The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials

Lawlor, Debbie A

doi:10.1136/bmj.322.7289.763

Cited by 820 publications

(616 citation statements)

References 57 publications

(59 reference statements)

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“…A secondary purpose was to examine the relationship between PA and the specific SWB constructs (for example, life satisfaction) that have been most studied in the SCI and PA literature. Consistent with research in the general and clinical populations, for example references, [6][7][8]14 it was hypothesized that PA and SWB would be positively related. A third purpose was to examine study design as a moderator of the PA-SWB relationship to determine if it can account for inconsistencies in the existing literature.…”

Section: Introductionmentioning

confidence: 86%

“…18 This definition encompasses all types of activity (for example, occupational activity, activities of daily living, sports, exercise). However, for the purpose of our meta-analysis and consistent with other meta-analyses conducted in the PA domain, 6 we focused on studies that examined participation in sport (both competitive and noncompetitive) and other activities that are carried out to improve or maintain one or more components of physical fitness (that is, aerobic fitness, muscular strength and endurance, body composition and flexibility).…”

Section: Methodsmentioning

confidence: 99%

“…5 For example, metaanalyses have documented the effectiveness of PA for decreasing depressive symptoms, 6 improving mood 7 and enhancing various dimensions of life satisfaction. 8 In contrast, relatively little research has examined PA and SWB among people living with SCI.…”

Section: Introductionmentioning

confidence: 99%

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Physical activity and subjective well-being among people with spinal cord injury: a meta-analysis

et al. 2009

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Study design: Meta-analysis of cross-sectional, quasi-experimental and experimental studies. Objective: To determine if there is an association between physical activity (PA) and subjective wellbeing (SWB) among people living with spinal cord injury (SCI). Methods: Literature searches were conducted using multiple databases (Embase, CINAHL, Medline, PsychINFO and SPORTDiscus) to identify studies involving people with SCI that included a measure of PA and at least one measure of SWB (for example, symptoms of depression, life satisfaction, mood). Relevant data were extracted from the studies and subjected to meta-analysis. Results: A total of 21 studies were retrieved yielding 78 effect sizes and a total sample size of 2354. Overall, there were statistically significant, small-to medium-sized effects for the relationships between PA and SWB (broadly defined), PA and depressive symptoms, and PA and life satisfaction. Studies using experimental and quasi-experimental designs yielded larger effects for SWB (broadly defined) and life satisfaction, than studies using nonexperimental study designs. Conclusions: There is a small-to medium-sized positive relationship between PA and SWB among people with SCI that holds across a wide range of measures and operational definitions of these constructs.

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Section: Introductionmentioning

confidence: 86%

Section: Methodsmentioning

confidence: 99%

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Physical activity and subjective well-being among people with spinal cord injury: a meta-analysis

et al. 2009

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“…For example, researchers undertaking a meta-analysis into the effectiveness of exercise in the management of depression were unable to draw any conclusion due to the methodological weaknesses of all 14 studies under analysis. 41 Unfortunately, many published qualitative studies are also of poor quality and lacking in rigour. 24 Therefore, as part of the process of the meta-synthesis, the quality of relevant studies was evaluated using predetermined criteria.…”

mentioning

confidence: 99%

Quality of life after spinal cord injury: a meta-synthesis of qualitative findings

Hammell¹

2006

Spinal Cord

162

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Study design: Meta-synthesis of qualitative research. Objectives: To identify, compare and synthesize the factors found to contribute to, or detract from the experience of a life worth living following spinal cord injury (SCI). Methods: Published articles were identified from the Medline, CINAHL and Sociological Abstracts databases, a hand search through selected journals published since 1990, and from reference lists. These were assessed for their relevance to the focus of interest and appraised for rigour and quality. The key themes that emerged from the data were summarized, compared and synthesized. Results: The search located 64 papers and four books, of which seven papers met the review criteria for relevance and rigour, and in which 10 main concepts were identified: (1) body problems, (2) loss, (3) relationships, (4) responsibility for, and control of one's life, (5) occupation, and ability to contribute, (6) environmental context, (7) new values/perspective transformation, (8) good and bad days, (9) self-worth, (10) self-continuity. Conclusions: This study demonstrates the utility of synthesizing qualitative research to provide a greater depth of insight into the factors that contribute to, and detract from, quality of life (QOL) after SCI. It also provides a more nuanced understanding of the experience of QOL following SCI than is achievable by quantitative methods. Future qualitative research is required to probe further the concepts and connections identified in this study, and to identify how rehabilitation services might best address these issues. Sponsorship: N/A. The vast majority of research into QOL following SCI has adopted a quantitative approach, 3 reflecting researchers' assumptions that quality can be measured quantitatively; that the determinants of QOL following SCI can be reliably predicted by able-bodied researchers; and that the subjective experience of a life can be objectively and accurately discerned by another person. These assumptions have been challenged [5][6][7][8][9][10] and it has been argued that the results of these studies are both misleading and of questionable value. 11 Indeed, it has been suggested that how someone attempts to 'measure' QOL says more about their own values, priorities and fundamental orientation to life than it does about the QOL of the people whose lives are ostensibly being studied. 3,12 Quantitative research is hypothesis-driven, requiring researchers to predetermine the variables to be measured and thus to identify in advance those factors that are relevant and important to the issue under investigation. This inevitably limits the range of possible findings. For example, if 'pain' is not included as a variable in a quantitative study of QOL then pain will not be found to influence QOL. Quantitative methods are therefore Recognizing the inherent problems with attempts to quantitatively measure QOL among people with SCI many researchers have advocated the use of qualitative methods that can explore both the meaning of QOL for people with SCI and the f...

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“…However, both pharmacological treatment [25] and psychoeducation [26,27] appear to be promising as treatment for mild depression and for improving glycaemic control in these patients. Physical activity has been demonstrated to alleviate depressive symptoms in the non-diabetic population as efficiently as cognitive behavioural therapy [28]. Lack of exercise in diabetic patients is associated with 72% to 75% higher likelihood of being depressed [29].…”

Section: Introductionmentioning

confidence: 99%

Does treatment of subsyndromal depression improve depression and diabetes related outcomes: protocol for a randomised controlled comparison of psycho-education, physical exercise and treatment as usual

Pibernik-Okanović

Ajduković

Lovrenčić

et al. 2011

Trials

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BackgroundThe prevalence of mood difficulties in persons with diabetes is approximately twice that in the general population, affecting the health outcomes and patients' quality of life in an undesirable way. Although subsyndromal depression is an important predictor of a more serious clinical depression, it is often overlooked. This study aims to compare the effects of two non-pharmacological interventions for subsyndromal depression, psychoeducation and physical exercise, with diabetes treatment as usual on mood- and diabetes-related outcomes.Methods and DesignType 2 diabetic patients aged 18-65 yrs. who report mood difficulties and the related need for help in a mail survey will be potential participants. After giving informed consent, they will be randomly assigned to one of the three groups (psychoeducation, physical activity, treatment as usual). Depressive symptoms, diabetes distress, health-related quality of life and diabetes self-care activities will be assessed at baseline, at 6 weeks, 6 months and 12 months. A structured clinical interview for DSM-IV Axis I Disorders (SCID-I) will be performed at baseline and at one-year follow-up in order to determine the clinical significance of the patients' depressive symptoms. Disease-related data will be collected from patients' files and from additional physical examinations and laboratory tests.The two interventions will be comparable in terms of format (small group work), duration (six sessions) and approach (interactive learning; supporting the participants' active roles). The group treated as usual will be informed about their screening results and about the importance of treating depression. They will be provided with brief re-education on diabetes and written self-help instructions to cope with mood difficulties.Primary outcomes will be depressive symptoms. Secondary outcomes will be glycaemic control, diabetes-related distress, self-management of diabetes and health-related quality of life. Tertiary outcomes will be biochemical markers reflecting common pathophysiological processes of insulin resistance, inflammation and oxidative damage that are assumed to be intertwined in both diabetes and depression. The mixed-effect linear model will be used to compare the outcome variables.Power analysis has indicated that the two intervention groups and the control group should comprise 59 patients to enable detection of clinically meaningful differences in depressive symptoms with a power of 80% and alpha = 0.05. Outcomes will be analysed on an intention-to-treat basis.Trial RegistrationISRCTN: ISRCTN05673017

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The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials

Cited by 820 publications

References 57 publications

Physical activity and subjective well-being among people with spinal cord injury: a meta-analysis

Physical activity and subjective well-being among people with spinal cord injury: a meta-analysis

Quality of life after spinal cord injury: a meta-synthesis of qualitative findings

Does treatment of subsyndromal depression improve depression and diabetes related outcomes: protocol for a randomised controlled comparison of psycho-education, physical exercise and treatment as usual

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