Exercise for Depression Symptoms?

Educational Objectives

Summary

Does Exercise Improve Symptoms of Depression?

Exercise appears to be effective as a complement or alternative to medications and psychotherapy for treating patients with depression, but evidence about the comparative value of specific exercise modalities and intensities is limited. In a network meta-analysis in The BMJ (https://doi.org/10.1136/bmj-2023-075847), researchers reviewed 218 randomized controlled trials (14,000 participants) in which any form of exercise was compared with any other intervention in patients with major depressive disorder.

Compared with active controls (e.g., usual care, stretching, education, social support), all of the following yielded at least moderate improvement in depression: Walking or jogging, yoga, exercise plus selective serotonin reuptake inhibitors (SSRIs), strength training, mixed aerobic exercises, tai chi or qigong, and dance. More vigorous exercise generally was more effective, and the optimal exercise modality varied with age and sex. In addition, cognitive behavioral therapy alone and aerobic exercise plus psychotherapy had moderate effects, whereas SSRIs alone had a small effect.

Effects of exercise might be mediated by some combination of social interaction, mindfulness, increased self-efficacy, immersion in green spaces, neurobiological mechanisms, and acute positive affect, depending on the modality. The authors and an editorialist (https://doi.org/10.1136/bmj.q320) suggest that guidelines for managing depression should include prescriptions for exercise that are individualized to each patient’s characteristics, preferences, and tolerance. Specific directives might be more effective than general advice. However, the authors acknowledge that confidence in the effects was low because of potential biases and heterogeneity in this large network of studies — a common limitation of network meta-analyses.

Bruce Soloway, MD

Readings

Disclosures

Acknowledgements

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.00 CE contact hours.

Lecture ID:

JW350614

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

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