Effect of exercise for depression: Systematic review and network meta-analysis of randomised controlled trials

Michael Noetel*, Taren Sanders, Daniel Gallardo-Gómez, Paul Taylor, Borja Del Pozo Cruz, Daniel Van Den Hoek, Jordan J. Smith, John Mahoney, Jemima Spathis, Mark Moresi, Rebecca Pagano, Lisa Pagano, Roberta Vasconcellos, Hugh Arnott, Benjamin Varley, Philip Parker, Stuart Biddle, Chris Lonsdale

*Corresponding author for this work

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Objective: To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions. Design: Systematic review and network meta-analysis. Methods: Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool. Data sources: Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases. Eligibility criteria for selecting studies: Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression. Results: 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges' g -0.62, 95% credible interval -0.80 to -0.45), yoga (n=1047, κ=33, g -0.55, -0.73 to -0.36), strength training (n=643, κ=22, g -0.49, -0.69 to -0.29), mixed aerobic exercises (n=1286, κ=51, g -0.43, -0.61 to -0.24), and tai chi or qigong (n=343, κ=12, g -0.42, -0.65 to -0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments. Conclusions: Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression. Systematic review registration: PROSPERO CRD42018118040.

Original languageEnglish
Article numbere075847
JournalThe BMJ
Number of pages17
Publication statusPublished - 14. Feb 2024

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.


  • Antidepressive Agents
  • Bayes Theorem
  • Depression/therapy
  • Depressive Disorder, Major/therapy
  • Exercise
  • Humans
  • Network Meta-Analysis
  • Quality of Life
  • Randomized Controlled Trials as Topic


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