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Intervention Review

Exercise for depression

  1. Jane Rimer1,
  2. Kerry Dwan2,
  3. Debbie A Lawlor3,
  4. Carolyn A Greig4,
  5. Marion McMurdo5,
  6. Wendy Morley1,
  7. Gillian E Mead6,*

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 11 JUL 2012

Assessed as up-to-date: 5 FEB 2010

DOI: 10.1002/14651858.CD004366.pub5


How to Cite

Rimer J, Dwan K, Lawlor DA, Greig CA, McMurdo M, Morley W, Mead GE. Exercise for depression. Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.: CD004366. DOI: 10.1002/14651858.CD004366.pub5.

Author Information

  1. 1

    NHS Lothian, University Hospitals Division, Edinburgh, Scotland, UK

  2. 2

    University of Liverpool, Institute of Child Health, Liverpool, England, UK

  3. 3

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

  4. 4

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

  5. 5

    University of Dundee, Centre for Cardiovascular and Lung Biology, Division of Medical Sciences, Dundee, UK

  6. 6

    University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, UK

*Gillian E Mead, Centre for Clinical Brain Sciences, University of Edinburgh, Room S1642, 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: New search for studies and content updated (no change to conclusions)
  2. Published Online: 11 JUL 2012

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This is not the most recent version of the article. View current version (12 SEP 2013)

 

Abstract

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

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. This is an update of an earlier review first published in 2009.

Objectives

To determine the effectiveness of exercise in the treatment of depression. Our secondary outcomes included drop-outs from exercise and control groups, costs, quality of life and adverse events.

Search methods

We searched the Cochrane Depression, Anxiety and Neurosis (CCDAN) Review Group's Specialised Register (CCDANCTR), CENTRAL, MEDLINE, EMBASE, Sports Discus and PsycINFO for eligible studies (to February 2010). We also searched www.controlled-trials.com in November 2010. The CCDAN Group searched its Specialised Register in June 2011 and potentially eligible trials were listed as 'awaiting assessment'.

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 postnatal depression.

Data collection and analysis

For this update, two review authors extracted data on outcomes at the end of the trial. We used these data to calculate effect sizes for each trial using Hedges' g 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. We systematically extracted data on adverse effects and two authors performed the 'Risk of bias' assessments.

Main results

Thirty-two trials (1858 participants) fulfilled our inclusion criteria, of which 30 provided data for meta-analyses. Randomisation was adequately concealed in 11 studies, 12 used intention-to-treat analyses and nine used blinded outcome assessors. For the 28 trials (1101 participants) comparing exercise with no treatment or a control intervention, at post-treatment analysis the pooled SMD was -0.67 (95% confidence interval (CI) -0.90 to -0.43), indicating a moderate clinical effect. 

However, when we included only the four trials (326 participants) with adequate allocation concealment, intention-to-treat analysis and blinded outcome assessment, the pooled SMD was -0.31 (95% CI -0.63 to 0.01) indicating a small effect in favour of exercise. There was no difference in drop-outs between exercise and control groups. Pooled data from the seven trials (373 participants) that provided long-term follow-up data also found a small effect in favour of exercise (SMD -0.39, 95% CI -0.69 to -0.09). Of the six trials comparing exercise with cognitive behavioural therapy (152 participants), the effect of exercise was not significantly different from that of cognitive therapy. There were insufficient data to determine risks, costs and quality of life.

Five potentially eligible studies identified by the search of the CCDAN Specialised Register in 2011 are listed as 'awaiting classification' and will be included in the next update of this review.

Authors' conclusions

Exercise seems to improve depressive symptoms in people with a diagnosis of depression when compared with no treatment or control intervention, however since analyses of methodologically robust trials show a much smaller effect in favour of exercise, some caution is required in interpreting these results.

 

Plain language summary

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

Exercise for depression

Depression is a common and disabling illness, affecting approximately 121 million adults worldwide. While depression is commonly treated with antidepressants or psychological therapy, there is increasing interest in the effect of alternative therapies. Exercise has been advocated as a treatment for depression and has been the subject of research for several decades. In our previous Cochrane review, we found that exercise seemed to improve depressive symptoms in people with a diagnosis of depression, but further research was needed. Since then, several new trials have been published. This updated review has identified all available randomised trials which compared exercise with either no treatment or an established treatment (e.g. talking therapy) for people with a diagnosis of depression. We combined data from 30 trials. There were some methodological problems with some of the trials, which limits our confidence in the conclusions drawn. There were 28 trials (1101 participants) that included a comparison of exercise with either waiting list or placebo; overall, we found exercise seemed to improve the symptoms of depression. However, when only the high-quality trials were included, the effect on depression was small. More research is needed to confirm these findings.

 

摘要

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

抑郁症的运动疗法

研究背景

抑郁症是全球常见的发病与死亡的重要原因。通常使用抗抑郁剂和(或)心理疗法来治疗抑郁症,但也有人偏好其他疗法,例如运动疗法。有许多理论依据支持运动疗法对抑郁症有效。

研究目的

确认运动疗法对抑郁症的效果。

检索方法

我们检索了Medline、Embase、Sports Discus 、PsycINFO、Cochrane Controlled Trials Register以及 Cochrane Database of Systematic Reviews等数据库截至2007年3月的文献。此外,手工检索了相关期刊,并与这一领域的专家联系,还追溯了纳入研究的参考文献。我们还于2008年5月检索了www.controlled-trials.com网站。

纳入标准

研究运动疗法与标准疗法、空白对照或安慰剂对成人(18岁或以上)抑郁症疗效比较的随机对照试验。排除产后抑郁症。

数据收集与分析

在随机效应模型下,使用Cohen's方法计算单个试验的效应量,以标准化均数差(SMD)计算总体合并效应。当试验使用了多种工具评价抑郁症时,我们在Meta分析中仅纳入一个最主要的结局测量指标。

主要结果

28个试验符合纳入标准,其中25个满足Meta-分析的条件。仅有少数研究分配隐藏充分,大多数研究没有使用意向性分析,且多数研究的结局指标为自评症状。23个试验(n=907)比较了运动疗法与空白对照或其他干预对照,合并SMD=−0.82 (95% CI −1.12∼ −0.51),提示运动疗法的临床效果显著。然而,如果仅分析三个分配隐藏充分、使用意向性分析及盲法评估结果的研究,则合并SMD=−0.42 (95% CI −0.88∼ 0.03),也就是说仅有较弱的效果,且无统计学意义。运动疗法与认知疗法的疗效未见差异。本研究没有充分资料进行风险和成本分析。

作者结论

运动疗法似乎能改善抑郁症患者的抑郁症状,但当仅分析高质量文献时,其效应量轻微且不具有统计学意义。今后应开展更多高质量的试验研究来更准确的评估效应量及确定风险与成本。今后的系统评价可以针对运动疗法对那些不满足抑郁症诊断标准的轻郁症患者的效果。

 

概要

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

抑郁症的运动疗法

抑郁症的运动疗法

抑郁症是一种常见且重要的疾病,它影响着超过五分之一的人口。运动被认为是常规疗法的辅助手段。本系统评价收录所有能获得的,比较运动疗法与空白对照或其它疗法(如谈话疗法)对抑郁症患者疗效的随机试验。对25个试验的数据进行了合并分析,发现运动疗法似乎可以改善抑郁症状,但效果不能肯定,也不能确定最有效的运动类型。证据显示,运动疗法需要长期坚持才可能表现出对情绪调节的持续作用。

翻译注解

本摘要由重庆医科大学中国循证卫生保健协作网(China Effective Health Care Network)翻译。

翻译注解":本摘要由重庆医科大学中国循证卫生保健协作网(China Effective Health Care Network)翻译。: China Effective Health Care Network