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Journal article
Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials
BMJ, Vol.384, pp.1-17
2024
PMID: 38355154
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Abstract
Objective: To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions.
Design: Systematic review and network meta-analysis.
Methods: Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool.
Data sources: Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases.
Eligibility criteria for selecting studies: Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression.
Results: 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges’ g −0.62, 95% credible interval −0.80 to −0.45), yoga (n=1047, κ=33, g −0.55, −0.73 to −0.36), strength training (n=643, κ=22, g −0.49, −0.69 to −0.29), mixed aerobic exercises (n=1286, κ=51, g −0.43, −0.61 to −0.24), and tai chi or qigong (n=343, κ=12, g −0.42, −0.65 to −0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments.
Conclusions: Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression.
Systematic review registration: PROSPERO CRD42018118040.
Details
- Title
- Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials
- Authors
- Michael Noetel (Corresponding Author) - The University of QueenslandTaren Sanders (Author) - Australian Catholic UniversityDaniel Gallardo-Gómez (Author) - Universidad de SevillaPaul Taylor (Author) - Australian Catholic UniversityBorja del Pozo Cruz (Author) - Biomedical Research and Innovation Institute of CadizDaniel van den Hoek (Author) - University of the Sunshine Coast, Queensland, School of Health - Sports & Exercise ScienceJordan J Smith (Author) - University of Newcastle AustraliaJohn Mahoney (Author) - Australian Catholic UniversityJemima Spathis (Author) - Australian Catholic UniversityMark Moresi (Author) - Australian Catholic UniversityRebecca Pagano (Author) - Australian Catholic UniversityLisa Pagano (Author) - Macquarie UniversityRoberta Vasconcellos (Author) - Australian Catholic UniversityHugh Arnott (Author) - Australian Catholic UniversityBenjamin Varley (Author) - Children's Hospital at WestmeadPhilip Parker (Author) - Australian Catholic UniversityStuart Biddle (Author) - University of JyväskyläChris Lonsdale (Author) - Australian Catholic University
- Publication details
- BMJ, Vol.384, pp.1-17
- Publisher
- BMJ Group
- Date published
- 2024
- DOI
- 10.1136/bmj-2023-075847
- ISSN
- 1756-1833; 0959-535X
- PMID
- 38355154
- Copyright note
- This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
- Data Availability
- Data and code for reproducing analyses are available on the Open Science Framework (https://osf.io/nzw6u/).
- Organisation Unit
- School of Health - Sports & Exercise Science
- Language
- English
- Record Identifier
- 991000466802621
- Output Type
- Journal article
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