Physical Exercise and Clinically Depressed Patients: A Systematic Review and Meta-Analysis

Abstract

Objective: The aim of this meta-analysis is to evaluate the effect of aerobic training and strength training as a treatment for depression in patients diagnosed with major depressive disorder. Methods: PubMed (Medline), ISI knowledge (Institute for Scientific Information), SciELO (Scientific Electronic Library) and Scopus databases were consulted from January 1970 to September 2011. Data were collected on variables as follows: total number of patients (pre- and postintervention), age, randomized (yes or no), diagnostic criteria, assessment instruments, and the percentage of remission and treatment response. Subsequently, we collected information on time intervention, intensity, duration, frequency, method of training (aerobic training and strength training) and type of supervision. Standardized mean differences were used for pooling continuous variables as endpoint scores. Binary outcomes, such as proportion of remission (no symptoms) and at least 50% reduction of initial scores (response), were pooled using relative risks. Random effects models were used that take into account the variance within and between studies. Results: Ten articles were selected and subdivided by their interventions, controlled training modality and levels of intensity. As there was no statistically significant difference between the two types of intervention (strength or aerobic training), we combined data which finally showed a 0.61 (95% CI: –0.88 to –0.33) standard deviation reduction in the intervention group compared to the control group. When the analysis was restricted only to those studies that used the Hamilton scale (n = 15), we observed a reduction of 3.49 points compared with the control group. Conclusion: Despite the heterogeneity of the studies, the present meta-analysis concluded that physical exercise improves the response to treatment, especially aerobic training. However, the efficacy of exercise in the treatment of depression was influenced by age and severity of symptoms.

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 5. Complementary and Alternative Medicine Treatments

“…Recent meta-analyses 37,[41][42][43][44] and systematic reviews 39,45 have evaluated exercise as monotherapy or adjunct to antidepressants or psychotherapy for mild to moderate depression (Suppl . Table S3).…”

“…Table S3). Two meta-analyses (39 trials, N ¼ 2326 31 ; 13 trials, N ¼ 720 36 ) and 2 systematic reviews 43,45 reported that exercise was as effective as pharmacotherapy or psychotherapy. Other meta-analyses reported that adjunctive exercise was effective in the short term (13 trials, N ¼ 687), 41 and superior to no-treatment control conditions (13 trials, N ¼ 720) 42 and to control conditions like treatment as usual (10 trials, N ¼ 758).…”

“…Other meta-analyses reported that adjunctive exercise was effective in the short term (13 trials, N ¼ 687), 41 and superior to no-treatment control conditions (13 trials, N ¼ 720) 42 and to control conditions like treatment as usual (10 trials, N ¼ 758). 43 For moderate to severe MDD, 1 meta-analysis (20 trials, N ¼ 1298) found exercise to be superior to control conditions. 44 Some methodological challenges, including suitability of control conditions, adequacy of blinding and self-selection bias, may limit interpretation of results.…”

A Case Demonstrating the Need to Emphasize Wellness as a Treatment Focus for Substance Abuse Disorders

“…Peer-reviewed research reports have demonstrated physical exercise's role in improving responses to treatment of major depressive disorder [8][9][10] the anxiolytic effects of exercise for anxiety disorders [10], posttraumatic stress disorder [11] and substance abuse disorders [12][13][14][15].…”

Brain science of exercise-eating linkage for improvements in modern human health

“…Regarding exercise, scientific evidence has confirmed a wide range of health benefits, including a higher energy expenditure and improved metabolic functioning 9,10) . Additionally, over the past few decades, a considerable amount of research has demonstrated the roles of exercise in the maintenance and enhancement of various brain functions including cognition, emotion, mood, and motivation [11][12][13][14][15] .…”