Walking, jogging, yoga, and strength training help treat depression, analysis finds

Walking or jogging, yoga, and strength training are more effective at treating depression than other exercises, especially when they're performed vigorously, according to new results of a systematic review and meta-analysis.

The review included 218 randomized controlled trials, with a total of 14,170 participants, that examined the effect of exercise on major depressive disorder to determine the optimal dose and modality and compare it with psychotherapy, antidepressants, and controls. Findings were published by The BMJ on Feb. 14.

Compared with active controls like usual care or a placebo tablet, there were moderate reductions in depression for walking or jogging (κ=51; Hedges' g −0.62; 95% credible interval, [CrI] −0.80 to −0.45), yoga (κ=33; g −0.55; 95% CI, −0.73 to −0.36), strength training (κ=22; g −0.49; 95% CrI, −0.69 to −0.29), mixed aerobic exercises (κ=51; g −0.43; 95% CrI, −0.61 to −0.24), and tai chi or qigong (κ=12; g −0.42; 95% CrI, −0.65 to −0.21). Walking and jogging were effective for all participants, while strength training was more effective for women and yoga or qigong was more effective for men.

Greater effects were seen when exercise intensity increased, and strength training and yoga appeared to be the most acceptable exercises. The effects of exercise on depression were consistent regardless of comorbidities and baseline depression levels. With the exception of yoga, group exercise was not more effective than individual exercise. Results appeared robust to publication bias, but only one included study had low risk of bias, the authors wrote.

Despite the limitations, the study authors suggested treatment guidelines "may be overly conservative by conditionally recommending exercise as complementary or alternative treatment for patients in whom psychotherapy or pharmacotherapy is either ineffective or unacceptable." They proposed that depression guidelines include "prescriptions for exercise and consider adapting the modality to participants' characteristics and recommending more vigorous intensity exercises." The authors hypothesized that the combined effects of social interaction, immersion in green spaces, and neurobiological mechanisms, among other factors, could explain the impact of exercise on depression.

An accompanying editorial highlighted the strengths of the meta-analysis and noted that the effect of exercise appeared superior to antidepressants, but when the two treatments were combined, the effect of the drugs improved. "Notably, physical exercise has also been shown to help prevent depression. For adults with severe or treatment resistant depression, the available evidence currently favors combined psychological and drug treatment," the editorial said. More real-world data are needed to evaluate physical activity programs for people with depression, it concluded.