Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of randomized controlled trials
PubMed 38355154 · doi:10.1136/bmj-2023-075847
What was done
The authors conducted a systematic review and Bayesian multilevel network meta-analysis of randomized controlled trials from Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO. Trials evaluated exercise modalities against active controls, psychotherapy, or antidepressants in participants meeting clinical thresholds for major depression. Quality of evidence was graded using the CINeMA tool.
What was found
Across 218 unique studies (495 arms, 14,170 participants), exercise modalities showed moderate reductions in depression compared with active controls: - Walking or jogging: Hedges' g -0.62 (95% credible interval -0.80 to -0.45; n=1210, k=51) - Yoga: g -0.55 (95% CrI -0.73 to -0.36; n=1047, k=33) - Strength training: g -0.49 (95% CrI -0.69 to -0.29; n=643, k=22) - Mixed aerobic exercises: g -0.43 (95% CrI -0.61 to -0.24; n=1286, k=51) - Tai chi or qigong: g -0.42 (95% CrI -0.65 to -0.21; n=343, k=12) Effects were proportional to prescribed exercise intensity. Yoga and strength training were the most acceptable modalities.
Why it matters
This network meta-analysis offers comparative effect estimates across specific exercise types, suggesting that walking/jogging, yoga, and strength training can serve as core clinical treatments for major depression alongside standard care.
Limits
Only one study met Cochrane criteria for low risk of bias. Overall confidence via CINeMA was low for walking or jogging and very low for all other modalities. Participants and staff could not be blinded in most exercise protocols, leaving potential for expectancy effects.
Cited by
- partial Exercise improves anxiety and depression conditions by up to 95%.