I’ve been thinking about the link between exercise and mental health. Most of us know it—we’ve felt it ourselves—and research confirms it. Physical activity lowers the risk of depression and can help treat symptoms. But in practice, it’s not always that simple.
You’ve probably seen it in clinic: a client shows up with a physical complaint, but the real issue runs deeper. They know they should move, but they’re stuck. Sleep is off, eating is off, motivation is low, they may speak quietly, stooped posture, and the things that used to bring joy now feel like work. That’s not laziness, it may be depression showing up as avoidance and disengagement.
This is where we can help. By turning “I should move more” into something doable, meaningful, and repeatable. Behavioural Activation (BA) is one approach—using values-based planning, scheduling, tracking, and reviewing—to help people re-engage with movement and life, one small step at a time.
A massive 2022 JAMA Psychiatry study (191,000+ people) found a clear dose–response between activity and depression risk:
75 min/week of moderate movement → 18% lower risk
150 min/week → 25% lower risk (then the curve flattens)
A 2018 Am J Psychiatry review (267,000 people, tracked up to 7 years) said the same: active folks had 17% lower odds of developing depression—no matter their age, gender, or location.
The takeaway? Movement doesn’t just make you feel better in the moment, it protects you long-term. And unlike many depression risk factors, this one’s changeable. Start small. It still counts.
It’s not just prevention. A 2024 BMJ meta-analysis (218 RCTs, 14,000+ people with depression) showed exercise can work as well as standard care:
Walking/jogging: g ≈ –0.62
Yoga: g ≈ –0.55
Strength training: g ≈ –0.49
Moderate–high intensity, and especially supervised or group programs, tended to help more—probably thanks to structure and social connection.
Bottom line: Exercise is legit treatment for depression. The hard part is getting going—and that’s where Behavioural Activation comes in. It helps bridge the gap between “I know I should…” and actually doing it, with structure, values, and support baked in.
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Before we get too excited about exercise, let’s ground the conversation. These strong effect sizes often come from comparing exercise to nothing or minimal treatment—real-world situations for many people, but not the gold standard. As Dr. Colleen Carney notes, when you compare exercise to CBT (with or without medication), the differences shrink.
That doesn’t make exercise less valuable, it’s still powerful, but it does mean we need to frame it precisely, especially for clients already struggling with activation. Exercise isn’t a cure-all, but it can absolutely help.
Here’s the nuance: plenty of clients are “active” on paper—hitting step goals, rolling out the yoga mat, showing up at the gym—yet still feel flat, unmotivated, or stuck. The problem isn’t always movement volume. Sometimes it’s a lack of meaning, structure, or reinforcement.
That’s where Behavioural Activation (BA) comes in.
The clinical pivot: Instead of asking, “What movement do you want to get back to?”, we ask, “What matters to you?” Movement might be part of the plan, but it’s not the whole plan.
BA is more appropriate than “just get active” when your client:
Is active but still feels low, disconnected, or flat
Knows what helps but can’t follow through
Has had multiple false starts with programs or routines
Feels life is dull, even with structure in place
Is struggling with sleep, mood, food, social connection, or meaning
Describes themselves as “lazy,” “burnt out,” or “irritable”
Avoids meaningful activities, even as their main problem improves
In these moments, the issue isn’t knowledge or capacity—it’s activation. That’s BA’s sweet spot. And sometimes, activation isn’t the priority—cognitive therapy, medication, or both may be a better fit. That’s a call to make with a mental health provider, physician, and the patient together.
BA in practice:
🧠 Choose a value-aligned activity
🗓️ Schedule it
📝 Track it (Pleasure + Mastery ratings)
🔁 Review and adjust weekly
Whether someone is under-active or over-functioning on autopilot, BA helps them move with intention—not just habit.
Tiny BA plan (keep the bar low, keep structure high):
Tie to a value: “Because connection matters, pick a 10-min walk while voice-messaging a friend.”
Make it concrete: “Mon/Wed/Fri at 12:45; front door to the corner and back.”
Plan a backup (if–then): “If it’s raining, then 10 min of step-ups indoors.”
Write & track: Log planned vs. done + P (Pleasure)/M (Mastery) ratings (0–10).
Sunday review: Keep, shrink, or swap; aim for repeatable wins, not heroic efforts.
Why this works: the prevention data says the first chunk of activity yields the biggest mental-health bang, and BA creates the container to repeat it.
Mood Moves: Mood Moves is a free, four-week email program we created to support people living with depression through small, manageable, science-backed actions. Each week, subscribers get 2 emails and simple strategies based on behavioural activation to help them feel more energized, connected, and in control. Share the link with someone who might need help.
Suicide Assessment and Intervention: Self-paced 4‑hour online course that equips clinicians with practical, compassionate skills for identifying warning signs of suicidal thoughts and intervening effectively—covering open conversation techniques, safety planning tools, and confidence-building strategies. Developed by occupational therapist Cassi Starc (MOT), counsellors and psychologists, it includes videos, templates, sample scripts, case studies, and quizzes to support learning and application.
The biggest gains often come from breaking the zero—going from nothing to something.
It’s the same for us as clinicians. Whether it’s adding more movement to our day or integrating a new tool like AI Scribe into your workflow, start with one meaningful, doable step. Write it down, try it, and review how it went. Then build from there.
Small, consistent actions, on the gym floor or in the clinic, are what stack up to big change.
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Exercise is one ingredient for good mental health; BA can be the container that helps patients follow through, especially in the presence of avoidance, low motivation and low energy. If you’re hearing “I didn’t get to it,” think less prescription change, and perhaps more BA structure.
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Stay nerdy,
Sean Overin, PT
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