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Challenges Establishing the Efficacy of Exercise as an Antidepressant Treatment: A Systematic Review and Meta-Analysis of Control Group Responses in Exercise Randomised Controlled Trials

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Abstract

Background

Whilst previous meta-analyses have demonstrated that control group responses (CGRs) can negatively influence antidepressant efficacy, no such meta-analysis exists in exercise randomised controlled trials (RCTs).

Objective

The aim of this study was to conduct a systematic review and meta-analysis investigating CGRs and predictors in control groups of exercise RCTs among adults with depression.

Methods

Three authors acquired RCTs from a previous Cochrane review (2013) and conducted updated searches of major databases from January 2013 to August 2015. We included exercise RCTs that (1) involved adults with major depressive disorder (MDD) or depressive symptoms; (2) measured depressive symptoms pre- and post-intervention using a validated measure [e.g. Hamilton Depression Scale (HAM-D)]; and (3) included a non-active control group. A random effects meta-analysis calculating the standardised mean difference (SMD) together with 95 % confidence intervals (CIs) was employed to determine CGR.

Results

Across 41 studies, 1122 adults with depression were included [mean (SD) age 50 (18) years, 63 % female]. A large CGR of improved depressive symptoms was evident across all studies (SMD −0.920, 95 % CI −1.11 to −0.729). CGRs were elevated across all subgroup analyses, including high quality studies (n = 11, SMD −1.430, 95 % CI −1.771 to −1.090) and MDD participants (n = 18, SMD −1.248, 95 % CI = −1.585 to −0.911). The CGR equated to an improvement of −7.5 points on the HAM-D (95 % CI −10.30 to −4.89). In MDD participants, increasing age moderated a smaller CGR, while the percentage of drop-outs, baseline depressive symptoms and a longer control group duration moderated a larger CGR (i.e. improvement) (p < 0.05).

Conclusion

In order to demonstrate effectiveness, exercise has to overcome a powerful CGR of approximately double that reported for antidepressant RCTS.

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Authors and Affiliations

  1. Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK

    Brendon Stubbs

  2. Health Service and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, Box SE5 8AF, London, UK

    Brendon Stubbs

  3. Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium

    Davy Vancampfort

  4. KU Leuven-University of Leuven, Z.org Leuven, campus Kortenberg, Kortenberg, Belgium

    Davy Vancampfort

  5. School of Psychiatry, University of New South Wales, Sydney, NSW, Australia

    Simon Rosenbaum & Philip B. Ward

  6. School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia

    Justin Richards

  7. Population Health Research Institute, St. George’s University of London, London, UK

    Michael Ussher

  8. Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil

    Felipe B. Schuch

  9. Graduate Program in Medical Sciences-Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Felipe B. Schuch

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  1. Brendon Stubbs
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  2. Davy Vancampfort
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  4. Philip B. Ward
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  5. Justin Richards
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  6. Michael Ussher
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  7. Felipe B. Schuch
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Correspondence to Brendon Stubbs.

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Funding

Davy Vancampfort has support from the Research Foundation—Flanders (FWO-Vlaanderen). Brendon Stubbs was supported by the Collaboration for Leadership in Applied Health Research and Care South London theme for this article. No other sources of funding were used to assist in the preparation of this article.

Conflicts of interest

Brendon Stubbs, Davy Vancampfort, Simon Rosenbaum, Philip Ward, Justin Richards, Michael Ussher and Felipe Schuch declare that they have no conflicts of interest relevant to the content of this review.

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Ethical approval was not required to conduct this review.

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Stubbs, B., Vancampfort, D., Rosenbaum, S. et al. Challenges Establishing the Efficacy of Exercise as an Antidepressant Treatment: A Systematic Review and Meta-Analysis of Control Group Responses in Exercise Randomised Controlled Trials. Sports Med 46, 699–713 (2016). https://doi.org/10.1007/s40279-015-0441-5

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