Exercise Interventions as the Primary Treatment for Depression: Evidence from a Narrative Review

The effects of aerobic exercise for depression: An umbrella review of systematic reviews and meta-analyses

OBJECTIVE

This review aims to determine whether aerobic exercise is beneficial in treating depression in adults in general.

METHODS

Review of systematic reviews and meta-analyses related to RCTs. PubMed, MEDLINE, PsycINFO, Embase, and Cochrane databases of systematic reviews were searched extensively between September 2009 and September 2023. An extensive search was conducted using MeSH terms, including ''depression'', ''depressive disorder'', ''depressive symptoms'', ''exercise'', ''aerobic exercise'', ''aerobic training'', ''walking'', ''running'', ''jogging'', ''bicycling'', ''physical activity'', ''adult (limiters 18-65 years)'', ''meta-analyses'' and ''systematic reviews''.

RESULT

In the initial search of the titles and abstracts of reviews, 2345 articles were found. 46 full-text reviews were selected for carefully scrutinized. A total of seven reviews were included in the analysis, and two of them were meta-analyses, which included 42 RCTs. The results of four reviews evaluated the effectiveness of aerobic exercise on depression. Moreover, two reviews examined the efficacy of aerobic exercise as an add-on intervention for depression treatment, one of which was a subgroup analysis. According to two reviews, aerobic exercise improved CRF in people with depression and affected people with MDD from a neurobiological standpoint.

CONCLUSION

This umbrella review systematically evaluated the efficacy of aerobic exercise in treating adult depression, revealing substantial evidence that supports its potential to alleviate depressive symptoms. The positive synthesis of findings advocates for integrating aerobic exercise as a non-pharmacological treatment option. Nevertheless, additional research is essential to confirm these benefits and optimize exercise protocols for depression management.

The effect of physical exercise on depression among college students: a systematic review and meta-analysis

Objective

The goal of the present research was to evaluate the effectiveness of physical exercise intervention in enhancing psychological well-being and decreasing symptoms of depression among college students, adopting a systematic review and meta-analysis.

Methodology

The study was performed by searching four databases (PubMed, Embase, Web of Science, and the Cochrane Library) to determine randomized controlled trials (RCTs) exploring the impacts of physical exercise therapies among college students with symptoms of depression. The sequential execution of a meta-analyses, subgroup analyses, and publication bias analyses was accomplished utilizing the software package RevMan version 5.3.

Results

There were eight articles included. This research demonstrated a significant impact (d = -0.75, P < 0.05), indicating that physical exercise has a substantial impact on decreasing or mitigating depression. The subgroup analyses revealed that interventions involving physical exercise workouts lasting 12 weeks or longer (d = -0.93, P < 0.05), with physical exercise sessions lasting between 30 and 60 min (d = -0.77, P < 0.05), and with physical exercise performed minimum of three times a week (d = -0.90, P < 0.05) were the most effective in reducing symptoms of depression.

Conclusion

Physical exercise interventions have a beneficial impact on reducing depression among college students. The optimal mode was discovered to be college students participating in each session for a duration of 30 to 60 min, at least three times per week, and for more than 12 weeks. College students are encouraged to cultivate a consistent and long-term physical exercise routine to sustain their physical and mental health.

Two symptoms can accurately identify post-exertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome

BACKGROUND

Post-exertional malaise (PEM) is the hallmark symptom of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) yet its diverse manifestations make it difficult to recognize. Brief instruments for detecting PEM are critical for clinical and scientific progress.

OBJECTIVE

To develop a clinical prediction rule for PEM.

METHOD

49 ME/CFS and 10 healthy, sedentary subjects recruited from the community completed two maximal cardiopulmonary exercise tests (CPETs) separated by 24 hours. At five different times, subjects reported symptoms which were then classified into 19 categories. The frequency of symptom reports between groups at each time point was compared using Fisher's exact test. Receiver operating characteristics (ROC) analysis with area under the curve calculation was used to determine the number of different types of symptom reports that were sufficient to differentiate between ME/CFS and sedentary groups. The optimal number of symptoms was determined where sensitivity and specificity of the types of symptom reports were balanced.

RESULTS

At all timepoints, a maximum of two symptoms was optimal to determine differences between groups. Only one symptom was necessary to optimally differentiate between groups at one week following the second CPET. Fatigue, cognitive dysfunction, lack of positive feelings/mood and decrease in function were consistent predictors of ME/CFS group membership across timepoints.

CONCLUSION

Inquiring about post-exertional cognitive dysfunction, decline in function, and lack of positive feelings/mood may help identify PEM quickly and accurately. These findings should be validated with a larger sample of patients.

Be Fit, Be Sharp, Be Well: The Case for Exercise as a Treatment for Cognitive Impairment in Late-life Depression

OBJECTIVE

To lay out the argument that exercise impacts neurobiological targets common to both mood and cognitive functioning, and thus more research should be conducted on its use as an alternative or adjunctive treatment for cognitive impairment in late-life depression (LLD).

METHOD

This narrative review summarizes the literature on cognitive impairment in LLD, describes the structural and functional brain changes and neurochemical changes that are linked to both cognitive impairment and mood disruption, and explains how exercise targets these same neurobiological changes and can thus provide an alternative or adjunctive treatment for cognitive impairment in LLD.

RESULTS

Cognitive impairment is common in LLD and predicts recurrence of depression, poor response to antidepressant treatment, and overall disability. Traditional depression treatment with medication, psychotherapy, or both, is not effective in fully reversing cognitive impairment for most depressed older adults. Physical exercise is an ideal treatment candidate based on evidence that it 1) is an effective treatment for depression, 2) enhances cognitive functioning in normal aging and in other patient populations, and 3) targets many of the neurobiological mechanisms that underlie mood and cognitive functioning. Results of the limited existing clinical trials of exercise for cognitive impairment in depression are mixed but overall support this contention.

CONCLUSIONS

Although limited, existing evidence suggests exercise may be a viable alternative or adjunctive treatment to address cognitive impairment in LLD, and thus more research in this area is warranted. Moving forward, additional research is needed in large, diverse samples to translate the growing research findings into clinical practice.