Meta-Analysis: Which Type of Exercise Has the Biggest Benefit When Treating Depression?
BACKGROUND AND PURPOSE:
- Noetel et al. (BMJ, 2024) sought to identify the optimal dose and modality of exercise for treating major depressive disorder
METHODS:
- Systematic review and network meta-analysis
- Inclusion criteria
- Randomized trials
- Studies of participants with clinical major depression that assessed the effects of exercise
- Study design
- Bayesian, multilevel network meta-analyses
- Quality of the evidence for each arm was graded
- Primary outcome
- Change in symptoms of depression from baseline
RESULTS:
- 218 studies | 495 arms | 14,170 participants
- Compared with active controls (usual care, placebo tablet), moderate reductions in depression were found for
- Walking or jogging
- Hedges’ g −0.62 (95% CrI, −0.80 to −0.45) | n=1210
- Yoga
- g −0.55 (95% CrI, −0.73 to −0.36) | n=1047
- Strength training
- g −0.49 (95% CrI, −0.69 to −0.29) | n=643
- Mixed aerobic exercises
- g −0.43 (95% CrI, −0.61 to −0.24) | n=1286
- Tai chi or qigong
- g −0.42 (95% CrI, −0.65 to −0.21) | n=343
- Walking or jogging
- The effects of exercise were proportional to their intensity
- The exercise modalities with the highest acceptability (least participant drop out) were strength training and yoga
- Confidence was low for walking or jogging and very low for other treatments
CONCLUSION:
- In this network meta-analysis, tested exercise modalities improved depression
- The greatest effects were seen for walking, jogging, yoga and strength training
- The most well-tolerated modalities were yoga and strength training
- The authors state
Health systems may want to provide these treatments as alternatives or adjuvants to other established interventions (cognitive behaviour therapy, SSRIs), while also attenuating risks to physical health associated with depression
Therefore, effective exercise modalities could be considered alongside those intervention as core treatments for depression
