• This is the first patient-oriented study to propose the combination of physical exercise and repetitive transcranial magnetic stimulation (rTMS) is acceptable for patients with treatment resistant depression. • Patients currently undergoing rTMS perceived moderate-intensity exercise to be an acceptable addition to their current treatment regime, with a strong preference for exercising at least 3 times a week for the entire treatment course (6 weeks). • An innovative aspect of this study was our collaboration with patient partners based on the strategy for patient oriented research (SPOR) patient engagement framework. Repetitive transcranial magnetic stimulation (rTMS) and physical exercise may have synergistic benefits for the treatment of depression. As a prelude to a clinical trial, we conducted a study in collaboration with patient partners to assess the acceptability and preferences of a combined exercise and rTMS intervention for patients with depression. This study employed a cross-sectional design. Patients receiving rTMS treatment completed a web-based survey. Acceptability and preferences for exercise were assessed, along with their perceptions of a hypothetical exercise intervention consisting of 30 -min of moderate-intensity treadmill exercise, 3 times per week, for the duration of an index course of rTMS (6 weeks). 44 patients (70% female, age = 47±14.7) with major depressive disorder completed the web-based survey. The majority of patients reported they would be interested in an exercise program while receiving rTMS (75%), with preferences for exercising for at least 3 days per week (80%), over the entire course of treatment (72%). Participants perceived the hypothetical exercise intervention to be acceptable (84%) and were clear how it would help manage their depression (80%). Patients perceived exercise to be an acceptable adjunct to rTMS treatment. The interpretation of these results, in collaboration with patient partners, have provided valuable information to design a sequential study examining the efficacy of a combined exercise and rTMS intervention for depression. Data was self-reported and there was the potential for recall and social desirability biases.