The Combined Effect of Exercise and Behavioral Therapy for Depression and Anxiety: Systematic Review and Meta-Analysis

Abstract

Behavioral therapy (BT) and exercise are efficacious treatments for depression and anxiety when employed separately. The combination of BT and exercise (BT+Ex) may augment improvements but the combined effect of these therapies is not fully elucidated. The purpose of this meta-analysis was to determine if BT+Ex yielded a significant reduction in depression and anxiety symptoms compared to BT alone (BT). Randomized controlled studies published prior to September 2019 were searched among several databases (PUBMED, MEDLINE, PsychArticle, and Cochrane Central Register of Clinical Trials). Studies that measured depression and anxiety symptoms following BT+Ex vs. BT were extracted and analyzed. The effect of these therapies on depression and anxiety were analyzed. Subgroup analyses were performed to evaluate the effect of exercise intensity (moderate and high), exercise type (aerobic and combined exercise), and baseline levels of depression. The moderating effects of gender, age, and treatment duration were performed. Data were extracted from 18 studies (1686 participants, mean age = 47 years, 65% female). There was a significant effect of BT+Ex on symptoms of depression. The effect of BT+Ex was significant for moderate intensity exercise and elevated baseline levels of depression. Age moderated the effect for depression. There was a significant effect of BT+Ex on depressive symptoms in humans. Exercise intensity and elevated depressive symptoms may play a role in the effect of exercise.

Bouldering psychotherapy is not inferior to cognitive behavioural therapy in the group treatment of depression: A randomized controlled trial

“…As the BPT concept focuses on established factors of action taken from CBT therapies, such as exposure training, problem solving, and the practising of new functional behaviour, BPT should not be seen as a different therapy but as an enrichment and implementation of CBT methods on the bouldering wall. Our results show that it is at least not inferior to CBT alone, a finding that is in line with current meta‐analyses that have shown that the combination of physical activity and psychotherapeutic methods (i.e., behavioural therapies) might go beyond the effect of psychotherapy alone (Bourbeau et al., 2020) and that physical activity is effective in reducing depression (Cooney et al., 2013) to a comparable extent as antidepressants (Blumenthal et al., 2007) or psychotherapy alone. Both therapies in this study are group therapies.…”

“…It has been known for a long time that body‐related interventions can have strong effects on mental states (Barnard & Teasdale, 1991). In recent studies, physical activity has been shown to be effective in the treatment of depression in general (Gordon et al., 2018; Schuch et al., 2016) and particularly when it is used to augment the effects of psychotherapy (Bourbeau, Moriarty, Ayanniyi, & Zuhl, 2020; NICE, 2009). Physical activity is even explicitly recommended in the current guidelines as a method that can complement the treatment of depression (DGPPN, 2015; NICE, 2009).…”

The impact of sleep, physical activity and sedentary behaviour on symptoms of depression and anxiety before and during the COVID-19 pandemic in a sample of South African participants

“…Additionally, physical activity is important for managing symptoms of depression and anxiety 26 – 28 . The therapeutic benefits of exercise in managing mental health are most prominent when used in combination with standard treatment, although it can also be efficacious as a stand-alone therapy, albeit with smaller effect sizes 29 , 30 . During the COVID-19 lockdown period, Zhang et al 31 found that either too little or too much physical activity worsened negative emotions including depression and anxiety.…”

The Impact Of Sleep, Physical Activity And Sedentary Behaviour On Symptoms of Depression And Anxiety Before And During The COVID-19 Pandemic

“…Additionally, physical activity is important for managing symptoms of depression and anxiety [26][27][28] . The therapeutic bene ts of exercise in managing mental health are most prominent when used in combination with standard treatment, although it can also be e cacious as a stand-alone therapy, albeit with smaller effect sizes 29,30 . During the COVID-19 lockdown period, Zhang, Zhang, Ma, and Di 31 found that either too little or too much physical activity worsened negative emotions including depression and anxiety.…”