Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials

Summary & key facts

Researchers looked at almost every trial of exercise for major depression to find which kinds and doses work best. They combined results from about 220 studies with roughly 14,000 people. They found that several types of exercise — especially walking or jogging, yoga, and strength training — reduced symptoms of depression more than usual care or placebo. Harder, more intense exercise usually worked better. Strength training and yoga had fewer people dropping out. But the overall quality of the evidence was low because most trials had risks of bias, so we should be careful about how certain we are. The authors say exercise can be considered alongside therapy and antidepressant medicine, but more high-quality studies are still needed.

Key facts:

• The review combined about 220 randomized trials with roughly 14,000 people to study exercise as a treatment for major depression.
• Compared with active control groups like usual care or placebo, walking or jogging showed moderate reductions in depression in about 1,200 people across 51 studies.
• Yoga reduced depressive symptoms in about 1,000 people across 33 studies, and strength training showed similar benefits in about 600 people across 22 studies.
• Mixed aerobic exercise and mind-body practices such as tai chi or qigong also reduced depression, though the evidence for tai chi and qigong came from fewer studies.
• The benefits of exercise were generally larger when the exercise was prescribed at higher intensity, meaning harder workouts tended to produce stronger effects.
• Strength training and yoga appeared to be the best tolerated treatments, with fewer people dropping out of those programs compared with other exercise types.
• Exercise effects looked similar for people with and without other health problems and across different starting levels of depression.
• The overall confidence in the results was low because only one trial met strict low-risk standards and many included studies had potential biases.
• The authors concluded that exercise could be considered alongside psychotherapy and antidepressants as a core treatment option, while calling for better-quality trials to be done.

Abstract

PROSPERO CRD42018118040.

Topics

Cardiovascular and exercise physiology Eating Disorders and Behaviors Physical Activity and Health

Categories

Health Sciences Medicine Physiology

Tags

Aerobic exercise Alternative medicine Cochrane Library Confidence interval Depression (economics) Economics Internal medicine Law Macroeconomics Medicine MEDLINE Meta-analysis Pathology Physical therapy Placebo Political science PsycINFO Publication bias Randomized controlled trial Strictly standardized mean difference Systematic review

Conditions & symptoms

Depression Lack of energy or motivation Sadness or low mood