We have all heard the advice to “walk it off” when feeling stressed. For decades this was vague lifestyle advice. But science has fundamentally changed this picture — exercise isn’t just a side dish in mental healthcare; it is the main course. Research now confirms that for many people, hitting the gym or the pavement can be just as effective as medication or counselling.1 

The exercise effect 

In 2023, researchers published a landmark umbrella review analysing 97 previous systematic reviews involving over 128,000 participants. The conclusion was quite revealing, engaging in physical activity can have effects similar to those of psychotherapy and medication for depression and anxiety symptoms 1. This doesn’t mean medication doesn’t have a place, but it highlights exercise as a genuine first-line option, not an optional add-on. This research also suggests that shorter and less demanding exercise programs can sometimes improve depression and anxiety more than longer or more intense ones 1. This tells us even short, gentle bouts of movement (eg like a 10–15 minute walk) can help lift your mood. 

It’s not just “endorphins” 

You have probably heard of the “runner’s high” and thought it was caused by endorphins. Modern science tells a more interesting story. In a 2021 study, researchers blocked the body’s endorphin system and asked people to run, and they still felt happier and less anxious after exercise. Instead, researchers found a rise in endocannabinoids – natural chemicals your body makes that can enter the brain and help you feel calmer, less stressed and in a better mood after physical activity 2. 

Take it outside 

Exercising in nature is also great. Physical activity in natural green and blue spaces produced significant improvements in mood, anxiety, and positive affect — beyond what indoor exercise offers alone.3 When you can, trade the fluorescent lights for sunlight and trees. 

Better together: The social connection 

Depression and anxiety may often get worse when people feel alone or disconnected. One of the powerful benefits of exercise is that it can bring people together. A large study of more than 1.2 million Americans found that people who played team sports had the biggest improvement in mental health compared with people who didn’t exercise 4. Joining a class, group or sports team doesn’t just get you moving, it also helps you connect with others, build support, build a sense of community, and feel less alone. 

Don’t skip the weights 

When we think about exercise for mental health, we often picture running or yoga. However, lifting weights can be just as helpful. Weightlifting can also reduce feelings of depression in many different groups of people, no matter their health, or how much they lift 5. Depression can sometimes make you feel like you can’t do things, but seeing yourself get stronger can show you that you really can change. 

What should you do? 

Major organisations including the Australian Government Department of Health and Aged Care  provides clear guidance 6: 

• Be active on most days with 2.5 to 5 hours of moderate aerobic activity per week or 1.25 to 2.5 hours of vigorous activity or an equivalent combination of both 6 

• Add strength training at least twice a week 

• Minimise and break up long periods of sitting 

 

Start slow and go easy. If you have anxiety, begin with gentle exercise at a comfortable level. Intense activity can cause feelings like a racing heart or shortness of breath, which might be upsetting. Take small steps and gradually increase your activity to build confidence.7 

The bottom line 

Exercise is free, accessible, and its side effects include better heart health and more energy. Whether it is a walk in the park, a group fitness class, or the weights room — moving your body is one of the most powerful things you can do to improve your mental wellbeing. Contact one of our exercise physiologists or physiotherapists if you would like to discuss how to build a safe, personalised program tailored to you. 

Disclaimer: This article is for informational purposes only. Always consult your doctor or mental health professional before making significant changes to your treatment plan. 

References 

1. Singh, B., Olds, T., Curtis, R., Dumuid, D., Virgara, R., Watson, A., Szeto, K., O’Connor, E., Ferguson, T., Eglitis, E., Miatke, A., Simpson, C. E., & Maher, C. (2023). Effectiveness of physical activity interventions for improving depression, anxiety and distress: An overview of systematic reviews. British Journal of Sports Medicine, 57(18), 1203–1209. https://doi.org/10.1136/bjsports-2022-106195 
2. Siebers, M., Biedermann, S. V., Bindila, L., Lutz, B., & Fuss, J. (2021). Exercise-induced euphoria and anxiolysis do not depend on endogenous opioids in humans. Psychoneuroendocrinology, 126, 105173.  
3. Coventry, P. A., Brown, J. E., Pervin, J., Brabyn, S., Pateman, R., Breedvelt, J., Gilbody, S., Stancliffe, R., McEachan, R., & White, P. L. (2021). Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis. SSM – Population Health, 16, 100934.  
4. Chekroud, S. R., Gueorguieva, R., Zheutlin, A. B., Paulus, M., Krumholz, H. M., Krystal, J. H., & Chekroud, A. M. (2018). Association between physical exercise and mental health in 1.2 million individuals in the USA between 2011 and 2015: A cross-sectional study. The Lancet Psychiatry, 5(9), 739–746.  
5. Gordon, B. R., McDowell, C. P., Hallgren, M., Meyer, J. D., Lyons, M., & Herring, M. P. (2018). Association of efficacy of resistance exercise training with depressive symptoms: Meta-analysis and meta-regression analysis of randomized clinical trials. JAMA Psychiatry, 75(6), 566–576.  
6. Australian Government Department of Health and Aged Care. (n.d.). Physical activity and exercise guidelines for all Australians. https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians 
7. Lederman, O., Grainger, K., Stanton, R., Douglas, A., Gould, K., Perram, A., Baldeo, R., Fokas, T., Nauman, F., Semaan, A., Hewavasam, J., Pontin, L., & Rosenbaum, S. (2016). Consensus statement on the role of Accredited Exercise Physiologists within the treatment of mental disorders: A guide for mental health professionals. Australasian Psychiatry, 24(4), 347–351.  

Lower back pain is one of the most prevalent health complaints worldwide. It is estimated that up to 80% of people will experience lower back pain at some point in their lives, making it the leading cause of disability globally (Hartvigsen et al., 2018). 

While lower back pain can be distressing, the majority of cases are not associated with serious pathology and tend to improve with appropriate management, education, and movement (Maher et al., 2017). 

 

What Is Lower Back Pain? 

Lower back pain refers to pain or discomfort in the lumbar spine and surrounding structures. Symptoms may range from stiffness to sharp pain and can be classified as: 

• Acute (less than 6 weeks) 

• Subacute (6–12 weeks) 

• Chronic or persistent (more than 12 weeks) 

Importantly, research shows that around 90% of lower back pain cases are “non-specific”, meaning no single tissue can be identified as the source of pain (Maher et al., 2017). This does not mean the pain is imagined — rather, it reflects the complex interaction between tissues, movement, nervous system sensitivity, and psychosocial factors.

 

Why Rest Is No Longer Recommended 

Older approaches to lower back pain often focused on rest and activity avoidance. However, strong evidence now shows that prolonged rest can worsen outcomes, leading to increased stiffness, reduced strength, and fear of movement (Qaseem et al., 2017). 

Clinical guidelines consistently recommend: 

• Staying active where possible 

• Gradual return to normal activities 

• Avoiding bed rest except for very short periods 

These recommendations are supported by international guidelines, including those from National Institute for Health and Care Excellence (NICE, 2020). 

 

How Physiotherapists Help with Lower Back Pain 

Physiotherapy management is guided by best-practice clinical guidelines and tailored to the individual rather than based on imaging findings alone (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2022). 

1. Comprehensive Assessment

Physiotherapists assess: 

• Movement patterns and spinal mobility 

• Muscle strength and endurance 

• Functional activities such as sitting, lifting, or sport 

• Psychosocial factors including fear of movement 

This whole-person approach is supported by evidence showing that addressing biological, psychological, and social factors improves outcomes in lower back pain (Hartvigsen et al., 2018). 

2. Education and Pain Understanding

Education is one of the most effective interventions for lower back pain. 

Physiotherapists provide reassurance that: 

• The spine is strong and adaptable 

• Pain does not equal damage 

• Imaging findings such as disc bulges are common even in pain-free people 

Studies show that improving understanding of pain reduces fear and disability and leads to better long-term outcomes (Maher et al., 2017; NICE, 2020). 

3. Exercise Therapy

Exercise therapy is strongly recommended across acute, subacute, and persistent lower back pain (Qaseem et al., 2017). 

Physiotherapy-led exercise may include: 

• Mobility exercises 

• Strength training for trunk and hips 

• Functional retraining for work or sport 

• Gradual exposure to movements that have become painful or avoided 

There is no single “best” exercise — success depends on individualisation and progression (ACSQHC, 2022). 

4. Manual Therapy

Manual therapy techniques such as mobilisation or soft-tissue therapy may be used to provide short-term symptom relief, particularly when pain is limiting movement (NICE, 2020). Evidence shows manual therapy is most effective when combined with exercise and education, rather than used in isolation (Qaseem et al., 2017). 

5. Long-Term Self-Management and Prevention

Lower back pain has a recurrent nature, with many people experiencing flare-ups over time. Physiotherapists help patients develop: 

• Flare-up management plans 

• Load and activity pacing strategies 

• Confidence to stay active during future episodes 

This aligns with modern pain science approaches that prioritise self-management and resilience (Hartvigsen et al., 2018). 

 

When to Seek Physiotherapy 

Early physiotherapy intervention is associated with reduced pain, improved function, and decreased reliance on imaging and medication (Qaseem et al., 2017). 

Urgent medical assessment is recommended if lower back pain is accompanied by symptoms such as significant and progressive neurological changes, trauma, or bowel or bladder dysfunction — though these cases are uncommon (NICE, 2020). 

 

Conclusion 

Lower back pain is common, complex, and sometimes persistent — but it is also highly manageable. Physiotherapy plays a central role in recovery by combining education, movement, and individualised care, helping people return to meaningful activities with confidence. 

References 

Australian Commission on Safety and Quality in Health Care. (2022). Low back pain clinical care standard. https://www.safetyandquality.gov.au/standards/clinical-care-standards/low-back-pain-clinical-care-standard 

Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J., Smeets, R. J., & Underwood, M. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356–2367. https://doi.org/10.1016/S0140-6736(18)30480-X 

Maher, C., Underwood, M., & Buchbinder, R. (2017). Non-specific low back pain. The Lancet, 389(10070), 736–747. https://doi.org/10.1016/S0140-6736(16)30970-9 

National Institute for Health and Care Excellence. (2020). Low back pain and sciatica in over 16s: Assessment and management (NICE guideline NG59). https://www.nice.org.uk/guidance/ng59 

Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514–530. https://doi.org/10.7326/M16-2367