Physical Activity Interventions to Alleviate Depressive Symptoms in Children and Adolescents

Abstract

ImportanceDepression is the second most prevalent mental disorder among children and adolescents, yet only a small proportion seek or receive disorder-specific treatment. Physical activity interventions hold promise as an alternative or adjunctive approach to clinical treatment for depression.ObjectiveTo determine the association of physical activity interventions with depressive symptoms in children and adolescents.Data SourcesPubMed, CINAHL, PsycINFO, EMBASE, and SPORTDiscus were searched from inception to February 2022 for relevant studies written in English, Chinese, or Italian.Study SelectionTwo independent researchers selected studies that assessed the effects of physical activity interventions on depressive symptoms in children and adolescents compared with a control condition.Data Extraction and SynthesisA random-effects meta-analysis using Hedges g was performed. Heterogeneity, risk of bias, and publication bias were assessed independently by multiple reviewers. Meta-regressions and sensitivity analyses were conducted to substantiate the overall results. The study followed the PRISMA reporting guideline.Main Outcomes and MeasuresThe main outcome was depressive symptoms as measured by validated depression scales at postintervention and follow-up.ResultsTwenty-one studies involving 2441 participants (1148 [47.0%] boys; 1293 [53.0%] girls; mean [SD] age, 14 [3] years) were included. Meta-analysis of the postintervention differences revealed that physical activity interventions were associated with a reduction in depressive symptoms compared with the control condition (g = −0.29; 95% CI, −0.47 to −0.10; P = .004). Analysis of the follow-up outcomes in 4 studies revealed no differences between the physical activity and control groups (g = −0.39; 95% CI, −1.01 to 0.24; P = .14). Moderate study heterogeneity was detected (Q = 53.92; df = 20; P < .001; I2 = 62.9% [95% CI, 40.7%-76.8%]). The primary moderator analysis accounting for total physical activity volume, study design, participant health status, and allocation and/or assessment concealment did not moderate the main treatment effect. Secondary analyses demonstrated that intervention (ie, <12 weeks in duration, 3 times per week, unsupervised) and participant characteristics (ie, aged ≥13 years, with a mental illness and/or depression diagnosis) may influence the overall treatment effect.Conclusions and RelevancePhysical activity interventions may be used to reduce depressive symptoms in children and adolescents. Greater reductions in depressive symptoms were derived from participants older than 13 years and with a mental illness and/or depression diagnosis. The association with physical activity parameters such as frequency, duration, and supervision of the sessions remains unclear and needs further investigation.

The effects of childhood maltreatment on cortical thickness and gray matter volume: a coordinate-based meta-analysis

“…Early interventions were meaningful for preventing the psychosocial impairment of childhood maltreatment. For example, previous evidence has proven that non-pharmacological treatments such as enhancing exercise were effective both in reducing mortality and treating depressive symptoms related with childhood maltreatment (Belvederi Murri et al, 2018; Recchia et al, 2023). Understanding the effects of early environmental adversity on the developing brain and providing perspectives for early interventions were of great importance.…”

Pediatrics up to date—Brief notes on research

“…Der positive Einfluss von körperlicher Betätigung auf das psychische Wohlbefinden ist vielfach dokumentiert. Nunmehr wurde eine Metaanalyse zu dieser Thematik durchgeführt [ 3 ]. Bei der in JAMA Pediatrics publizierten Analyse wurden 21 Einzelstudien mit insgesamt 2441 Teilnehmern berücksichtigt.…”

Unlocking the Promise of Physical Activity for Mental Health Promotion

“…Shifting away from the explanatory study designs may also have an unexpected benefit: greater reductions in depressive symptoms. Viewed from the perspective of broad health benefits arising from physical activity, it is no surprise that Recchia et al found a significant association between physical activity and reduced depression in youth. However, the included studies tested physical activity interventions carefully designed to generate a specific dose of aerobic physical activity without confounds.…”

“…However, where we are willing to deemphasize these mechanistic concerns, we are free to blur the lines between physical activity and psychosocial treatments, combining the intrinsic mental health–promoting benefits of physical activity with the explicit pursuit of mental health through established means—a reframing from physical activity as medicine alone to physical activity as both medicine and medium . In our view, the systematic review and meta-analysis by Recchia et al is part of a potential watershed moment for the field. The evidence that physical activity is effective medicine for mental health is robust; now we need to find ways to get people to take it.…”

“…These new benefits are, of course, not new in the sense that active people in the past did not receive them; rather, they are new in the sense that sufficient evidence arose in meta-analyses to affirm them. In their systematic review and meta-analysis published in this issue of JAMA Pediatrics , Recchia et al extend the evidence on health benefits of physical activity. Their meta-analysis includes data from more than 2400 youth who participated in more than 20 randomized clinical trial and quasi-experimental design studies.…”