Physical Activity for the Treatment of Adolescent Depression: A Systematic Review and Meta-Analysis

Abstract

Background: A noticeable proportion of adolescents with depression do not respond to guideline recommended treatment options. This systematic review and meta-analysis investigated the effectiveness of physical activity interventions as an alternative or complementary treatment for adolescents (12-18 years) with depression. The characteristics of the physical activity treatment that were most effective in reducing symptoms in adolescents with depression and the impact of methodological shortcomings in the existing research were also examined. Methods: Medline, PsycINFO, SPORTDiscus, ProQuest, and CENTRAL were searched for eligible records. Effect size estimates were pooled based on the application of a random-effects model. Potential moderation by physical activity characteristics (i.e., intensity, type, context, and time frame) and methodological features (i.e., type of control group and diagnostic tool to identify depression at baseline) was investigated by means of subgroup analyses and meta-regressions. The certainty of evidence was assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The primary outcome was the antidepressant effect of physical activity at postintervention measurement time point. As secondary outcomes, the sustainability of effects after the end of physical activity treatment and the acceptability of physical activity treatments were assessed. Overall, 10 studies were included in the qualitative synthesis and 9 studies involving 431 patients were included in the quantitative synthesis. Conclusions: This review suggests that physical activity is effective in treating depression in adolescents. Physical activity sessions should be at least moderately intense [rate of perceived exertion (RPE) between 11 and 13] to be effective. Furthermore, our results suggest that physical activity treatments are well accepted. However, the low methodological quality in included studies might have led to effect overestimation. Therefore, more studies with higher methodological quality are needed to confirm the recommendation for physical activity treatments in adolescents with depression.

Joy of living through exercise - a qualitative study of clinically referred adolescents’ experiences of moderate to vigorous exercise as treatment for depression

“…However, exercise as a treatment for depression in adolescence has shown a moderate effect in reducing depressive symptoms. Methodological quality of studies was low and effects might have been overestimated [12][13][14]. An RCT with an intervention program for adolescents with depression of 12 exercise sessions with preferred intensity aerobic exercise, twice weekly for six weeks showed significantly improved depression and a trend-level favorable comparison to the control group (treatment as usual) upon the completion of this short-term intervention.…”

The Importance of Nature Exposure and Physical Activity for Psychological Health and Stress Perception: Evidence From the First Lockdown Period During the Coronavirus Pandemic 2020 in France and Germany

“…Chronic physical activity, in particular physical exercise training, leads to metabolic adaptations like decreased cortisol levels (Huang et al, 2013 ), decreased inflammation (Koliamitra et al, 2019 ; Małkiewicz et al, 2019 ), reduced central kynurenine pathway activity (Agudelo et al, 2014 ; Metcalfe et al, 2018 ), improved immune function (Phillips and Fahimi, 2018 ; Rumpf et al, 2021 ), and decreased permeability of the blood–brain barrier (Małkiewicz et al, 2019 ). Furthermore, these metabolic changes due to physical activity and exercise offer some benefits on mental health for both clinical and nonclinical populations (Laporte et al, 1985 ; Deslandes et al, 2009 ; Javelle et al, 2020 ; Oberste et al, 2020 ).…”

Integrative Management of Metabolic Syndrome in Youth Prescribed Second-Generation Antipsychotics

“…As an additional benefit, physical activity is associated with fewer depressive symptoms and functions as a treatment for adolescent depressive symptoms of moderate effect size according to several meta analyses [ 66 , 67 ].…”