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Physical activity associated with reduced incidence of depression
Clinical Question
Is physical activity at baseline associated with a reduced risk of subsequent incident depression?
Bottom line
This was a large meta-analysis of prospective cohort studies of individuals of all ages without depression at baseline. All of the studies included at least one year of follow-up. People with high physical activity (> 150 minutes per week of at least moderate-intensity activity) were less likely to have subsequent incident depression than those who had low levels of physical activity. Given the large size of the population, the prospective nature of the studies, and the consistency across age groups, the suggestion that exercise is a preventive factor for new onset depression is relatively strong. This is further evidence that exercise is medicine. 2a
Reference
Study design: Meta-analysis (other)
Funding: Unknown/not stated
Setting: Various (meta-analysis)
Synopsis
For this meta-analysis of prospective cohort studies the authors included 49 studies without overlapping populations. The studies included a total of 266,939 individuals who were followed up for more than 1.8 million person-years. Men and women were nearly equally represented (47% and 53%, respectively). Studies were included if: the participants were free of depression or threshold depressive symptoms as measured by any of several tools; physical activity was measured (generally with a self-report questionnaire); the study was a prospective cohort design with at least one year of follow-up (average 7.4 years); and the study evaluated incident depression as an outcome (various methods). Higher physical activity was considered to be more than 150 minutes per week of at least moderate-intensity activity, such as brisk walking. People with higher levels of physical activity were less likely to have incident depression (adjusted odds ratio 0.83; 95% CI 0.79 - 0.88; P < .001). Several potential confounders (including age, sex, body mass index, smoking, and baseline [subthreshold] depressive symptoms) were considered and did not significantly change the results. Subgroup analyses by age group (< 18 years, 18 – 65 years, > 65 years) showed no significant differences from the baseline analysis.
Reviewer
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo
Toledo, OH
Comments
I would still be cautious about drawing conclusions about causation in the context of this correlation. There may be many other unknown factors (physical, psychological, psychosocial) which were not identified or controlled for, that differentiate between the group who exercised and the group who did not. (For this and other public health reasons, it would be interesting to understand why some people are exercising more than others and what the innate or external barriers to exercise might be.) I think this might have been an important point to raise in the summary.
Magical thinking meta analysis conclusion. Correlation not causation. Classic chicken egg. It may be that non depressed folks enjoy excercising.
raw numbers?
What are the raw numbers - critically important in assessing significance. (E.g. if incidence is 1% untreated but 1.5% treated, then a 50% improvement matters less than with higher percentages.) Can't get at original article without paying.
Hallelujah! Finally a preventative measure that is recognized by EBM that doesn’t require me to prescribe medications. I was beginning to think that my own experience and that of many others was just a figment of our imagination. Thankfully we can now confidently tell our patients that exercise is medicine! On a less sarcastic note I’m truly grateful these preventative medicine studies are seeing the light of day and being included in the POEMs. Thank you
I once heard a respected psychiatrist say ‘A long walk is worth a long talk!’
Most of patients with chronic are depressed activity improve their depression and chronic pain,in my experience as Neurosurgeon increase activity is more effective , but you need to spend time with patient to convince him or her In office I book them for one hour and as often as possible< although I did as much as I could before retiring from active surgery but I can do that more often now.
good poem
Excellenth