Evidence Summary (Updated 2022)
Guidelines(11), high quality studies and reviews, including a Cochrane review(12), support the improvement of scores on standardised depression outcome measures(12–20). Schuch, et al evaluated the anti-depressant effects of exercise in older adults and found 8 RCTs which showed a significant benefit on depression (standardised mean difference = -0.90, 95% CI) measured with validated screening tools (e.g. Hamilton Depression Scale, Beck Depression Inventory, etc.).(13) The same group published a meta-analysis including all adult patients with a major depressive disorder participating in RCTs. The evidence revealed a significant improvement in depression with exercise (SMD -1.11, 95% CI 0.79 – 1.43).(21)
Several studies considered exercise or physical activity intervention types; favourable outcomes have been found for several PA interventions when compared to controls. These included but was not limited to Aerobic exercise(22), HIIT, mind-body such as yoga(23–25), and resistance(26). HIIT has been found to reduce the depression severity when compared to moderate intensity exercise (SMD 0.373, 95%CI 0.18 – 0.57; p=0.0002).(27) Others concluded that mind-body exercises produced a greater improvement on depressive symptoms compared to aerobic and resistance controls.(28) Guo and colleagues found significant improvements in depressive symptoms in college students when comparing badminton, yoga and Tai-chi interventions to controls. They also ranked 7 included exercise interventions according to respective effectiveness, Tai chi > Yoga > Volleyball > Dance > Run > basketball > Badminton.(29)
The duration, intensity of frequency of exercise interventions was reported in several studies. Chan et al found that moderate intensity anaerobic activity even as short as a ten minute session can improve mood.(30)
Other studies report lower quality of evidence with risk of bias and marked heterogeneity, however the conclusion remained that exercise-based interventions have a significant positive effect on symptoms in people with clinical depression when compared to inactive controls.(28,31,32)
Quality of Evidence
Grade A – High quality
Strength of recommendation
Grade 1 – Strong recommendation
There is strong evidence that physical activity improves mood and scores on validated depression screening tools. When considering physical activity interventions, patient preference is more important than the type, frequency, duration, and intensity of intervention.
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