Introduction

Depression is a common and disabling disorder that significantly reduces quality of life and is associated with medical comorbidities and increased mortality1,2. Over 300 million people worldwide are affected by depressive disorder3. Currently, psychotherapy and antidepressant medications, either alone or in combination, are the recommended treatments for depression4. However, psychotherapy achieves remission in only about 50% of cases and is typically expensive5. Antidepressant medications frequently lead to side effects, relapses, and withdrawal symptoms6. One serious side effect linked to antidepressants is suicide, with an increased risk of suicidal behavior in adults, suggesting careful monitoring during treatment7. Another significant issue with antidepressants is that a substantial number of patients discontinue their medication within the first six months and varying adherence rates with a median of 63% 8,9. Notably, around 70% of adults with depression do not receive adequate treatment10. Untreated depression can lead to the worsening of the illness and the development of comorbidities, resulting in increased costs for society11,12. This emphasizes the need for easily accessible alternative treatment options13.

Several guidelines, including those from the European Psychiatric Association (EPA), the National Institute for Health and Care Excellence (NICE), and the World Health Organization (WHO), endorse exercise as an alternative treatment for non-severe depression4,14,15. In contrast, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) only recommends exercise when antidepressants or psychotherapy are ineffective or unacceptable and states there is insufficient evidence to support it as an official treatment16. This discrepancy highlights the difficulty in drawing definitive conclusions about the role of exercise in treating non-severe depression 17. This systematic review aims to examine the impact of exercise on depression. 

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Exercise and Depression: A Systematic Review of Randomized Controlled Trials

Abstract

Background 

Depression is a prevalent and debilitating disorder impacting over 300 million individuals globally. Traditional treatments include psychotherapy and antidepressant medications; However, these methods often fall short due to high costs, adverse side effects, and suboptimal remission rates. Consequently, there is a growing need for alternative treatment options. Exercise is recognized by various health guidelines as a potential supplementary treatment for non-severe depression, yet the evidence supporting its efficacy remains inconsistent.  

Methods 

A systematic review was conducted following PRISMA guidelines. The review focused on RCTs published between 2011 and 2024, evaluating the effects of exercise interventions on depressive symptoms. Studies included adults diagnosed with depression using validated screening measures, excluding those involving mind-body exercises like tai chi or yoga. The primary outcome was a change in depressive symptoms, assessed using validated scales such as the Beck Depression Inventory and the Hamilton Rating Scale for Depression (HAM-D).

Results 

Eight RCTs met the inclusion criteria, encompassing a range of exercise interventions and durations. The review revealed that short-duration exercise interventions (8-12 weeks) consistently resulted in significant improvements in depressive symptoms compared to longer-duration studies (24 weeks). Light to vigorous exercises were effective in reducing depression severity, and self-selected intensity exercises showed particularly promising results in enhancing adherence and outcomes. However, variations in control group activities and the nature of the exercise prescribed often introduce confounding factors. 

Conclusion 

The findings support the efficacy of exercise as an adjunct treatment for depression, particularly for short-term intervention. Despite the methodological challenges and variability in study designs, exercise demonstrates significant potential in improving depressive symptoms. Future research should aim to standardize intervention protocols and control conditions, include long-term follow-up periods, and explore tailored exercise prescriptions to optimize treatment outcomes. The review underscores the importance of incorporating exercise into treatment plans for depression to enhance overall well-being.

 

 

Introduction

Depression is a common and disabling disorder that significantly reduces quality of life and is associated with medical comorbidities and increased mortality1,2. Over 300 million people worldwide are affected by depressive disorder3. Currently, psychotherapy and antidepressant medications, either alone or in combination, are the recommended treatments for depression4. However, psychotherapy achieves remission in only about 50% of cases and is typically expensive5. Antidepressant medications frequently lead to side effects, relapses, and withdrawal symptoms6. One serious side effect linked to antidepressants is suicide, with an increased risk of suicidal behavior in adults, suggesting careful monitoring during treatment7. Another significant issue with antidepressants is that a substantial number of patients discontinue their medication within the first six months and varying adherence rates with a median of 63% 8,9. Notably, around 70% of adults with depression do not receive adequate treatment10. Untreated depression can lead to the worsening of the illness and the development of comorbidities, resulting in increased costs for society11,12. This emphasizes the need for easily accessible alternative treatment options13.

Several guidelines, including those from the European Psychiatric Association (EPA), the National Institute for Health and Care Excellence (NICE), and the World Health Organization (WHO), endorse exercise as an alternative treatment for non-severe depression4,14,15. In contrast, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) only recommends exercise when antidepressants or psychotherapy are ineffective or unacceptable and states there is insufficient evidence to support it as an official treatment16. This discrepancy highlights the difficulty in drawing definitive conclusions about the role of exercise in treating non-severe depression 17. This systematic review aims to examine the impact of exercise on depression. 

Literature Review

The World Health Organization (WHO) guidelines recommend exercise as an adjunct treatment for non-severe depression14. This recommendation is supported by evidence from various meta-analyses that have examined the antidepressant effects of exercise in individuals w

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