Exercise for depression.

BACKGROUND Depression is a common and important cause of morbidity and mortality worldwide. Depression is commonly treated with antidepressants and/or psychotherapy, but some people may prefer alternative approaches such as exercise. There are a number of theoretical reasons why exercise may improve depression. OBJECTIVES To determine the effectiveness of exercise in the treatment of depression. SEARCH STRATEGY We searched Medline, Embase, Sports Discus, PsycINFO, the Cochrane Controlled Trials Register, and the Cochrane Database of Systematic Reviews for eligible studies in March 2007. In addition, we hand-searched several relevant journals, contacted experts in the field, searched bibliographies of retrieved articles, and performed citation searches of identified studies. We also searched www.controlled-trials.com in May 2008. SELECTION CRITERIA Randomised controlled trials in which exercise was compared to standard treatment, no treatment or a placebo treatment in adults (aged 18 and over) with depression, as defined by trial authors. We excluded trials of post-natal depression. DATA COLLECTION AND ANALYSIS We calculated effect sizes for each trial using Cohen's method and a standardised mean difference (SMD) for the overall pooled effect, using a random effects model. Where trials used a number of different tools to assess depression, we included the main outcome measure only in the meta-analysis. MAIN RESULTS Twenty-eight trials fulfilled our inclusion criteria, of which 25 provided data for meta-analyses. Randomisation was adequately concealed in a minority of studies, most did not use intention to treat analyses and most used self-reported symptoms as outcome measures. For the 23 trials (907 participants) comparing exercise with no treatment or a control intervention, the pooled SMD was -0.82 (95% CI -1.12, -0.51), indicating a large clinical effect. However, when we included only the three trials with adequate allocation concealment and intention to treat analysis and blinded outcome assessment, the pooled SMD was -0.42 (95% CI -0.88, 0.03) i.e. moderate, non-significant effect. The effect of exercise was not significantly different from that of cognitive therapy. There was insufficient data to determine risks and costs. AUTHORS' CONCLUSIONS Exercise seems to improve depressive symptoms in people with a diagnosis of depression, but when only methodologically robust trials are included, the effect sizes are only moderate and not statistically significant. Further, more methodologically robust trials should be performed to obtain more accurate estimates of effect sizes, and to determine risks and costs. Further systematic reviews could be performed to investigate the effect of exercise in people with dysthymia who do not fulfil diagnostic criteria for depression.

[1]  P. Doraiswamy,et al.  Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder , 2007, Psychosomatic medicine.

[2]  M. Trivedi,et al.  TREAD: TReatment with Exercise Augmentation for Depression: study rationale and design , 2006, Clinical trials.

[3]  James F. Konopack,et al.  Depressive Symptoms Among Older Adults: Long-Term Reduction After a Physical Activity Intervention , 2005, Journal of Behavioral Medicine.

[4]  T. Vahlberg,et al.  Effects of a health advocacy, counselling, and activation programme on depressive symptoms in older coronary heart disease patients , 2005, International journal of geriatric psychiatry.

[5]  S. Naudé,et al.  Exercise and depression: a treatment manual , 2004 .

[6]  Miriam C. Morey,et al.  From Supervised to Unsupervised Exercise: Factors Associated with Exercise Adherence , 2003 .

[7]  H. Tsang,et al.  The effect of Qigong on general and psychosocial health of elderly with chronic physical illnesses: a randomized clinical trial , 2003, International journal of geriatric psychiatry.

[8]  C. Cotman,et al.  Exercise: a behavioral intervention to enhance brain health and plasticity , 2002, Trends in Neurosciences.

[9]  M. Trivedi,et al.  EXERCISE AND DEPRESSION: MEETING STANDARDS TO ESTABLISH TREATMENT EFFICACY , 2001 .

[10]  K. Krishnan,et al.  Effects of exercise training on older patients with major depression. , 1999, Archives of internal medicine.

[11]  N. Mutrie,et al.  Exercise is beneficial adjunctive treatment in depression , 1997, BMJ.

[12]  Y. Netz,et al.  The Effect of Supervised Physical Activity on Cognitive and Affective State of Geriatric and Psychogeriatric In-Patients , 1994 .

[13]  C. Pantelis,et al.  Aerobic Exercise in the Adjunctive Treatment of Depression: A Randomized Controlled Trial , 1992, Journal of the Royal Society of Medicine.

[14]  J. Blumenthal,et al.  Perceived change among participants in an exercise program for older adults. , 1990, The Gerontologist.

[15]  U. Storb.  The Published Data , 1990, Immunological reviews.

[16]  J. Raglin,et al.  Exercise and Mental Health , 1990 .

[17]  M. Gatz,et al.  Psychological and cognitive effects of an exercise program for community-residing older adults. , 1990, The Gerontologist.

[18]  S. Biddle.  Exercise and the treatment of depression. , 1989, British journal of hospital medicine.

[19]  Athayde Ribeiro da Silva.  Sport and depression therapy , 1983 .

[20]  M. Trivedi,et al.  Exercise treatment for depression: efficacy and dose response. , 2005, American journal of preventive medicine.

[21]  W. Haskell,et al.  The effects of exercise training programs on psychosocial improvement in uncomplicated postmyocardial infarction patients. , 1986, Journal of psychosomatic research.