The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials

Abstract Objective: To determine the effectiveness of exercise as an intervention in the management of depression. Design: Systematic review and meta-regression analysis of randomised controlled trials obtained from five electronic databases (Medline, Embase, Sports Discus, PsycLIT, Cochrane Library) and through contact with experts in the field, bibliographic searches, and hand searches of recent copies of relevant journals. Main outcome measures: Standardised mean difference in effect size and weighted mean difference in Beck depression inventory score between exercise and no treatment and between exercise and cognitive therapy. Results: All of the 14 studies analysed had important methodological weaknesses; randomisation was adequately concealed in only three studies, intention to treat analysis was undertaken in only two, and assessment of outcome was blinded in only one. The participants in most studies were community volunteers, and diagnosis was determined by their score on the Beck depression inventory. When compared with no treatment, exercise reduced symptoms of depression (standardised mean difference in effect size −1.1 (95% confidence interval −1.5 to −0.6); weighted mean difference in Beck depression inventory −7.3 (−10.0 to −4.6)). The effect size was significantly greater in those trials with shorter follow up and in two trials reported only as conference abstracts. The effect of exercise was similar to that of cognitive therapy (standardised mean difference −0.3 (95% confidence interval −0.7 to 0.1)). Conclusions: The effectiveness of exercise in reducing symptoms of depression cannot be determined because of a lack of good quality research on clinical populations with adequate follow up. What is already known on this topic Depression is common Management is often inadequate and many patients do not comply with antidepressant medication The effect of exercise on depression has been a subject of interest for many years What this study adds Most studies of the effect of exercise on depression are of poor quality, have brief follow up, and are undertaken on non-clinical volunteers Exercise may be efficacious in reducing symptoms of depression in the short term but its effectiveness in clinical populations is unknown A well designed, randomised controlled trial with long term follow up is needed

[1]  Influence of aerobic exercise on depression. , 1984, Journal of personality and social psychology.

[2]  D. Veale,et al.  Exercise and mental health , 1987 .

[3]  D. Kupfer,et al.  Exercise as a treatment for depression: An update , 1985 .

[4]  The effect of exercise on depressive symptoms in the moderately depressed elderly. , 1991, Psychology and aging.

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

[6]  D. Scully,et al.  Physical exercise and psychological well being: a critical review. , 1998, British journal of sports medicine.

[7]  T. Plante.  Getting physical Does Exercise Help in the Treatment of Psychiatric Disorders , 1996 .

[8]  S. Biddle.  Exercise and psychosocial health. , 1995, Research quarterly for exercise and sport.

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

[10]  D. Streiner,et al.  The Adequacy of Reporting Randomized, Controlled Trials in the Evaluation of Antidepressants , 1998, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[11]  Conrad M. Harris,et al.  Treatment of Depression in General Practice , 1973, British medical journal.

[12]  H. Sexton,et al.  Exercise intensity and reduction in neurotic symptoms , 1989, Acta psychiatrica Scandinavica.

[13]  A. Meyers,et al.  Running as Treatment for Depression: Is It Worth It? , 1983 .

[14]  G A Colditz,et al.  A meta-analysis of physical activity in the prevention of coronary heart disease. , 1990, American journal of epidemiology.

[15]  E. Martinsen,et al.  Aerobic exercise in the treatment of nonpsychotic mental disorders: An exploratory study , 1989 .

[16]  R. Neimeyer,et al.  Running versus weight lifting in the treatment of depression. , 1987, Journal of consulting and clinical psychology.

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

[18]  P. Salmon.  Psychiatric benefits of physical exercise. , 1990, British journal of hospital medicine.

[19]  G Lewis,et al.  Putting trials on trial--the costs and consequences of small trials in depression: a systematic review of methodology. , 1997, Journal of epidemiology and community health.

[20]  J. Raglin,et al.  Exercise and mental health : beneficial and detrimental effects , 1991 .

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

[22]  E. Rüther,et al.  [Value of sports in treatment of psychiatric illness]. , 1997, PPmP. Psychotherapie, Psychosomatik, medizinische Psychologie.

[23]  P. Frensch,et al.  Aerobic Exercise and Mood , 1992, Sports medicine.

[24]  W. Rief,et al.  Responses to activation and rest in patients with panic disorder and major depression. , 1996, The British journal of clinical psychology.

[25]  R. J. Hayes,et al.  Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. , 1995, JAMA.

[26]  T G Plante.  Does exercise help in the treatment of psychiatric disorders? , 1996, Journal of psychosocial nursing and mental health services.

[27]  D. A. Johnson.  Treatment of Depression in General Practice , 1973, British medical journal.

[28]  D. S. Holmes,et al.  Influence of aerobic exercise training and relaxation training on physical and psychologic health following stressful life events. , 1987, Psychosomatic medicine.

[29]  W. Wallace,et al.  Effect of Aerobic Conditioning upon Mood in Clinically Depressed Men and Women: A Preliminary Investigation , 1982, Perceptual and motor skills.

[30]  E. Martinsen.  Physical activity and depression: clinical experience , 1994, Acta psychiatrica Scandinavica. Supplementum.

[31]  Movement therapy with depressed inpatients: a randomized multiple single case design. , 1994, Archives of psychiatric nursing.

[32]  D. Glenister.  Exercise and mental health: a review , 1996, Journal of the Royal Society of Health.

[33]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

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

[35]  H. Mendelberg,et al.  Exercise and sport in mental health: a review of the literature. , 1990, The Israel journal of psychiatry and related sciences.

[36]  J. Greist,et al.  Running as treatment for depression. , 1979, Comprehensive psychiatry.

[37]  J. Williams,et al.  Effect of Levels of Exercise on Psychological Mood States, Physical Fitness, and Plasma Beta-Endorphin , 1986, Perceptual and motor skills.

[38]  P. Thorén,et al.  Endorphins and exercise: physiological mechanisms and clinical implications. , 1990, Medicine and science in sports and exercise.

[39]  M. Fiatarone,et al.  A randomized controlled trial of progressive resistance training in depressed elders. , 1997, The journals of gerontology. Series A, Biological sciences and medical sciences.

[40]  F. Burbach.  The efficacy of physical activity interventions within mental health services: Anxiety and depressive disorders , 1997 .

[41]  L. Mynors-Wallis,et al.  Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care , 2000, BMJ : British Medical Journal.

[42]  Z. Tran,et al.  Effect of Exercise on Depression , 1990, Exercise and sport sciences reviews.

[43]  J. Blumenthal,et al.  Exercise training as an alternative treatment for depression among older adults. , 1998, Alternative therapies in health and medicine.

[44]  P. Ritvo,et al.  The effects of exercise therapy on clients in a psychiatric rehabilitation program. , 1993 .

[45]  D. L. Meyer,et al.  Reducing symptoms of depression with exercise. , 1990, Psychosomatics.

[46]  E. Martinsen.  The role of aerobic exercise in the treatment of depression , 1987 .

[47]  E. Martinsen,et al.  Adherence to exercise and patients' evaluation of physical exercise in a comprehensive treatment programme for depression , 1989 .

[48]  D. Landers,et al.  The Effect of Exercise on Clinical Depression and Depression Resulting from Mental Illness: A Meta-Analysis , 1998 .

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

[50]  L. Leith.  Foundations of Exercise and Mental Health , 1994 .

[51]  J. McQueen,et al.  The treatment of depression in general practice: a comparison of L-tryptophan, amitriptyline, and a combination of L-tryptophan and amitriptyline with placebo , 1982, Psychological Medicine.

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

[53]  A. Byrne,et al.  The effect of exercise on depression, anxiety and other mood states: a review. , 1993, Journal of psychosomatic research.

[54]  F R Blue,et al.  Aerobic Running as a Treatment for Moderate Depression , 1979, Perceptual and motor skills.

[55]  V. Marigliano,et al.  The role of exercise training in aged subjects with anxiety-depression syndrome , 1998 .

[56]  K. Fox,et al.  Physical activity promotion through primary health care in England. , 1997, The British journal of general practice : the journal of the Royal College of General Practitioners.

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

[58]  L. Hedges,et al.  The Handbook of Research Synthesis , 1995 .

[59]  D. Templer,et al.  The Effects of an Aerobic Exercise Program on Psychological Variables in Older Adults , 1985, International journal of aging & human development.

[60]  E. Martinsen.  Therapeutic implications of exercise for clinically anxious and depressed patients. , 1993 .

[61]  P. Fentem,et al.  ABC of Sports Medicine: Benefits of exercise in health and disease , 1994 .

[62]  S. Weyerer,et al.  Physical Exercise and Psychological Health , 1994, Sports medicine.

[63]  E. Martinsen,et al.  Comparing aerobic with nonaerobic forms of exercise in the treatment of clinical depression: a randomized trial. , 1989, Comprehensive psychiatry.

[64]  H. Houston,et al.  Distance learning package for eye disease. , 1995, The British journal of general practice : the journal of the Royal College of General Practitioners.

[65]  E. Doyne,et al.  Aerobic exercise as a treatment for depression in women , 1983 .

[66]  R. J. Sonstroem.  The psychological benefits of exercise. , 1997, Medicine and health, Rhode Island.

[67]  M. Hess-Homeier.  A COMPARISON OF BECK'S COGNITIVE THERAPY AND JOGGING AS TREATMENTS FOR DEPRESSION , 1981 .

[68]  I. Olkin,et al.  Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement , 1999, The Lancet.

[69]  R. Hales,et al.  Exercise as a treatment option for anxiety and depressive disorders. , 1987, Military medicine.

[70]  R. Conroy,et al.  The value of exercise on a psychiatric hospital unit. , 1982, Hospital & community psychiatry.

[71]  T C Chalmers,et al.  A comparison of statistical methods for combining event rates from clinical trials. , 1989, Statistics in medicine.

[72]  R. Dishman.  Physical Activity and Public Health: Mental Health , 1995 .

[73]  J. Greist,et al.  A Comparative Outcome Study of Group Psychotherapy vs. Exercise Treatments for Depression , 1984 .

[74]  R. Rosenthal.  Parametric measures of effect size. , 1994 .

[75]  R. Bosscher.  Running and mixed physical exercises with depressed psychiatric patients. , 1993 .

[76]  M. Sachs.  Exercise and Running: Effects on Anxiety, Depression, and Psychology , 1982 .

[77]  E. Harrell,et al.  Psychophysiological Effects of A Running Program on Depression and Anxiety in A Psychiatric Population , 1988 .

[78]  S. Lepore,et al.  Journal of Personality and Social Psychology Expressive Writing Moderates the Relation between Intrusive Thoughts and Depressive Symptoms , 2022 .

[79]  P. Frensch,et al.  Long-term effects of aerobic exercise on psychological outcomes. , 1999, Preventive medicine.

[80]  Weight lifting therapy: A preliminary report. , 1994 .

[81]  E. Martinsen,et al.  Effects of aerobic exercise on depression: a controlled study. , 1985, British medical journal.