Resistance Exercise as a Dual-Target Strategy in Physical Therapy: Reducing Depressive Symptoms to Improve...

Depressive symptoms are prevalent in physical therapy and rehabilitation populations and can act as a limiting factor for rehabilitation participation and outcomes across diagnoses. Even when not meeting criteria for major depressive disorder, elevated depressive symptoms can undermine rehabilitation participation through reduced motivation, impaired self-regulation, sleep disturbance, fatigue, low perceived control, and avoidance of effort or movement. Although referral pathways for mental health care remain essential, access barriers and stigma commonly delay help-seeking. This Special Communication argues that resistance exercise can be positioned in physical therapy as a dual-target intervention: supporting functional recovery while concurrently engaging mood-relevant mediators that influence rehabilitation participation and outcomes. Beyond physiological adaptations, resistance training provides rapid and measurable experiences of mastery and agency (eg, progressive increases in repetitions, time under tension, or load), which may strengthen self-efficacy and perceived control, reduce helplessness, and improve tolerance to discomfort through graded exposure to effort. These mediators are clinically relevant because they map directly onto modifiable drivers of adherence, persistence, and dropout risk in rehabilitation. Pragmatic, safety-oriented principles are outlined for prescribing resistance exercise across settings (clinic- or home-based; minimal equipment), including techniques to maximize early achievable success, simplify programs to reduce cognitive load, apply symptom- and fatigue-guided progression, and monitor engagement outcomes. Scope of practice boundaries and red flags requiring timely referral are also discussed. Future work should test implementation strategies and quantify whether targeting mood-related mediators through resistance exercise improves both depressive symptoms and rehabilitation endpoints, including adherence, functional outcomes, and return to valued activities.