Everything you need to know about TMS and Exercise: Can Physical Activity Support Your Treatment? — how it works, what it costs, and how to find a provider who actually knows what they're doing.
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Exercise is one of the best-supported lifestyle interventions for depression — not as a replacement for treatment, but as a useful adjunct. Both exercise and TMS have been proposed to influence brain plasticity, including through brain-derived neurotrophic factor (BDNF), which raises the question of whether combining them might help. That idea is plausible, but it has not been proven.
What You’ll Learn
- What we know and don’t know about combining exercise with TMS
- Why exercise is worth considering during a TMS course
- How to think about timing and type of exercise
- How to start safely
What the evidence does and does not show
Exercise has been studied extensively as a treatment for depression, and many clinicians recommend regular physical activity alongside other treatments. Separately, it has been proposed that exercise and TMS might both influence plasticity-related pathways such as BDNF.
What we could not find is high-quality evidence that adding exercise to a TMS course improves TMS remission rates. We are not aware of a trial showing a specific benefit such as higher remission rates in people who exercise during TMS. So the combination should be viewed as a reasonable, low-risk addition to treatment rather than a proven way to boost TMS outcomes.
Why exercise is still worth it
- Evidence as a depression treatment. Regular physical activity is associated with lower depressive symptoms and is recommended in many depression guidelines as an adjunct.
- Sleep and energy. Many people sleep better and feel more energetic when they exercise regularly.
- Structure and mastery. Scheduling activity around a daily TMS appointment can add helpful structure to your day.
- Overall health. Exercise supports cardiovascular and metabolic health, which matters for people with depression.
Timing
There is no established best time to exercise relative to TMS sessions. Some people exercise in the morning before an appointment, others afterward. Choose whatever you can sustain.
What type of exercise
Moderate aerobic activity such as brisk walking, cycling, or swimming has the most evidence for depression. Resistance training and mind-body exercises such as yoga also have evidence for mood benefits. The best exercise is the one you will keep doing.
Starting an exercise program during TMS
- Start slowly. If you have been sedentary, begin with brief, low-intensity activity.
- Check with your doctor if you have cardiovascular, orthopedic, or other medical conditions.
- Don’t wait to feel motivated. Depression reduces motivation, so a scheduled routine helps.
- Tell your TMS clinic about your plans, and ask whether anything about your treatment affects your exercise.
The bottom line
Exercise is not a substitute for TMS and is not proven to make it work better, but it is a worthwhile addition to depression care. Starting light activity alongside TMS is reasonable, and it is not a reason to delay treatment.
Frequently asked questions
Does exercise improve TMS outcomes? This has not been established. Exercise has evidence as a depression treatment on its own, and many clinicians encourage it alongside TMS.
Should I exercise before or after TMS sessions? There is no proven best timing. Choose what fits your schedule.
What type of exercise is best during TMS treatment? Moderate aerobic activity has the strongest evidence for depression. Resistance training and yoga also have evidence for mood benefits.
