Barriers and facilitators of evidence-based exercise therapy as adjunct treatment for major depressive disorder in specialized mental health care

Major Depressive Disorder (MDD) is a pervasive public health challenge, and although exercise therapy shows promise as an adjunct treatment, its integration into routine mental health care remains limited. This study examines the barriers and facilitators to implementing evidence-based exercise therapy for MDD in Dutch specialized mental health care settings. We explored implementation processes alongside the Exercise Enhances randomized controlled trial. Data were collected through semi-structured interviews with patients (N=6) and with professionals through focus group discussions (N=8) and a questionnaire exploring barriers and facilitators to implementation (N=12). Results indicate that both patients and professionals perceive exercise therapy as beneficial for mood and overall well-being. Key facilitators include the intervention’s adaptability, its alignment with existing clinical routines, and the patient-centred support provided by exercise therapists. However, barriers included limited exercise modalities, challenges in adherence to home-based sessions, interprofessional communication gaps, and insufficient organizational resources. While integrating exercise as an adjunct treatment for MDD is feasible and well received, sustained implementation requires enhanced flexibility in program design, improved interdisciplinary collaboration, and dedicated implementation coordination. These insights contribute to the evidence base for scaling exercise interventions within specialized mental health care and underscore the need for structural adjustments and targeted funding. • Evidence-based exercise adjuncts are well received by both patients and clinicians • Supervised, adaptable sessions outperform home-only exercise, enhancing adherence among people with depression • Embedding exercise therapists in multidisciplinary care and routines smooths implementation pathways. • Flexible program design and a dedicated implementation coordinator are essential to scale exercise as routine MDD treatment.