Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials

Abstract

Objective To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions. Design Systematic review and network meta-analysis. Methods Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool. Data sources Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases. Eligibility criteria for selecting studies Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression. Results 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges’ g −0.62, 95% credible interval −0.80 to −0.45), yoga (n=1047, κ=33, g −0.55, −0.73 to −0.36), strength training (n=643, κ=22, g −0.49, −0.69 to −0.29), mixed aerobic exercises (n=1286, κ=51, g −0.43, −0.61 to −0.24), and tai chi or qigong (n=343, κ=12, g −0.42, −0.65 to −0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments. Conclusions Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression. Systematic review registration PROSPERO CRD42018118040.

Evidence based exercise prescriptions in primary care

“…Noetel and colleagues’ study provides compelling evidence supporting the effectiveness of various exercise modalities in alleviating symptoms of depression 1. This empowers primary care doctors to make recommendations grounded in solid evidence, tailored to the unique preferences, abilities, and needs of individual patients.…”

“…Many types of exercise—for example, walking, jogging, strength training, yoga, tai chi, and qigong—were effective interventions for depression 1. This diversity enables primary care doctors to present patients with various options, thereby increasing the likelihood of adherence and success.…”

“…This diversity enables primary care doctors to present patients with various options, thereby increasing the likelihood of adherence and success. Some exercise modalities might be more effective in specific demographic groups or personality types 1. This underscores the importance of adopting an individualised approach, considering factors such as age, sex, preferences, and baseline health status when prescribing exercise.…”

“…The study gives practical recommendations on exercise intensity, duration, and frequency based on observed dose-response relations 1. Primary care doctors can use this information to help patients develop personalised exercise plans aligned with their capabilities and goals.…”

Scarlett McNally: Enabling active travel can improve the UK’s health

“…Active travel is a “best buy” for improving health. Commuting by cycling reduces incidence of, and mortality from, heart disease and cancer by over 30% in a dose dependent manner5 and reduces sick days and depression 6. People don’t swap from their car to active travel because cars are normalised and our infrastructure is built around them.…”