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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

The effect of exercise in clinically depressed adults: systematic review and meta-analysis of randomized controlled trials

Review published: 2011.

Bibliographic details: Krogh J, Nordentoft M, Sterne JA, Lawlor DA.  The effect of exercise in clinically depressed adults: systematic review and meta-analysis of randomized controlled trials. Journal of Clinical Psychiatry 2011; 72(4): 529-538. [PubMed: 21034688]

Quality assessment

This review concluded that exercise may have small, short-term effects in relieving symptoms of patients experiencing depression, but there was no effect after ten weeks of intervention and no long-term effect after the intervention. These conclusions reflect the data presented, but should be interpreted cautiously given the limited number of small, low-quality and varied trials included. Full critical summary

Abstract

OBJECTIVE: To assess the effectiveness of exercise in adults with clinical depression.

DATA SOURCES: The databases CINAHL, Embase, Cochrane Database of Systematic reviews, Cochrane Controlled Trials Register, MEDLINE, and PsycINFO were searched (1806-2008) using medical subject headings (MeSH) and text word terms depression, depressive disorder and exercise, aerobic, non-aerobic, physical activity, physical fitness, walk*, jog*, run*, bicycling, swim*, strength, and resistance.

STUDY SELECTION: Randomized trials including adults with clinical depression according to any diagnostic system were included.

DATA EXTRACTION: Two investigators evaluated trials using a prepiloted structured form.

DATA SYNTHESIS: Thirteen trials were identified that fulfilled the inclusion criteria. Eight had adequate allocation concealment, 6 had a blinded outcome, and 5 used intention-to-treat analyses. The pooled standardized mean difference (SMD) calculated using a random-effects model was -0.40 (95% CI, -0.66 to -0.14), with evidence of heterogeneity between trials (I(2) = 57.2%, P = .005). There was an inverse association between duration of intervention and the magnitude of the association of exercise with depression (P = .002). No other characteristics were related to between-study heterogeneity. Pooled analysis of 5 trials with long-term follow-up (ie, that examined outcomes beyond the end of the intervention) suggested no long-term benefit (SMD, -0.01; 95% CI, -0.28 to 0.26), with no strong evidence of heterogeneity in this pooled analysis (I(2) = 23.4%, P = .27). There was no strong statistical evidence for small study bias (P > .27). Only 3 studies were assessed as high quality (adequately concealed random allocation, blinded outcome assessment, and intention-to-treat analysis). When we pooled results from these, the estimated beneficial effect of exercise was more modest (SMD, -0.19; 95% CI, -0.70 to 0.31) than the pooled result for all 13 studies, with no strong evidence of benefit.

CONCLUSIONS: Our results suggest a short-term effect of exercise on depression: on average, depression scores 0.4 of a standard deviation lower in clinically depressed patients randomly assigned to an exercise intervention at the end of that intervention compared to those randomly assigned to a none exercise group. There is little evidence of a long-term beneficial effect of exercise in patients with clinical depression.

© Copyright 2011 Physicians Postgraduate Press, Inc.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

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