Home Medizin Sport ist eine wirksame Behandlung bei Depressionen, wobei Gehen, Joggen, Yoga und Krafttraining wirksamer sind als andere Übungen

Sport ist eine wirksame Behandlung bei Depressionen, wobei Gehen, Joggen, Yoga und Krafttraining wirksamer sind als andere Übungen

von NFI Redaktion

A recent systematic review and network meta-analysis published in the British Medical Journal identified the potentially most effective exercise program and dosage for treating major depressive disorder (MDD) compared to antidepressants, psychotherapy, and control interventions.

Study: Effect of Exercise on Depression: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Image credit: Dmytrenko Vlad/Shutterstock.com
Study: Effect of Exercise on Depression: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Image credit: Dmytrenko Vlad/Shutterstock.com

The researchers found that exercise in the form of yoga, walking, jogging, or strength training is an effective and well-tolerated treatment for depression, suggesting its potential as a core intervention alongside antidepressants and psychotherapy, regardless of comorbidities or initial depression levels.

Background

MDD is a leading global cause of disability, significantly impacting life satisfaction and worsening comorbidities. Despite the availability of treatments, potential resistance and limited access to them emphasize the urgent need for evidence-based interventions. While exercise is recommended as a potential supplement or alternative to traditional depression treatments, recommendations for dosage and modality vary by region. Guidelines suggest various approaches, including group exercise programs, aerobic or strength training, or a combination of both.

Existing pairwise meta-analyses to evaluate specific exercise modalities compared to control conditions face challenges due to heterogeneous treatments and comparisons, leading to ambiguous effect estimates. Overview of reviews has attempted to address this issue by combining pairwise meta-analyses, but differences in analysis methods can still lead to confusion.

In this respect, network meta-analyses may provide a more accurate approach by modeling direct and indirect comparisons between interventions simultaneously. Previous network meta-analyses have examined the effects of exercise on various outcomes, including depression, but may not have been sufficient to examine moderators such as dosage and modality.

To address this gap, the researchers conducted a comprehensive search of randomized studies to determine the optimal dose and exercise modality for depression. They considered factors such as participants‘ gender, age, and baseline depression level. To enhance intervention effects for depression, they examined autonomy support and behavior change techniques, investigating their relationship with intervention outcomes. Additionally, they examined intervention mechanisms, including self-confidence and affect, through formal mediation analyses in the included studies.

About the Study

The study included randomized controlled trials investigating physical activity as a treatment method for depression. Participants met the criteria for MDD, either clinically diagnosed or self-reporting exceeding specified clinical thresholds. The data was obtained from the databases Medline, Embase, Cochrane Library, SPORTDiscus, and PsycINFO. Studies were considered regardless of whether all participants or only a subgroup suffered from depression.

Studies with different comparison conditions, participant profiles, and languages were considered to comprehensively evaluate the effectiveness of physical activity in treating depression. Exclusion criteria included interventions lasting less than a week, insufficient data on depression outcomes, and the inability to calculate effect sizes. In total, 218 studies with 495 study arms and 14,170 participants were included.

For each study, intervention details, including exercise frequency, intensity, type, and duration, as well as behavior change techniques, degree of autonomy, comparison conditions, and participant characteristics, were evaluated. The energy expenditure dose of the exercise was determined for each arm in the form of metabolic equivalents of task (METs) min/week.

The risk of bias in the included studies was assessed using the Cochrane tool. Bayes‘ multi-stage network meta-analysis models were used for the main and moderation analyses, using the standardized mean change from baseline as a summary measure. Active control conditions were pooled into groups (e.g., usual care and placebo pill), while the waitlist control, due to its typically poorer effect, was considered separately. Netmeta and CINeMA were used to assess the credibility and acceptability of the modeling. Predetermined moderation and sensitivity analyses were conducted to assess the robustness of the results.

Results and Discussion

Compared to active control participants, dancing showed a strong reduction in depression (Hedges‘ g -0.96), followed by moderate reductions in walking or jogging (g -0.63), yoga (g -0.55), strength training (g -0.49), mixed aerobic exercises (g -0.43), and Tai Chi or Qigong (g -0.42). Moderate effects were also observed with the combination of physical activity with SSRIs (selective serotonin reuptake inhibitors, g -0.55) or the combination of aerobic exercises with psychotherapy (g -0.54).

These treatments exceeded the clinically important difference threshold (g -0.20). Strength training and yoga had lower dropout rates compared to active control participants and were deemed the most acceptable options. The effects were moderate for standalone cognitive behavioral therapy (g -0.55) and minimal for SSRIs (g -0.26). While publication bias was found to be low, only one study met the criteria for low risk of bias.

While the review provides insights into the potential of dance for treating depression, the limited number of studies, bias in study designs, and the lack of blinding of interventions restrict the conclusiveness of the overall recommendations.

Conclusion

In conclusion, according to the study, exercises such as walking, strength training, and yoga show promise as treatments for depression, although confidence in the results may vary. In the future, tailoring exercise-based interventions to individual characteristics and their combination as core treatment alongside antidepressants and psychotherapy could improve outcomes for patients with MDD and offer accessible options, especially for those facing barriers to participation.

Related Posts

Adblock Detected

Please support us by disabling your AdBlocker extension from your browsers for our website.