Intervention Review

Exercise in prevention and treatment of anxiety and depression among children and young people

  1. Lillebeth Larun1,*,
  2. Lena V. Nordheim2,
  3. Eilin Ekeland3,
  4. Kåre Birger Hagen4,
  5. Frode Heian5

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 22 MAY 2006

DOI: 10.1002/14651858.CD004691.pub2

Database Title

Additional Information

How to Cite

Larun L, Nordheim LV, Ekeland E, Hagen KB, Heian F. Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004691. DOI: 10.1002/14651858.CD004691.pub2.

Author Information

  1. 1

    Department of Public Health and Primary Health Care, Norwegian Knowledge Centre for Health Services, Oslo, Norway

  2. 2

    Norwegian Directorate for Health and Social Affairs, Department for Knowledge Support, NO-0031 Oslo, Norway

  3. 3

    Norwegian Physiotherapist Association/ Norsk Fysioterapeutforbund, Oslo, Norway

  4. 4

    Diakonhjemmet Hospital, National Resource Centre for Rehabilitation in Rheumatology, 0319 Oslo, Norway

  5. 5

    Molde Hospital, Child and Adolescence Psychiatric Dept, NO-6407 Molde, Norway

*Lillebeth Larun, Norwegian Knowledge Centre for Health Services, Department of Public Health and Primary Health Care, University of Bergen, PO Box 7004, St Olav's plass, Oslo, 0130, Norway. lillebeth.larun@kunnskapssenteret.no.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

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

Background

Depression and anxiety are common psychological disorders for children and adolescents. Psychological (e.g. psychotherapy), psychosocial (e.g. cognitive behavioral therapy) and biological (e.g. SSRIs or tricyclic drugs) treatments are the most common treatments being offered. The large variety of therapeutic interventions give rise to questions of clinical effectiveness and side effects. Physical exercise is inexpensive with few, if any, side effects.

Objectives

To assess the effects of exercise interventions in reducing or preventing anxiety or depression in children and young people up to 20 years of age.

Search methods

We searched the Cochrane Controlled Trials Register (latest issue available), MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC and Sportdiscus up to August 2005.

Selection criteria

Randomised trials of vigorous exercise interventions for children and young people up to the age of 20, with outcome measures for depression and anxiety.

Data collection and analysis

Two authors independently selected trials for inclusion, assessed methodological quality and extracted data. The trials were combined using meta-analysis methods. A narrative synthesis was performed when the reported data did not allow statistical pooling.

Main results

Sixteen studies with a total of 1191 participants between 11 and 19 years of age were included.

Eleven trials compared vigourous exercise versus no intervention in a general population of children. Six studies reporting anxiety scores showed a non-significant trend in favour of the exercise group (standard mean difference (SMD) (random effects model) -0.48, 95% confidence interval (CI) -0.97 to 0.01). Five studies reporting depression scores showed a statistically significant difference in favour of the exercise group (SMD (random effects model) -0.66, 95% CI -1.25 to -0.08). However, all trials were generally of low methodological quality and they were highly heterogeneous with regard to the population, intervention and measurement instruments used. One small trial investigated children in treatment showed no statistically significant difference in depression scores in favour of the control group (SMD (fixed effects model) 0.78, 95% CI -0.47 to 2.04). No studies reported anxiety scores for children in treatment.

Five trials comparing vigorous exercise to low intensity exercise show no statistically significant difference in depression and anxiety scores in the general population of children. Three trials reported anxiety scores (SMD (fixed effects model) -0.14, 95% CI -0.41 to 0.13). Two trials reported depression scores (SMD (fixed effects model) -0.15, 95% CI -0.44 to 0.14). Two small trials found no difference in depression scores for children in treatment (SMD (fixed effects model) -0.31, 95% CI -0.78 to 0.16). No studies reported anxiety scores for children in treatment.

Four trials comparing exercise with psychosocial interventions showed no statistically significant difference in depression and anxiety scores in the general population of children. Two trials reported anxiety scores (SMD (fixed effects model) -0.13, 95% CI -0.43 to 0.17). Two trials reported depression scores (SMD (fixed effects model) 0.10, 95% CI
-0.21 to 0.41). One trial found no difference in depression scores for children in treatment (SMD (fixed effects model) -0.31, 95% CI -0.97 to 0.35). No studies reported anxiety scores for children in treatment.

Authors' conclusions

Whilst there appears to be a small effect in favour of exercise in reducing depression and anxiety scores in the general population of children and adolescents, the small number of studies included and the clinical diversity of participants, interventions and methods of measurement limit the ability to draw conclusions. It makes little difference whether the exercise is of high or low intensity. The effect of exercise for children in treatment for anxiety and depression is unknown as the evidence base is scarce.

 

Plain language summary

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

Exercise for preventing and treating anxiety and depression in children and young people

Exercise is promoted as an active strategy to prevent and treat depression and anxiety. We found that the research data are sparse and mostly done on college students. Six small trials indicate that exercise decreases reported anxiety scores in healthy children when compared to no intervention. Five small trials indicate that exercise decreases reported depression scores when compared to no intervention. The research base for children in treatment is scarce; only three small trials investigated the effect of exercise in depression.

 

摘要

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

背景

運動對於預防和治療兒童及青少年的焦慮、憂鬱

對兒童和青少年而言，憂鬱和焦慮是常見的心理疾病。最常使用的治療方式包括心理上(例如心理治療)、心理社會(認知行為治療)和生理上(SSRIs或三環類藥物)的治療。各種不同的治療處置常引發了臨床效果和副作用的疑問，其中，運動的成本較低且副作用較少。

目標

評估在兒童及20歲以下青少年，運動的效果是如何降低或預防焦慮或憂鬱

搜尋策略

我們搜尋Cochrane Controlled Trials Register(latest issue available), MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC and Sportdiscus ，至2005年8月。

選擇標準

對兒童及20歲以下青少年的運動處遇的隨機試驗，其結果是測量憂鬱、焦慮。

資料收集與分析

兩位作者分別挑選試驗、評估方法學上的品質和抽取資料。結合所有試驗後進行後設分析。如果資料無法進行統計分析，則進行描述整合。

主要結論

內容包括16篇研究，總共1191名受試，年紀在11 – 19歲。其中，11篇的研究是比較沒有處置和有氧運動處置的一般兒童，6篇研究顯示在運動組的焦慮分數並沒有較為顯著的趨勢(標準差(SMD)隨機因子模型−0.48, 95%信賴區間(CI) −0.97 to 0.01). 5 篇研 究顯示憂鬱分數在運動組有統計上顯著差異 (SMD (隨機因子模型) −0.66, 95% CI −1.25 to −0.08). 然而，所有試驗的方法學上的品質較低，在考量所有研究的母群、處置和測量後發現異質性相當高。一篇小的試驗發現，比起控制組的兒童，在運動組的兒童憂鬱分數並沒有達到統計上的顯著差異(SMD (固定效果模式) 0.78, 95% CI −0.47 to 2.04). 沒有任何一篇研究所報告的焦慮分數是治療組的分數；5篇研究是比較不同強度的運動組，結果顯示在憂鬱及焦慮的分數上並沒有達到統計上顯著的差異。3篇試驗是報告焦慮分數(SMD (固定效果模式) −0.14, 95% CI −0.41 to 0.13).2篇的研究是報告憂鬱分數(SMD (固定效果模式) −0.15, 95% CI −0.44 to 0.14).2篇試驗發現在治療組，憂鬱分數並無差異。(SMD (固定效果模式) −0.31, 95% CI −0.78 to 0.16). 以上沒有一篇研究所報告的焦慮分數是治療組的分數。4篇研究是比較運動和不同的心理社會處置，結果顯示沒有達到統計上顯著的差異。其中2篇是報告焦慮分數(SMD (固定效果模式) −0.13, 95% CI −0.43 to 0.17)。2篇是報告憂鬱分數(SMD (固定效果模式) 0.10, 95% CI0.21 to 0.41).1篇的試驗發現在治療組的兒童，憂鬱分數並無差異(SMD (固定效果模式) −0.31, 95% CI −0.97 to 0.35). 以上沒有一篇的研究有治療組的焦慮分數。

作者結論

在一般青少年及兒童身上，運動對於降低憂鬱、焦慮分數上似乎只有少數的效果，這是由於只包含少數的研究，而且受試者的異質性高，又有不同的處置及不同的研究方法限制了得到結論的能力。而且運動的強度的不同所造成的差別似乎不大。由於證據少，因此無法得知運動對於降低兒童的焦慮和憂鬱的效果。

翻譯人

本摘要由彰化基督教醫院胡淑惠翻譯。

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

總結

運動被認為是一個主動的策略來預防和治療憂鬱及焦慮。我們發現目前的研究的資料較少，如果有，資料多來自大學生。6篇的試驗指出比起沒有接受治療的兒童，在健康的兒童報告運動會降低焦慮。5篇的試驗指出比起沒有接受治療的兒童，運動會降低憂鬱。而研究兒童的資料少，只有3篇的試驗調查運動對於憂鬱的效果。

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