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Supervised exercise is effective for some patients with depression
Clinical Question
Is supervised aerobic exercise effective for people with depression or depressive symptoms?
Bottom line
This study is difficult to parse, given the nonspecificity of the diagnosis of depression, the low quality of half the included studies, the small numbers of participants in each study, and the high degree of heterogeneity among the interventions and results. But here goes: With an NNT of between 2 and 3, it seems worth a try to offer a supervised exercise program to patients with less severe depression to help reduce symptoms. 1a-
Reference
Study design: Meta-analysis (other)
Funding: Self-funded or unfunded
Setting: Various (meta-analysis)
Synopsis
These investigators searched 7 databases, as well as a trials database and reference lists of identified studies, to identify randomized controlled studies of adults with a diagnosis of depression (or who screened positive for depressive symptoms) that compared an exercise intervention group with a nonexercising control group. Articles were selected and abstracted by 3 independent researchers and risk of bias was assessed by 3 investigators. The authors identified 41 studies that enrolled a total of 2264 participants. Half the studies enrolled patients who were given a diagnosis (severity not specified) of depression and half the studies enrolled patients with depressive symptoms. Most of the studies evaluated the effect of aerobic exercise alone (n = 30) or in combination with resistance training (n = 10). Lots of problems with this literature. Heterogeneity was high for both interventions and outcomes. There was a high risk of bias in half the studies. Three of the studies included patients with dysthymia. Overall, an exercise intervention produced a greater reduction in symptoms than nonexercise comparators, with an overall number needed to treat (NNT) of 2.0; the NNT was slightly higher (2.8) in studies with a low risk of bias. The effect was larger in patients with depression and when a supervised exercise program was recommended.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Exercice et depression
Rassurant de voir que l’exercice peut améliorer les symptômes dépressifs avec un nombre à traiter bas!
Impact assessment
Very good
Supervised excercise for depression
Interesting choice of article for a POEM given its goal is to review "Patient Oriented Evidence that Matters". Not sure this article meets the bill. With a NNT between 2 and 3, it means there would be a HUGE beneficial treatment effect so for the reviewer to be so circumspect (maybe hesitant would be a better word) in his review suggests to me the article is highly suspect in its conclusions. A meta-regression of a meta-analysis of articles that have high heterogeneity and at high risk of bias make me conclude the article is of extremely limited value from a evidence basis. Add that to the topic being limited to "supervised exercise" rather than just "exercise" makes me also conclude I'd need much more primary research done in this area to suggest this to a patient.
Exercise and depression
As per the reviewers comments