The last decade has seen a renewed recognition of the interconnection of the mental and physical well-being of people living with anxiety and depression disorders. Research has assessed the impact of exercise and psychological interventions as monotherapy and complementary treatments to usual care and found considerable benefits to reduce psychiatric symptoms and improve better quality of life. There is growing interest in online interventions, and online counseling can be an alternative to traditional face-to-face therapies. Questions remain on the effectiveness and best practices to deliver such interventions. The authors identify and summarize research evaluating online psychotherapy and exercise interventions in individuals with anxiety and depression disorders. They address web-based psychotherapy interventions and web-based exercise interventions for anxiety and depression disorders, followed by combined web-based intervention with psychotherapy and exercise, and discuss strategies to improve adherence to treatments.
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A WHO-led study which estimates, for the first time, both the health and economic benefits of investing in treatment of the most common forms of mental illness globally, have found that every US$ 1 invested in scaling up treatment for depression and anxiety leads to a return of US$ 4 in better health and ability to work (Chisholm et al., 2016). Recently, this situation has exacerbated; the COVID-19 pandemic, declared on March 11st 2020, and the resulting economic recession has negatively affected many people’s mental health and created new barriers for people already suffering from mental diseases (Panchal, Kamal, Cox, & Garfield, 2021). For example, in comparison with a global estimated prevalence of depression of 3.44% in 2017, one recent meta-analysis estimated that the pooled prevalence of 25% appears to be 7 times higher, thus suggesting an important impact of the COVID-19 outbreak on people's mental health (Bueno-Notivol et al., 2021). In this vein, web-based interventions could help minimize the transmission of COVID-19 and may help alleviate some of the detrimental impacts of social distancing and quarantine (Middleton, Simpson, Bettger, & Bowden, 2020). Moreover, during the COVID-19 pandemic, levels of anxiety and depression increased exponentially (Hawes, Szenczy, Klein, Hajcak, & Nelson, 2021; Hou, Bi, Jiao, Luo, & Song, 2020). During this period, studies demonstrated the important protective role of physical activity (PA) for symptoms of anxiety and depression (Frontini et al., 2021; Giuntella, Hyde, Saccardo, & Sadoff, 2021).
Effective treatments are available for depression and anxiety disorders, including several types of psychotherapy and antidepressant medication (Cuijpers et al., 2014). For major depressive disorder, antidepressant medication and psychotherapy offer effective treatments for most patients, as shown in meta-analyses (Cipriani et al., 2018; Cuijpers, Cristea, Karyotaki, Reijnders, & Huibers, 2016). The largest open trial measuring the effects of pharmacological antidepressant, psychotherapy, or both, in the treatment of depression (the STAR*D study), found that the response rate following the first pharmacological attempt was less than 50% (Sinyor, Schaffer, & Levitt, 2010). Roughly 75% of patients prefer psychotherapy over the use of medication (McHugh, Whitton, Peckham, Welge, & Otto, 2013). Nonetheless, psychological therapies are less available (Olfson & Marcus, 2010), especially in low‐and middle‐income countries (Singla et al., 2017). Although psychotherapy and antidepressants are equally effective for the majority of anxiety and depressive disorders (Cuijpers et al., 2013), there is evidence that combined treatments may be more effective (Cuijpers et al., 2020; de Maat, Dekker, Schoevers, & de Jonghe, 2007). However, not everyone responds to those treatments (medication and/or psychotherapy) (Meyer & Schuch, 2018).
There is evidence showing that PA and exercise may be an effective adjunct to pharmacology treatment for people with depression (Krogh, Hjorthøj, Speyer, Gluud, & Nordentoft, 2017; Schuch et al., 2016) or anxiety disorders (Gordon, McDowell, Lyons, & Herring, 2017; Stubbs et al., 2017). A meta-review confirmed the beneficial effects of exercise training for depressive and anxiety symptoms (Ashdown-Franks et al., 2020). It is less clear whether web-based exercise training interventions are effective for reducing such symptoms. One systematic review addressed this question (Rosenbaum, Newby, Steel, Andrews, & Ward, 2015), and found only two randomized trials, denoting how scarce data is. The evidence concerning the effects of exercise among subjects diagnosed with an anxiety or stress-related disorder also remains limited (Herring, 2018).