
By MikeNotThePope 2026-01-0922:302 reply Exercise is great for addressing feelings related to being physically inactive. It won’t address other mental health issues, such as learning to control your emotions & fostering healthy relationships.
By observationist 2026-01-0922:431 reply There's a deeper level to the way you calibrate your mental operation. If you're under a lot of mental stress, your body is evolved to prime you for physical effort, beyond the fight or flight responses. By engaging in exercise, you're resetting your physical condition, and that can put you in a much better position to mentally cope with whatever is happening.
This is something that has very deep evolutionary roots. A looming project deadline, a relationship crisis, feeling burned out, general malaise about your place in life - all of those stressors can bring about different neurochemical and hormonal changes that are in whole or in part dealt with in a healthy way by engaging in strenuous physical activities.
That puts you in a position to gain perspective without the immediacy of the negative emotion, so you don't have to feel anxious, or have subtle negative threat framing around everything.
You can abuse that, like anything else, and mask real negative factors in your life, or it can be a phenomenal and healthy way to deal with the negative framing of otherwise neutral or even positive circumstances in your life.
By nerdsniper 2026-01-0922:37 > Exercise is great for addressing feelings related to being physically inactive.
That definition is probably too narrow.
https://en.wikipedia.org/wiki/Neurobiological_effects_of_phy...
