Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression

Andreas Heissel; Darlene Heinen; Luisa Leonie Brokmeier; Nora Skarabis; Maria Kangas; Davy Vancampfort; Brendon Stubbs; Joseph Firth; Philip B. Ward; Simon Rosenbaum; Mats Hallgren; Felipe Schuch

doi:10.1136/bjsports-2022-106282

Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression

Andreas Heissel^*, Darlene Heinen, Luisa Leonie Brokmeier, Nora Skarabis, Maria Kangas, Davy Vancampfort, Brendon Stubbs, Joseph Firth, Philip B. Ward, Simon Rosenbaum, Mats Hallgren, Felipe Schuch

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

147 Citations (Scopus)

Abstract

Objective To estimate the efficacy of exercise on depressive symptoms compared with non-active control groups and to determine the moderating effects of exercise on depression and the presence of publication bias. Design Systematic review and meta-analysis with meta-regression. Data sources The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, Embase, SPORTDiscus, PsycINFO, Scopus and Web of Science were searched without language restrictions from inception to 13 September2022 (PROSPERO registration no CRD42020210651). Eligibility criteria for selecting studies Randomised controlled trials including participants aged 18 years or older with a diagnosis of major depressive disorder or those with depressive symptoms determined by validated screening measures scoring above the threshold value, investigating the effects of an exercise intervention (aerobic and/or resistance exercise) compared with a non-exercising control group. Results Forty-one studies, comprising 2264 participants post intervention were included in the meta-analysis demonstrating large effects (standardised mean difference (SMD)=-0.946, 95% CI -1.18 to -0.71) favouring exercise interventions which corresponds to the number needed to treat (NNT)=2 (95% CI 1.68 to 2.59). Large effects were found in studies with individuals with major depressive disorder (SMD=-0.998, 95% CI -1.39 to -0.61, k=20), supervised exercise interventions (SMD=-1.026, 95% CI -1.28 to -0.77, k=40) and moderate effects when analyses were restricted to low risk of bias studies (SMD=-0.666, 95% CI -0.99 to -0.34, k=12, NNT=2.8 (95% CI 1.94 to 5.22)). Conclusion Exercise is efficacious in treating depression and depressive symptoms and should be offered as an evidence-based treatment option focusing on supervised and group exercise with moderate intensity and aerobic exercise regimes. The small sample sizes of many trials and high heterogeneity in methods should be considered when interpreting the results.

Original language	English
Pages (from-to)	1049-1057
Number of pages	9
Journal	British Journal of Sports Medicine
Volume	57
Issue number	16
DOIs	https://doi.org/10.1136/bjsports-2022-106282
Publication status	Published - 1 Aug 2023

Keywords

Depression
Exercise
Psychiatry
Public health

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10.1136/bjsports-2022-106282

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Heissel, A., Heinen, D., Brokmeier, L. L., Skarabis, N., Kangas, M., Vancampfort, D., Stubbs, B., Firth, J., Ward, P. B., Rosenbaum, S., Hallgren, M., & Schuch, F. (2023). Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression. British Journal of Sports Medicine, 57(16), 1049-1057. https://doi.org/10.1136/bjsports-2022-106282

@article{5e24f3904d49419598e54b7a6e2e4e17,

title = "Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression",

abstract = "Objective To estimate the efficacy of exercise on depressive symptoms compared with non-active control groups and to determine the moderating effects of exercise on depression and the presence of publication bias. Design Systematic review and meta-analysis with meta-regression. Data sources The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, Embase, SPORTDiscus, PsycINFO, Scopus and Web of Science were searched without language restrictions from inception to 13 September2022 (PROSPERO registration no CRD42020210651). Eligibility criteria for selecting studies Randomised controlled trials including participants aged 18 years or older with a diagnosis of major depressive disorder or those with depressive symptoms determined by validated screening measures scoring above the threshold value, investigating the effects of an exercise intervention (aerobic and/or resistance exercise) compared with a non-exercising control group. Results Forty-one studies, comprising 2264 participants post intervention were included in the meta-analysis demonstrating large effects (standardised mean difference (SMD)=-0.946, 95% CI -1.18 to -0.71) favouring exercise interventions which corresponds to the number needed to treat (NNT)=2 (95% CI 1.68 to 2.59). Large effects were found in studies with individuals with major depressive disorder (SMD=-0.998, 95% CI -1.39 to -0.61, k=20), supervised exercise interventions (SMD=-1.026, 95% CI -1.28 to -0.77, k=40) and moderate effects when analyses were restricted to low risk of bias studies (SMD=-0.666, 95% CI -0.99 to -0.34, k=12, NNT=2.8 (95% CI 1.94 to 5.22)). Conclusion Exercise is efficacious in treating depression and depressive symptoms and should be offered as an evidence-based treatment option focusing on supervised and group exercise with moderate intensity and aerobic exercise regimes. The small sample sizes of many trials and high heterogeneity in methods should be considered when interpreting the results.",

keywords = "Depression, Exercise, Psychiatry, Public health",

author = "Andreas Heissel and Darlene Heinen and Brokmeier, {Luisa Leonie} and Nora Skarabis and Maria Kangas and Davy Vancampfort and Brendon Stubbs and Joseph Firth and Ward, {Philip B.} and Simon Rosenbaum and Mats Hallgren and Felipe Schuch",

note = "Funding Information: AH is founder and CEO of the Centre for Emotional Health Germany GmbH supported by the Potsdam Transfer Centre from the University of Potsdam. BS has an NIHR Advanced fellowship (NIHR-301206, 2021–2026) and is coinvestigator on an NIHR program grant: Supporting Physical and Activity through Co-production in people with Severe Mental Illness (SPACES). BS is on the Editorial board of Mental Health and Physical Activity and The Brazilian Journal of Psychiatry. BS has received honorarium from a coedited book on exercise and mental illness and advisory work from ASICS for unrelated work. MK is on the Editorial boards for Behavior Therapy (Associate Editor), Stress and Health (Sections Editor), Psychological Bulletin, and Behaviour Research and Therapy. JF is supported by a UK Research and Innovation Future Leaders Fellowship (MR/T021780/1) and has received honoraria / consultancy fees from Atheneum, Informa, Gillian Kenny Associates, Big Health, Wood For Trees, Nutritional Medicine Institute, Angelini, ParachuteBH, Richmond Foundation and Nirakara, independent of this work. FS is on the Editorial board of Mental Health and Physical Activity, The Brazilian Journal of Psychiatry and Journal Brasileiro de Psiquiatria. FS has received honorarium from a co-edited book on lifestyle and mental illness. The other authors declare no funding, editorial or potential competing interests. Publisher Copyright: {\textcopyright} 2023 BMJ Publishing Group. All rights reserved.",

year = "2023",

month = aug,

day = "1",

doi = "10.1136/bjsports-2022-106282",

language = "English",

volume = "57",

pages = "1049--1057",

journal = "British Journal of Sports Medicine",

issn = "0306-3674",

publisher = "BMJ Publishing Group",

number = "16",

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Heissel, A, Heinen, D, Brokmeier, LL, Skarabis, N, Kangas, M, Vancampfort, D, Stubbs, B, Firth, J, Ward, PB, Rosenbaum, S, Hallgren, M & Schuch, F 2023, 'Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression', British Journal of Sports Medicine, vol. 57, no. 16, pp. 1049-1057. https://doi.org/10.1136/bjsports-2022-106282

TY - JOUR

T1 - Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression

AU - Heissel, Andreas

AU - Heinen, Darlene

AU - Brokmeier, Luisa Leonie

AU - Skarabis, Nora

AU - Kangas, Maria

AU - Vancampfort, Davy

AU - Stubbs, Brendon

AU - Firth, Joseph

AU - Ward, Philip B.

AU - Rosenbaum, Simon

AU - Hallgren, Mats

AU - Schuch, Felipe

N1 - Funding Information: AH is founder and CEO of the Centre for Emotional Health Germany GmbH supported by the Potsdam Transfer Centre from the University of Potsdam. BS has an NIHR Advanced fellowship (NIHR-301206, 2021–2026) and is coinvestigator on an NIHR program grant: Supporting Physical and Activity through Co-production in people with Severe Mental Illness (SPACES). BS is on the Editorial board of Mental Health and Physical Activity and The Brazilian Journal of Psychiatry. BS has received honorarium from a coedited book on exercise and mental illness and advisory work from ASICS for unrelated work. MK is on the Editorial boards for Behavior Therapy (Associate Editor), Stress and Health (Sections Editor), Psychological Bulletin, and Behaviour Research and Therapy. JF is supported by a UK Research and Innovation Future Leaders Fellowship (MR/T021780/1) and has received honoraria / consultancy fees from Atheneum, Informa, Gillian Kenny Associates, Big Health, Wood For Trees, Nutritional Medicine Institute, Angelini, ParachuteBH, Richmond Foundation and Nirakara, independent of this work. FS is on the Editorial board of Mental Health and Physical Activity, The Brazilian Journal of Psychiatry and Journal Brasileiro de Psiquiatria. FS has received honorarium from a co-edited book on lifestyle and mental illness. The other authors declare no funding, editorial or potential competing interests. Publisher Copyright: © 2023 BMJ Publishing Group. All rights reserved.

PY - 2023/8/1

Y1 - 2023/8/1

N2 - Objective To estimate the efficacy of exercise on depressive symptoms compared with non-active control groups and to determine the moderating effects of exercise on depression and the presence of publication bias. Design Systematic review and meta-analysis with meta-regression. Data sources The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, Embase, SPORTDiscus, PsycINFO, Scopus and Web of Science were searched without language restrictions from inception to 13 September2022 (PROSPERO registration no CRD42020210651). Eligibility criteria for selecting studies Randomised controlled trials including participants aged 18 years or older with a diagnosis of major depressive disorder or those with depressive symptoms determined by validated screening measures scoring above the threshold value, investigating the effects of an exercise intervention (aerobic and/or resistance exercise) compared with a non-exercising control group. Results Forty-one studies, comprising 2264 participants post intervention were included in the meta-analysis demonstrating large effects (standardised mean difference (SMD)=-0.946, 95% CI -1.18 to -0.71) favouring exercise interventions which corresponds to the number needed to treat (NNT)=2 (95% CI 1.68 to 2.59). Large effects were found in studies with individuals with major depressive disorder (SMD=-0.998, 95% CI -1.39 to -0.61, k=20), supervised exercise interventions (SMD=-1.026, 95% CI -1.28 to -0.77, k=40) and moderate effects when analyses were restricted to low risk of bias studies (SMD=-0.666, 95% CI -0.99 to -0.34, k=12, NNT=2.8 (95% CI 1.94 to 5.22)). Conclusion Exercise is efficacious in treating depression and depressive symptoms and should be offered as an evidence-based treatment option focusing on supervised and group exercise with moderate intensity and aerobic exercise regimes. The small sample sizes of many trials and high heterogeneity in methods should be considered when interpreting the results.

AB - Objective To estimate the efficacy of exercise on depressive symptoms compared with non-active control groups and to determine the moderating effects of exercise on depression and the presence of publication bias. Design Systematic review and meta-analysis with meta-regression. Data sources The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, Embase, SPORTDiscus, PsycINFO, Scopus and Web of Science were searched without language restrictions from inception to 13 September2022 (PROSPERO registration no CRD42020210651). Eligibility criteria for selecting studies Randomised controlled trials including participants aged 18 years or older with a diagnosis of major depressive disorder or those with depressive symptoms determined by validated screening measures scoring above the threshold value, investigating the effects of an exercise intervention (aerobic and/or resistance exercise) compared with a non-exercising control group. Results Forty-one studies, comprising 2264 participants post intervention were included in the meta-analysis demonstrating large effects (standardised mean difference (SMD)=-0.946, 95% CI -1.18 to -0.71) favouring exercise interventions which corresponds to the number needed to treat (NNT)=2 (95% CI 1.68 to 2.59). Large effects were found in studies with individuals with major depressive disorder (SMD=-0.998, 95% CI -1.39 to -0.61, k=20), supervised exercise interventions (SMD=-1.026, 95% CI -1.28 to -0.77, k=40) and moderate effects when analyses were restricted to low risk of bias studies (SMD=-0.666, 95% CI -0.99 to -0.34, k=12, NNT=2.8 (95% CI 1.94 to 5.22)). Conclusion Exercise is efficacious in treating depression and depressive symptoms and should be offered as an evidence-based treatment option focusing on supervised and group exercise with moderate intensity and aerobic exercise regimes. The small sample sizes of many trials and high heterogeneity in methods should be considered when interpreting the results.

KW - Depression

KW - Exercise

KW - Psychiatry

KW - Public health

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U2 - 10.1136/bjsports-2022-106282

DO - 10.1136/bjsports-2022-106282

M3 - Review article

C2 - 36731907

AN - SCOPUS:85149881249

SN - 0306-3674

VL - 57

SP - 1049

EP - 1057

JO - British Journal of Sports Medicine

JF - British Journal of Sports Medicine

IS - 16

ER -

Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression

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