Effect of exercise for depression : systematic review and network meta-analysis of randomised controlled trials
Journal article
Noetel, Michael, Sanders, Taren Grant, Gallardo-Gómez, Daniel, Taylor, Paul, del Pozo Cruz, Borja, van den Hoek, Daniel, Smith, Jordan J, Mahoney, John William, Spathis, Jemima, Moresi, Mark Peter, Pagano, Rebecca Stella, Pagano, Lisa, Pires Vasconcellos, Roberta, Arnott, Hugh, Varley, Benjamin, Parker, Philip David, Biddle, Stuart and Lonsdale, Christopher Sean. (2024). Effect of exercise for depression : systematic review and network meta-analysis of randomised controlled trials. The BMJ. pp. 1-17. https://doi.org/10.1136/bmj-2023-075847
Authors | Noetel, Michael, Sanders, Taren Grant, Gallardo-Gómez, Daniel, Taylor, Paul, del Pozo Cruz, Borja, van den Hoek, Daniel, Smith, Jordan J, Mahoney, John William, Spathis, Jemima, Moresi, Mark Peter, Pagano, Rebecca Stella, Pagano, Lisa, Pires Vasconcellos, Roberta, Arnott, Hugh, Varley, Benjamin, Parker, Philip David, Biddle, Stuart and Lonsdale, Christopher Sean |
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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. |
Keywords | major depressive disorder; exercise; psychotherapy; antidepressants; systematic review; netowrk meta-analysis |
Year | 01 Jan 2024 |
Journal | The BMJ |
Journal citation | pp. 1-17 |
Publisher | BMJ GROUP |
ISSN | 0959-8146 |
Digital Object Identifier (DOI) | https://doi.org/10.1136/bmj-2023-075847 |
Web address (URL) | https://www.bmj.com/content/384/bmj-2023-075847/related |
Open access | Open access |
Research or scholarly | Research |
Page range | 1-17 |
Publisher's version | |
Output status | Published |
Publication dates | |
Online | 14 Feb 2024 |
Publication process dates | |
Accepted | 15 Jan 2024 |
Deposited | 27 Jun 2024 |
Supplemental file | License File Access Level Open |
Additional information | Copyright © 2024, The Author(s). Published by BMJ Publishing Group Ltd. |
Related content: | |
Place of publication | United Kingdom |
https://acuresearchbank.acu.edu.au/item/90q3v/effect-of-exercise-for-depression-systematic-review-and-network-meta-analysis-of-randomised-controlled-trials
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Supplemental file
SM_Noetel_2024_Effect_of_exercise_for_depression_systematic.pdf | |
License: CC BY-NC 4.0 | |
File access level: Open |
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