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Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials.
BMJ. 2024 Feb 14; 384:e075847.BMJ

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.

Links

PMC Free PDF

Authors+Show Affiliations

Noetel M
School of Psychology, University of Queensland, St Lucia, QLD 4072, Australia m.noetel@uq.edu.au.
Sanders T
Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW, Australia.
Gallardo-Gómez D
Department of Physical Education and Sport, University of Seville, Seville, Spain.
Taylor P
School of Health and Behavioural Sciences, Australian Catholic University, Strathfield, NSW, Australia.
Del Pozo Cruz B
Department of Clinical Biomechanics and Sports Science, University of Southern Denmark, Odense, Denmark. Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, University of Cádiz, Spain.
van den Hoek D
School of Health and Behavioural Sciences, University of the Sunshine Coast, Petrie, QLD, Australia.
Smith JJ
School of Education, University of Newcastle, Callaghan, NSW, Australia.
Mahoney J
School of Health and Behavioural Sciences, Australian Catholic University, Banyo, QLD, Australia.
Spathis J
School of Health and Behavioural Sciences, Australian Catholic University, Banyo, QLD, Australia.
Moresi M
School of Health and Behavioural Sciences, Australian Catholic University, Strathfield, NSW, Australia.
Pagano R
School of Education, Australian Catholic University, Strathfield, NSW, Australia.
Pagano L
Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia.
Vasconcellos R
Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW, Australia.
Arnott H
Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW, Australia.
Varley B
Children's Hospital Westmead Clinical School, University of Sydney, Westmead, NSW, Australia.
Parker P
Australian Catholic University, North Sydney, NSW, Australia.
Biddle S
Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia. Faculty of Sport and Health Science, University of Jyvaskyla, Jyvaskyla, Finland.
Lonsdale C
Australian Catholic University, North Sydney, NSW, Australia.

MeSH

HumansRandomized Controlled Trials as TopicDepressive Disorder, MajorExercise TherapyAntidepressive AgentsYogaExercisePsychotherapyTreatment Outcome

Pub Type(s)

Systematic Review
Journal Article
Network Meta-Analysis

Language

eng

PubMed ID

38355154

Clinical Trial Links

Effectiveness of Exercise, Walking, and Education on Mental Health, Mobility and Quality of Life in Elderly Residents of Nursing Homes

Citation

Noetel, Michael, et al. "Effect of Exercise for Depression: Systematic Review and Network Meta-analysis of Randomised Controlled Trials." BMJ (Clinical Research Ed.), vol. 384, 2024, pp. e075847.
Noetel M, Sanders T, Gallardo-Gómez D, et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2024;384:e075847.
Noetel, M., Sanders, T., Gallardo-Gómez, D., Taylor, P., Del Pozo Cruz, B., van den Hoek, D., Smith, J. J., Mahoney, J., Spathis, J., Moresi, M., Pagano, R., Pagano, L., Vasconcellos, R., Arnott, H., Varley, B., Parker, P., Biddle, S., & Lonsdale, C. (2024). Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ (Clinical Research Ed.), 384, e075847. https://doi.org/10.1136/bmj-2023-075847
Noetel M, et al. Effect of Exercise for Depression: Systematic Review and Network Meta-analysis of Randomised Controlled Trials. BMJ. 2024 Feb 14;384:e075847. PubMed PMID: 38355154.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. AU - Noetel,Michael, AU - Sanders,Taren, AU - Gallardo-Gómez,Daniel, AU - Taylor,Paul, AU - Del Pozo Cruz,Borja, AU - van den Hoek,Daniel, AU - Smith,Jordan J, AU - Mahoney,John, AU - Spathis,Jemima, AU - Moresi,Mark, AU - Pagano,Rebecca, AU - Pagano,Lisa, AU - Vasconcellos,Roberta, AU - Arnott,Hugh, AU - Varley,Benjamin, AU - Parker,Philip, AU - Biddle,Stuart, AU - Lonsdale,Chris, Y1 - 2024/02/14/ PY - 2024/2/16/medline PY - 2024/2/15/pubmed PY - 2024/2/14/entrez PY - 2024/2/14/pmc-release SP - e075847 EP - e075847 JF - BMJ (Clinical research ed.) JO - BMJ VL - 384 N2 - 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. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/38355154/full_citation DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓228 ↑55]

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