Annals of Behavioral Medicine

, Volume 39, Issue 2, pp 128–138 | Cite as

Depressive Symptom Outcomes of Physical Activity Interventions: Meta-analysis Findings

Original Article

Abstract

Background

Physical activity (PA) is consistently linked to mental health outcomes.

Purpose

This meta-analysis synthesized depressive symptom outcomes of supervised and unsupervised PA interventions among healthy adults.

Methods

Comprehensive searching and coding were applied to PA interventions among adults without clinical depression. Analyses included random-effects standardized means, Q, and moderator analysis using analysis of variance and regression meta-analytic analogues.

Results

Treatment versus control comparisons yielded a standardized mean effect size of 0.372 among 38 supervised PA studies and 0.522 among 22 unsupervised PA studies. Preliminary moderator analyses suggested that supervised PA interventions may be more effective when they include flexibility/resistance and low-intensity exercise. Unsupervised PA interventions may be more effective when they recommend center-based PA. Methodological moderators (random assignment, control group management) were identified.

Conclusions

These findings document that PA interventions reduce depressive symptoms even in adults without clinical depression. Moderator analyses suggest directions for future research as well as practice.

Keywords

Meta-analysis Exercise Depression Intervention studies 

Notes

Acknowledgement

Financial support provided by a grant from the National Institutes of Health (R01NR009656) to Vicki Conn, principal investigator. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.

Conflict of interest

The author declares no conflicts of interest. The author has no financial relationship with the funding agency (NIH). The author has full control of all primary data and agrees to allow the journal to review the data.

References

  1. 1.
    Franz SL, Hamilton GV. Effect of exercise upon the retardation in condition of depression. Am J Insanity. 1905; 62: 239–256.Google Scholar
  2. 2.
    Martinsen EW. Physical activity in the prevention and treatment of anxiety and depression. Nord J Psychiatry. 2008; 62(Suppl 47): 25–29.CrossRefPubMedGoogle Scholar
  3. 3.
    Deslandes A, Moraes H, Ferreira C, et al. Exercise and mental health: Many reasons to move. Neuropsychobiology. 2009; 59: 191–198.CrossRefPubMedGoogle Scholar
  4. 4.
    Dunn AL, Trivedi MH, O'Neal HA. Physical activity dose-response effects on outcomes of depression and anxiety. Med Sci Sports Exerc. 2001; 33: S587–S597; S609–S510.CrossRefPubMedGoogle Scholar
  5. 5.
    Lawlor DA, Hopker SW. The effectiveness of exercise as an intervention in the management of depression: Systematic review and meta-regression of randomised controlled trials. BMJ. 2001; 322: 763–767.CrossRefPubMedGoogle Scholar
  6. 6.
    Craft LL, Landers DM. The effects of exercise on clinical depression and depression resulting from mental illness: A meta-regression. J Sport Exerc Psychol. 1998; 20: 339–347.Google Scholar
  7. 7.
    Stathopoulou G, Powers MB, Berry AC, Smits JAJ, Otto MW. Exercise interventions for mental health: A quantitative and qualitative review. Clin Psychol Sci Pract. 2006; 13: 179–193.CrossRefGoogle Scholar
  8. 8.
    Pinquart M, Duberstein PR, Lyness JM. Effects of psychotherapy and other behavioral interventions on clinically depressed older adults: A meta-analysis. Aging Ment Health. 2007; 11: 645–657.CrossRefPubMedGoogle Scholar
  9. 9.
    aan het Rot M, Collins KA, Fitterling HL. Physical exercise and depression. Mt Sinai J Med. 2009; 76: 204–214.CrossRefGoogle Scholar
  10. 10.
    Arent S, Landers DM, Etnier J. The effects of exercise on mood in older adults: A meta-analytic review. J Aging Phys Act. 2000; 8: 407–430.Google Scholar
  11. 11.
    Sjosten N, Kivela SL. The effects of physical exercise on depressive symptoms among the aged: A systematic review. Int J Geriatr Psychiatry. 2006; 21: 410–418.CrossRefPubMedGoogle Scholar
  12. 12.
    Daley A, Daley A. Exercise and depression: A review of reviews. J Clin Psychol Med Settings. 2008; 15: 140–147.CrossRefPubMedGoogle Scholar
  13. 13.
    Penedo FJ, Dahn JR. Exercise and well-being: A review of mental and physical health benefits associated with physical activity. Curr Opin Psychiatry. 2005; 18: 189–193.CrossRefPubMedGoogle Scholar
  14. 14.
    North TC, McCullagh P, Tran ZV. Effect of exercise on depression. Exerc Sport Sci Rev. 1990; 18: 379–415.CrossRefPubMedGoogle Scholar
  15. 15.
    Cooper H, Hedges L, Valentine J, eds. The Handbook of Research Synthesis and Meta-Analysis. 2nd ed. New York: Russell Sage; 2009.Google Scholar
  16. 16.
    White H. Scientific communication and literature retrieval. In: Cooper H, Hedges L, Valentine J, eds. The Handbook of Research Synthesis and Meta-Analysis. 2nd ed. New York: Russell Sage; 2009: 51–71.Google Scholar
  17. 17.
    Reed J, Baxter P. Using reference databases. In: Cooper H, Hedges L, Valentine J, eds. The Handbook of Research Synthesis and Meta-Analysis. 2nd ed. New York: Russell Sage; 2009: 73–101.Google Scholar
  18. 18.
    Rothstein HR, Hopewell S. Grey literature. In: Cooper H, Hedges L, Valentine J, eds. The Handbook of Research Synthesis and Meta-Analysis. 2nd ed. New York: Russell Sage; 2009: 103–125.Google Scholar
  19. 19.
    Shadish W, Haddock C. Combining estimates of effect size. In: Cooper H, Hedges L, Valentine J, eds. The Handbook of Research Synthesis and Meta-Analysis. 2nd ed. New York: Russell Sage; 2009: 257–277.Google Scholar
  20. 20.
    Borenstein M, Hedges L, Higgins JP, Rothstein HR. Introduction to Meta-Analysis. UK: Wiley; 2009.CrossRefGoogle Scholar
  21. 21.
    Raudenbush SW. Analyzing effect sizes: Random-effect models. In: Cooper H, Hedges L, Valentine J, eds. The Handbook of Research Synthesis and Meta-Analysis. 2nd ed. New York: Russell Sage; 2009: 295–316.Google Scholar
  22. 22.
    Wood W, Eagly A. Advantages of certainty and uncertainty. In: Cooper H, Hedges L, Valentine J, eds. The Handbook of Research Synthesis and Meta-Analysis. 2nd ed. New York: Russell Sage; 2009: 455–472.Google Scholar
  23. 23.
    Conn VS, Hafdahl AR, Brown SA, et al. Meta-analysis of patient education interventions to increase physical activity among chronically ill adults. Patient Educ Couns. 2008; 70: 157–172.CrossRefPubMedGoogle Scholar
  24. 24.
    Sutton AJ. Publication bias. In: Cooper H, Hedges L, Valentine J, eds. The Handbook of Research Synthesis and Meta-Analysis. 2nd ed. New York: Russell Sage; 2009: 435–452.Google Scholar
  25. 25.
    Borenstein M. Effect sizes of continuous data. In: Cooper H, Hedges L, Valentine J, eds. The Handbook of Research Synthesis and Meta-Analysis. 2nd ed. New York: Russell Sage; 2009: 221–235.Google Scholar
  26. 26.
    *Andersen RE, Wadden TA, Bartlett SJ, et al. Effects of lifestyle activity vs. structured aerobic exercise in obese women: A randomized trial. JAMA. 1999; 281: 335–340.Google Scholar
  27. 27.
    *Annesi JJ, Westcott WL. Age as a moderator of relations of physical self-concept and mood changes associated with 10 weeks of programmed exercise in women. Percept Mot Skills. 2005; 101: 840–844.Google Scholar
  28. 28.
    *Annesi JJ, Westcott WW, Gann S. Preliminary evaluation of a 10-wk. resistance and cardiovascular exercise protocol on physiological and psychological measures for a sample of older women. Percept Mot Skills. 2004; 98: 163–170.Google Scholar
  29. 29.
    *Annesi JJ. Sex differences in relations of cardiorespiratory and mood changes associated with self-selected amounts of cardiovascular exercise. Psychol Rep. 2003; 93: 1339–1346.Google Scholar
  30. 30.
    *Anshel MH. Effect of chronic aerobic exercise and progressive relaxation on motor performance and affect following acute stress. Behav Med. 1996; 21: 186–196.Google Scholar
  31. 31.
    *Atlantis E, Chow CM, Kirby A, Singh MF. An effective exercise-based intervention for improving mental health and quality of life measures: A randomized controlled trial. Prev Med. 2004; 39: 424–434.Google Scholar
  32. 32.
    *Bacon L, Keim NL, Van Loan MD, et al. Evaluating a 'non-diet' wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors. Int J Obes Relat Metab Disord. 2002; 26: 854–865.Google Scholar
  33. 33.
    *Blair SN, Smith M, Collingwood TR, et al. Health promotion for educators: Impact on absenteeism. Prev Med. 1986; 15: 166–175.Google Scholar
  34. 34.
    *Blumenthal JA, Emery CF, Madden DJ, et al. Long-term effects of exercise on psychological functioning in older men and women. J Gerontol. 1991; 46: P352–P361.Google Scholar
  35. 35.
    *Boileau RA, McAuley E, Demetriou D, et al. Aerobic exercise training and cardiorespiratory fitness in older adults: A randomized trial. J Aging Phys Act. 1999; 7: 374–385.Google Scholar
  36. 36.
    *Brown D, Wang Y, Ward A, et al. Chronic psychological effects of exercise and exercise plus cognitive strategies. Med Sci Sports Exerc. 1995; 27: 765–775.Google Scholar
  37. 37.
    *Brown RS, Ramirez DE, Taub JM. The prescription of exercise for depression. Phys Sportsmed. 1978; 6: 34–49.Google Scholar
  38. 38.
    *Byrom JM. The Effects of a Cardiovascular Fitness Program on Depression, Anxiety, Self-Concept, and Perceived Physical Fitness in College Women [dissertation]. California School of Professional Psychology; 1983.Google Scholar
  39. 39.
    *Casal DC. Effects of 2000 Kilocalories Per Week of Treadmill Walking and Stairclimbing on Physical Fitness and Coronary Risk Factors of Obese Young Men [dissertation]. University of Minnesota; 1984.Google Scholar
  40. 40.
    *Cormier A, Prefontaine M, MacDonald H, Stuart RB. Lifestyle change on the campus: pilot test of a program to improve student health practices. In: Davidson PO, Davidson SM, eds. Behavioral Medicine: Changing Health Lifestyles. New York: Brunner/Mazel; 1980: 222–255.Google Scholar
  41. 41.
    *Craft L, Freund KM, Culpepper L, Perna FM. Intervention study of exercise for depressive symptoms in women. J Womens Health. 2007; 16: 1499–1509.Google Scholar
  42. 42.
    *Cramer SR, Nieman DC, Lee JW. The effects of moderate exercise training on psychological well-being and mood state in women. J Psychosom Res. 1991; 35: 437–449.Google Scholar
  43. 43.
    *Dennis KD, Pane, KW, Adams BK, Qi BB. The impact of a shipboard weight control program. Obes Res. 1999; 7: 60–67.Google Scholar
  44. 44.
    *DiLorenzo TM, Bargman EP, Stucky-Ropp R, et al. Long-term effects of aerobic exercise on psychological outcomes. Prev Med. 1999; 28: 75–85.Google Scholar
  45. 45.
    *Dunai A, Novak M, Chung SA, et al. Moderate exercise and bright light treatment in overweight and obese individuals. Obes Res. 2007; 15: 1749–1757.Google Scholar
  46. 46.
    *Eby JM. An investigation into the effects of aerobic exercise on anxiety and depression [dissertation]. University of Toronto; 1984.Google Scholar
  47. 47.
    *Elavsky S, McAuley E. Physical activity and mental health outcomes during menopause: A randomized controlled trial. Ann Behav Med. 2007; 33: 132–142.Google Scholar
  48. 48.
    *Elliot DL, Goldberg L, Duncan TE, et al. The PHLAME firefighters' study: Feasibility and findings. Am J Health Behav. 2004; 28: 13–23.Google Scholar
  49. 49.
    *Emery CF, Blumenthal JA. Effects of exercise training on psychological functioning in healthy type A men. Psychol Health. 1988; 2: 367–379.Google Scholar
  50. 50.
    *Emery CF, Gatz M. Psychological and cognitive effects of an exercise program for community-residing older adults. Gerontologist. 1990; 30: 184–188.Google Scholar
  51. 51.
    *Engels HJ, Drouin J, Zhu W, Kazmierski JF. Effects of low-impact, moderate-intensity exercise training with and without wrist weights on functional capacities and mood states in older adults. Gerontology. 1998; 44: 239–244.Google Scholar
  52. 52.
    *Galletly C, Clark A, Tomlinson L, Blaney F. A group program for obese, infertile women: Weight loss and improved psychological health. J Psychosom Obstet Gynaecol. 1996; 17: 125–128.Google Scholar
  53. 53.
    *Glisky ML: Interventions for Cognitive and Psychosocial Functioning in Older Adults: a Comparison of Aerobic Exercise and Cognitive Training [dissertation]. University of Arizona; 1997.Google Scholar
  54. 54.
    *Guest RS, Klose KJ, Needham-Shropshire BM, Jacobs PL. Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: Effect on physical self-concept and depression. Arch Phys Med Rehabil. 1997; 78: 804–807.Google Scholar
  55. 55.
    *Gusi N, Reyes MC, Gonzalez-Guerrero JL, Herrera E, Garcia JM. Cost-utility of a walking programme for moderately depressed, obese, or overweight elderly women in primary care: a randomised controlled trial. BMC Public Health [serial online]. 2008; 8: 231. Available from http://www.biomedcentral.com/1471-2458/8/231. Accessed December 9, 2009.
  56. 56.
    *Harralson TL, Emig JC, Polansky M, et al. Un Corazon Saludable: Factors influencing outcomes of an exercise program designed to impact cardiac and metabolic risks among urban Latinas. J Community Health. 2007; 32: 401–412.Google Scholar
  57. 57.
    *Hassmen P, Koivula N. Mood, physical working capacity and cognitive performance in the elderly as related to physical activity. Aging Clin Exp Res. 1997; 9: 136–142.Google Scholar
  58. 58.
    *Hayward LM, Sullivan AC, Libonati JR. Group exercise reduces depression in obese women without weight loss. Percept Mot Skills. 2000; 90: 204–208.Google Scholar
  59. 59.
    *Hicks AL, Martin KA, Ditor DS, et al. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being. Spinal Cord. 2003; 41: 34–43.Google Scholar
  60. 60.
    *Holder JD. The Effects of Low Level Aerobic Activity Upon Systolic Blood Pressure Heart Rate and Depression Levels among the Elderly [dissertation]. Boston University School of Education; 1982.Google Scholar
  61. 61.
    *Hunter M, O'Dea I. An evaluation of a health education intervention for mid-aged women: five year follow-up effects upon knowledge, impact of menopause and health. Patient Educ Couns. 1999; 38: 249–255.Google Scholar
  62. 62.
    *King AC, Baumann K, O'Sullivan P, Wilcox S, Castro C. Effects of moderate-intensity exercise on physiological, behavioral, and emotional responses to family caregiving: A randomized controlled trial. J Gerontol. 2002; 57: M26-M36.Google Scholar
  63. 63.
    *King AC, Brassington G. Enhancing physical and psychological functioning in older family caregivers: The role of regular physical activity. Ann Behav Med. 1997; 19: 91–100.Google Scholar
  64. 64.
    *King AC, Taylor CB, Haskell WL. Effects of differing intensities and formats of 12 months of exercise training on psychological outcomes in older adults. Health Psychol. 1993; 12: 292–300.Google Scholar
  65. 65.
    *Klein MH, Greist JH, Gurman AS, et al. A comparative outcome study of group psychotherapy vs. exercise treatments for depression. Int J Ment Health. 1985; 13: 148–177.Google Scholar
  66. 66.
    *Knittle VR. Effect of Twelve Weeks of Exercise on Depression, Self-Esteem, and Locus-of-Control in a Wellness Program Sample of Women Aged 65 and Older [thesis]. The University of Arizona; 1988.Google Scholar
  67. 67.
    *Kohut ML, McCann DA, Russell DW, et al. Aerobic exercise, but not flexibility/resistance exercise, reduces serum IL-18, CRP, and IL-6 independent of beta-blockers, BMI, and psychosocial factors. Brain Behav Immun. 2006; 20: 201–209.Google Scholar
  68. 68.
    *Lane A, Mills M, Terry P. Mood regulation among corporate workers: Effects of exercise on mood. J Sports Sci. 1998; 16: 87.Google Scholar
  69. 69.
    *Lennox SS. The Effect of Aerobic Exercise on Self-Reported Mood [dissertation]. State University of New York at Stony Brook; 1987.Google Scholar
  70. 70.
    *McDonald DG, Norton JP, Hodgdon JA. Training success in U.S. Navy special forces. Aviat Space Environ Med. 1990; 61: 548–554.Google Scholar
  71. 71.
    *McSherry WC, II. Effects of Aerobic Fitness Training on Migraine Headache [dissertation]. University of North Dakota; 1993.Google Scholar
  72. 72.
    *Melanson KJ, Dell'Olio J, Carpenter MR, Angelopoulos TJ. Changes in multiple health outcomes at 12 and 24 weeks resulting from 12 weeks of exercise counseling with or without dietary counseling in obese adults. Nutrition. 2004; 20: 849–856.Google Scholar
  73. 73.
    *Mellin L, Croughan-Minihane M, Dickey L. The Solution Method: 2-year trends in weight, blood pressure, exercise, depression, and functioning of adults trained in development skills. J Am Diet Assoc. 1997; 97: 1133–1138.Google Scholar
  74. 74.
    *Morgan WP, Costill DL, Flynn MG, Raglin JS, O'Connor PJ. Mood disturbance following increased training in swimmers. Med Sci Sports Exerc. 1988; 20: 408–414.Google Scholar
  75. 75.
    *Morgan WP, Roberts JA, Brand FR, Feinerman AD. Psychological effect of chronic physical activity. Med Sci Sports Exerc. 1970; 2: 213–217.Google Scholar
  76. 76.
    *Nagy S, Frazier S. The impact of exercise on locus of control, self-esteem, and mood states. J Soc Behav Pers. 1988; 3: 263–268.Google Scholar
  77. 77.
    *Nieman D, Warren B, Dotson R, Butterworth D, Henson D. Physical activity, psychological well-being, and mood state in elderly. J Aging Phys Act. 1993; 1: 22–33.Google Scholar
  78. 78.
    *Palmer LK. Effects of a walking program on attributional style, depression, and self-esteem. Percept Mot Skills. 1995; 81: 891–898.Google Scholar
  79. 79.
    *Pensabene T. Impact of a Walking Intervention on Perimenopausal Symptoms (Menopause) [dissertation]. Texas Women’s University; 1997.Google Scholar
  80. 80.
    *Perri S, II, Templer DI. The effects of an aerobic exercise program on psychological variables in older adults. Int J Aging Hum Dev. 1985; 20: 167–172.Google Scholar
  81. 81.
    *Rapoport L, Clark M, Wardle J. Evaluation of a modified cognitive-behavioural programme for weight management. Int J Obes Relat Metab Disord. 2000; 24: 1726–1737.Google Scholar
  82. 82.
    *Rhodes DL. Mens Sana, Corpore Sano: A Study of the Effect of Jogging on Depression, Anxiety and Self Concept [dissertation]. Duke University; 1980.Google Scholar
  83. 83.
    *Roth DL, Holmes DS. Influence of aerobic exercise training and relaxation training on physical and psychologic health following stressful life events. Psychosom Med. 1987; 49: 355–365.Google Scholar
  84. 84.
    *Simons CW, Birkimer JC. An exploration of factors predicting the effects of aerobic conditioning on mood state. J Psychosom Res. 1988; 32: 63–75.Google Scholar
  85. 85.
    *Sinatra S, Allen G, Camaione D, Abraham A. Effects of continuous passive motion, walking, and a placebo intervention on physical and psychological well-being. J Cardiopulm Rehabil. 1990; 10: 279–286.Google Scholar
  86. 86.
    *Sorensen M, Anderssen S, Hjerman I, Holme I, Ursin H. The effect of exercise and diet on mental health and quality of life in middle-aged individuals with elevated risk factors for cardiovascular disease. J Sports Sci. 1999; 17: 369–377.Google Scholar
  87. 87.
    *Stevenson DB. A Comparison of Group and Individual Physical Training Programs and Their Effect on Mood [dissertation]. The American University; 1990.Google Scholar
  88. 88.
    *Swoap RA, Norvell N, Graves JE, Pollock ML. High versus moderate intensity aerobic exercise in elderly: Psychological and physiological effects. J Aging Phys Act. 1994; 2: 293–303.Google Scholar
  89. 89.
    *Teixeira PJ. Weight Reduction in Middle-Aged Women: Readiness Profiles and Correlates of Success in a Lifestyle Intervention [dissertation]. The University of Arizona; 2001.Google Scholar
  90. 90.
    *Wadden TA, Stunkard AJ: Controlled trial of very low calorie diet, behavior therapy, and their combination in the treatment of obesity. J Consult Clin Psychol. 1996; 54: 482–488.Google Scholar
  91. 91.
    *Wallace JI, Buchner DM, Grothaus L, et al. Implementation and effectiveness of a community-based health promotion program for older adults. J Gerontol. 1998; 53A: M301-M306.Google Scholar
  92. 92.
    *Weaver DC. A Study to Determine the Effect of Exercise on Depression in Middle-Aged Women [dissertation]. Middle Tennessee State University; 1984.Google Scholar
  93. 93.
    *Wilson LFM. The Effects of an Exercise Conditioning Program on Reducing the Stress Response in Nurses [dissertation]. Wayne State University; 1985.Google Scholar
  94. 94.
    *Young RJ. The effect of regular exercise on cognitive functioning and personality. Br J Sports Med. 1979; 13: 110–117.Google Scholar
  95. 95.
    *Zigun SM. Multimodal Approach to Treatment of Obesity [dissertation]. The Union Institute; 1989.Google Scholar
  96. 96.
    Paluska SA, Schwenk TL. Physical activity and mental health: Current concepts. Sports Med. 2000; 29: 167–180.CrossRefPubMedGoogle Scholar
  97. 97.
    Teychenne M, Ball K, Salmon J. Physical activity and likelihood of depression in adults: A review. Prev Med. 2008; 46: 397–411.CrossRefPubMedGoogle Scholar
  98. 98.
    Ernst C, Olson AK, Pinel JP, Lam RW, Christie BR. Antidepressant effects of exercise: Evidence for an adult-neurogenesis hypothesis? J Psychiatry Neurosci. 2006; 31: 84–92.PubMedGoogle Scholar
  99. 99.
    Conn VS, Valentine JC, Cooper HM. Interventions to increase physical activity among aging adults: A meta-analysis. Ann Behav Med. 2002; 24: 190–200.CrossRefPubMedGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2010

Authors and Affiliations

  1. 1.University of MissouriColumbiaUSA

Personalised recommendations