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Intervention Review

Exercise for depression

  1. Gillian E Mead1,*,
  2. Wendy Morley2,
  3. Paul Campbell3,
  4. Carolyn A Greig1,
  5. Marion McMurdo4,
  6. Debbie A Lawlor5

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 25 MAR 2007

DOI: 10.1002/14651858.CD004366.pub4


How to Cite

Mead GE, Morley W, Campbell P, Greig CA, McMurdo M, Lawlor DA. Exercise for depression. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD004366. DOI: 10.1002/14651858.CD004366.pub4.

Author Information

  1. 1

    University of Edinburgh, School of Clinical Sciences and Community Health, Edinburgh, UK

  2. 2

    University of Edinburgh, NHS Lothian, Edinburgh, UK

  3. 3

    5 Boroughs Partnership NHS Trust, Psychological Therapies Service, Manchester, UK

  4. 4

    University of Dundee, Ageing and Health, Dundee, UK

  5. 5

    University of Bristol, MRC Centre for Causal Analyses in Translational Epidemiology, Department of Social Medicine, Bristol, Avon, UK

*Gillian E Mead, School of Clinical Sciences and Community Health, University of Edinburgh, Room F1424, Royal Infirmary, Little France Crescent, Edinburgh, EH16 4SA, UK. gillian.e.mead@ed.ac.uk. gmead@staffmail.ed.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions), comment added to review
  2. Published Online: 8 JUL 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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 methods

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, non-significant 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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Exercise for depression

Depression is a common and important illness affecting at least 1 in 5 people during their lifetime. Exercise has been advocated as an adjunct to usual treatment. This review identified all available randomised trials which compared exercise with either no treatment or an established treatment (e.g. talking therapy) for people with a clinical diagnosis of depression. Data from 25 trials were combined. We found exercise did seem to improve the symptoms of depression, but we cannot be sure exactly how effective it is, or the most effective type of exercise. The evidence suggests that exercise probably needs to be continued in the longer-term for benefits on mood to be maintained.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以運動治療憂鬱症

憂鬱症是造成全球性罹病與死亡的常見及重要的原因。憂鬱症通常以抗憂鬱劑和以心理治療來治療,但有些人可能偏好其他的取代方式,譬如運動。有許多理論性的理由說明為何運動可能改善憂鬱症。

目標

確認運動在治療憂鬱症的療效。

搜尋策略

於2007年3月搜尋Medline、Embase、Sports Discus、PsycINFO、the Cochrane Controlled Trials Register以及 the Cochrane Database of Systematic Reviews 以找出合適的研究。 此外,以人工搜尋相關期刊,並且與本領域的專家接洽、搜尋回溯性研究的書目、並且搜尋已確定之研究的引用文獻。我們並且於2008年5月搜尋 www.controlledtrials.com 。

選擇標準

隨機控制試驗方式比較標準治療、無治療或安慰劑治療在成人(18歲或以上)的憂鬱症,定義由試驗作者進行界定。排除產後憂鬱症的試驗。

資料收集與分析

療效的大小(effect sizes)是使用Cohen's方式計算,而整體集合效應(overall pooled effect)則使用標準平均差來計算,使用隨機效應模式(random effects model)來進行。當試驗使用許多不同的工具來測量憂鬱症時,在後設分析中,我們僅納入主要的結果進行評估。

主要結論

28個試驗符合我們的收案標準,其中25個提供後設分析的資料。適當的隱密隨機分配只有在少數的研究中,那部份沒有使用意向分析法的分析,而且大部分使用自評症狀作為結果的評估。23個試驗(907參與者)比較單純運動與無治療或對照組,集合後的標準差為−0.82 (95% CI −1.12, −0.51) ,顯示其臨床效果。然而當我們僅納入有適當隱密分組,有使用意向分析法及適當結果評估(單盲或雙盲評估)的三個研究,集合的標準差為−0.42 (95% CI −0.88, 0.03) ,換言之,是輕微而無顯著的效果。運動效果沒有顯著不同於認知治療。沒有充分資料斷定其風險與成本。

作者結論

運動似乎改善診斷為憂鬱症患者的憂鬱症狀,但當僅納入有良好方法學的試驗時,效果規模(effect sizes)只是輕微而未達顯著。未來需要更多有良好方法學的試驗來精確評估效果規模及確認風險及成本。未來的系統回顧可以去探究在未達憂鬱症診斷的情緒低落疾患(dysthymia)病人,運動的治療效果。

翻譯人

本摘要由彰化基督教醫院李柏賢翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

憂鬱症這個常見的重要疾病在人一生當中,至少每五個人有一個人罹患。運動被宣揚在一般治療中有輔助的效果。這篇回顧找出所有可得的隨機試驗,其比較運動與無治療或治療(如談話治療)在診斷為憂鬱的患者身上的效果。來自25個試驗資料被收集合併。我們發現運動似乎改善憂鬱症狀,但不能清楚確定治療多有效,或者哪一種運動方式最有效。證據建議運動需要長期的維持來保持心情效果的持續。