In a network meta-analysis, a variety of exercise-based interventions had at least moderate beneficial effects.

Exercise appears to be effective as a complement or alternative to medications and psychotherapy for treating patients with depression, but evidence about the comparative value of specific exercise modalities and intensities is limited. In a network meta-analysis, researchers reviewed 218 randomised controlled trials (14,000 participants) in which any form of exercise was compared with any other intervention in patients with major depressive disorder.

Compared with active controls (e.g. usual care, stretching, education, social support), all of the following yielded at least moderate improvement in depression: walking or jogging, yoga, exercise plus selective serotonin reuptake inhibitors, strength training, mixed aerobic exercises, tai chi or qigong, and dance. More vigorous exercise generally was more effective, and the optimal exercise modality varied with age and sex. In addition, cognitive behavioural therapy alone and aerobic exercise plus psychotherapy had moderate effects, whereas SSRIs alone had a small effect. 

Comment: Effects of exercise might be mediated by some combination of social interaction, mindfulness, increased self-efficacy, immersion in green spaces, neurobiological mechanisms and acute positive affect, depending on the modality. The authors and an editorialist suggest that guidelines for managing depression should include prescriptions for exercise that are individualised to each patient’s characteristics, preferences and tolerance. Specific directives might be more effective than general advice. However, the authors acknowledge that confidence in the effects was low because of potential biases and heterogeneity in this large network of studies – a common limitation of network meta-analyses.

Bruce Soloway, MD, Associate Professor Emeritus of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.

Noetel M, et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ 2024; 384: e075847.

Bellón JÁ. Exercise for the treatment of depression. BMJ 2024; 384: q320.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Psychiatry.