Exercise for depression

Gillian E. Mead (Lead / Corresponding author), Wendy Morley, Paul Campbell, Carolyn A. Greig, Marion McMurdo, Debbie A. Lawlor

    Research output: Contribution to journalReview article

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    Abstract

    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, nonsignificant 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.
    This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2010, Issue 1. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.

    Original languageEnglish
    Article numberCD004366
    Pages (from-to)-
    Number of pages63
    JournalCochrane Database of Systematic Reviews
    Volume2010
    Issue number1
    DOIs
    Publication statusPublished - 2010

    Keywords

    • RANDOMIZED CONTROLLED-TRIAL
    • AEROBIC EXERCISE
    • PHYSICAL-EXERCISE
    • MENTAL-HEALTH
    • OLDER-ADULTS
    • CLINICAL DEPRESSION
    • MAJOR DEPRESSION
    • PSYCHIATRIC-PATIENTS
    • ADJUNCTIVE TREATMENT
    • MODERATE DEPRESSION

    Cite this

    Mead, G. E., Morley, W., Campbell, P., Greig, C. A., McMurdo, M., & Lawlor, D. A. (2010). Exercise for depression. Cochrane Database of Systematic Reviews, 2010(1), -. [CD004366]. https://doi.org/10.1002/14651858.CD004366.pub4
    Mead, Gillian E. ; Morley, Wendy ; Campbell, Paul ; Greig, Carolyn A. ; McMurdo, Marion ; Lawlor, Debbie A. / Exercise for depression. In: Cochrane Database of Systematic Reviews. 2010 ; Vol. 2010, No. 1. pp. -.
    @article{5dc848afd53c48f89dfc5f3f028442bc,
    title = "Exercise for depression",
    abstract = "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, nonsignificant 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. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2010, Issue 1. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.",
    keywords = "RANDOMIZED CONTROLLED-TRIAL, AEROBIC EXERCISE, PHYSICAL-EXERCISE, MENTAL-HEALTH, OLDER-ADULTS, CLINICAL DEPRESSION, MAJOR DEPRESSION, PSYCHIATRIC-PATIENTS, ADJUNCTIVE TREATMENT, MODERATE DEPRESSION",
    author = "Mead, {Gillian E.} and Wendy Morley and Paul Campbell and Greig, {Carolyn A.} and Marion McMurdo and Lawlor, {Debbie A.}",
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    Mead, GE, Morley, W, Campbell, P, Greig, CA, McMurdo, M & Lawlor, DA 2010, 'Exercise for depression', Cochrane Database of Systematic Reviews, vol. 2010, no. 1, CD004366, pp. -. https://doi.org/10.1002/14651858.CD004366.pub4

    Exercise for depression. / Mead, Gillian E. (Lead / Corresponding author); Morley, Wendy; Campbell, Paul; Greig, Carolyn A.; McMurdo, Marion; Lawlor, Debbie A.

    In: Cochrane Database of Systematic Reviews, Vol. 2010, No. 1, CD004366, 2010, p. -.

    Research output: Contribution to journalReview article

    TY - JOUR

    T1 - Exercise for depression

    AU - Mead, Gillian E.

    AU - Morley, Wendy

    AU - Campbell, Paul

    AU - Greig, Carolyn A.

    AU - McMurdo, Marion

    AU - Lawlor, Debbie A.

    PY - 2010

    Y1 - 2010

    N2 - 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, nonsignificant 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. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2010, Issue 1. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.

    AB - 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, nonsignificant 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. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2010, Issue 1. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.

    KW - RANDOMIZED CONTROLLED-TRIAL

    KW - AEROBIC EXERCISE

    KW - PHYSICAL-EXERCISE

    KW - MENTAL-HEALTH

    KW - OLDER-ADULTS

    KW - CLINICAL DEPRESSION

    KW - MAJOR DEPRESSION

    KW - PSYCHIATRIC-PATIENTS

    KW - ADJUNCTIVE TREATMENT

    KW - MODERATE DEPRESSION

    U2 - 10.1002/14651858.CD004366.pub4

    DO - 10.1002/14651858.CD004366.pub4

    M3 - Review article

    C2 - 19588354

    VL - 2010

    SP - -

    JO - Cochrane Database of Systematic Reviews

    JF - Cochrane Database of Systematic Reviews

    SN - 1469-493X

    IS - 1

    M1 - CD004366

    ER -

    Mead GE, Morley W, Campbell P, Greig CA, McMurdo M, Lawlor DA. Exercise for depression. Cochrane Database of Systematic Reviews. 2010;2010(1):-. CD004366. https://doi.org/10.1002/14651858.CD004366.pub4