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Running from Depression: A Systematic Review and Network Meta-Analysis of Exercise Dose and Modality in the Treatment for Depression
15 Pages Posted: 17 Mar 2023
More...Abstract
Background: Depression is a leading source of global disease burden. Clinical practice guidelines recommend exercise as part of routine care, alongside psychotherapy and antidepressant medication. Our network meta-analysis aims to inform those guidelines with evidence regarding the optimal dose and modality of exercise for alleviating depression.
Methods: We replicated the most recent Cochrane review on exercise for depression, searching five databases (Cochrane Library, MEDLINE, EMBASE, SPORTDiscus, and PsycINFO). We included any randomised trial with exercise arms for participants meeting clinical cutoffs for depression. We did all screening, data extraction, coding, and risk of bias assessment independently and in duplicate. For our primary analyses, we conducted Bayesian arm-based, multilevel network meta-analyses.
Findings: We included 177 studies, with a total of 404 unique arms, and 10,673 participants. Compared with waitlist control, the largest effects on depression were for dance (n = 107, k = 5, g = -1·21 [-1·59, -0·84]), cognitive behaviour therapy with aerobic exercise (n = 198, k = 10, g = -1·04 [-1·36, -0·73]), walking or jogging (n = 914, k = 46, g = -0·92 [-1·08, -0·76]), and strength training (n = 369, k = 16, g = -0·92 [-1·14, -0·70]). Effects were stronger as dose increased until meeting the WHO guidelines for physical activity (~150 min moderate intensity), beyond which there were few additional benefits. Results appeared robust to publication bias, but only one study met Cochrane criteria for low risk of bias.
Interpretation: Exercise is an effective treatment for depression, with dance, walking/jogging, and strength training appearing more effective than other exercises. Exercise appeared equally effective for people with and without comorbidities, and of different baseline levels of depression. Many forms of exercise could be considered first-line treatment, alongside psychotherapy and antidepressant medication.
Registration: This review was registered with PROSPERO (CRD42018118040).
Funding: We received no funding for this review.
Declaration of Interest: No competing interests.
Keywords: Exercise, Depression, Physical activity, Major Depressive Disorder, Behaviour Change Techniques, Yoga, Qigong
Suggested Citation: Suggested Citation