Individuals with severe central nervous system injuries have an increased in-cidence of depression, with 53% of those with traumatic brain injury (TBI) meeting the Diagnostic and Statistical Manual of Mental Disorders criteria for major depression. This is important because depression results in wide-ranging cognitive and functional symptomology. Physical exercise has been widely shown to improve depressive symptoms of able-bodied individuals; however, the effects of exercise on depression in individuals with severe central neurologic disability remain unclear. This literature review investigates the effects of exercise in a variety of environments and modalities on depression in those with TBI. The reviewed studies indicate that increases in general physical activity level may be effective in produc-ing improvements in overall mental health, including depression for individuals with TBI; however, more research is needed before cause-and-effect relationships can be stated with confidence.