Clinical Question

Is exercise an effective treatment for patients with symptoms of depression?

Bottom Line

Prescribing a specific exercise program, whether aerobic or strength training, produces a clinically meaningful result in patients with depression. The advice cannot be simply to exercise more but should be a prescription, similar to a medication prescription, that specifies the frequency, intensity, duration, and type of exercise. (Level of Evidence = 1a−)

Synopsis

The authors conducted this network meta-analysis using PRISMA guidelines. They identified randomized trials with an exercise arm by searching five databases, including Cochrane Central, and found 218 studies (N = 14,170) that included patients with mild to severe depression. Most of the studies were unmasked, which (combined with other bias risks) led the authors to judge the risk of bias to be high for almost 60% of the studies. There was no evidence of publication bias. Simple counseling on physical exercise or giving participants a choice of frequency, intensity, type, or time for exercise did not produce a clinically important benefit. However, many prescribed exercise interventions, including dance classes, walking or jogging, yoga, and strength training, produced a clinical benefit vs. other active treatments. Higher-intensity exercise was associated with greater benefit. There may be an expectancy bias (a type of placebo effect) that could explain the results.