Physical Activity Interventions and Depression in Children and Adolescents
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Evidence suggests chronic physical activity (PA) participation may be both protective against the onset of and beneficial for reducing depressive symptoms.
The aim of this article is to assess the impact of PA interventions on depression in children and adolescents using meta-analysis.
Published English language studies were located from manual and computerized searches of the following databases: PsycInfo, The Cochrane Database of Systematic Reviews and The Cochrane Central Register of Controlled Trials, Trials Register of Promoting Health Interventions (TRoPHI; EPPI Centre), Web of Science and MEDLINE.
Studies meeting inclusion criteria (1) reported on interventions to promote or increase PA; (2) included children aged 5–11 years and/or adolescents aged 12–19 years; (3) reported on results using a quantitative measure of depression; (4) included a non-physical control or comparison group; and (5) were published in peer-reviewed journals written in English, up to and including May 2011 (when the search was conducted).
Studies were coded for methodological, participant and study characteristics. Comprehensive Meta-Analysis version-2 software was used to compute effect sizes, with subgroup analyses to identify moderating characteristics. Study quality was assessed using the Delphi technique.
Nine studies were included (n = 581); most were school-based randomized controlled trials, randomized by individual. Studies used a variety of measurement tools to assess depressive symptoms. The summary treatment effect was small but significant (Hedges’ g = −0.26, standard error = 0.09, 95% confidence intervals = −0.43, −0.08, p = 0.004). Subgroup analyses showed that methodological (e.g. studies with both education and PA intervention; those with a higher quality score; and less than 3 months in duration) and participant characteristics (e.g. single-gender studies; those targeting overweight or obese groups) contributed most to the reduction in depression.
There was a small significant overall effect for PA on depression. More outcome-focused, high-quality trials are required to effectively inform the implementation of programmes to reduce depressive symptoms in children and adolescents.
KeywordsPhysical Activity Depressive Symptom Physical Activity Intervention Methodological Characteristic Great Treatment Effect
Funding sources: This work was supported by an Alf Howard International Travel Scholarship (School of Human Movement Studies, University of Queensland) that enabled international collaborative work to be undertaken. Helen Elizabeth Brown was partially supported by an Australian NHMRC Program Grant (# 301110). The authors have no conflicts of interest that are directly relevant to the content of this review.
- 1.W.H.O. Atlas: child and adolescent mental health resources: global concerns, implications for the future. 2005; ISBN 92 4 156304 4.Google Scholar
- 2.Satcher DS. Executive summary: a report of the Surgeon General on mental health. Public Health Rep. 2000;115(1):89–101. PubMed PMID: 10968589. Pubmed Central PMCID: 1308561. Epub 2000/09/01. eng.Google Scholar
- 4.Guberman C, Manassis K. Symptomatology and family functioning in children and adolescents with comorbid anxiety and depression. J Can Acad Child Adolesc Psychiatry. 2011;20(3):186–95. PubMed PMID: 21804847. Pubmed Central PMCID: 3143694. Epub 2011/08/02. eng.Google Scholar
- 5.Lundy SM, Silva GE, Kaemingk KL, Goodwin JL, Quan SF. Cognitive functioning and academic performance in elementary school children with anxious/depressed and withdrawn symptoms. Open Pediatr Med J. 2010;4:1–9. PubMed PMID: 20664711. Pubmed Central PMCID: 2909621. Epub 2010/07/29. Eng.Google Scholar
- 6.W.H.O. The World Health Report. ISBN 92 4 156201 3; 2001.Google Scholar
- 7.Larun L, Nordheim Lena V, Ekeland E, Hagen Kåre B, Heian F. Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane Database Syst Rev [Internet]. 2006; (3). Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004691/frame.html.
- 8.Biddle SJH, Fox KR, Boutcher, SH. Physical activity and psychological well-being. London: Routledge; 2000.Google Scholar
- 9.Martinsen EW. Physical activity in the prevention and treatment of anxiety and depression. Nord J Psychiatry. 2008;62 Suppl 47:25–9. PubMed PMID: 18752115. Epub 2008/09/09. eng.Google Scholar
- 10.Fox KR. The influence of physical activity on mental well-being. Public Health Nutr. 1999;2(3A):411–8. PubMed PMID: 10610081. Epub 1999/12/28. eng.Google Scholar
- 11.Landers DM. The influence of exercise on mental health. Research Digest (President’s Council on Physical Fitness and Sports (US). 1997; Series 2 (no. 12).Google Scholar
- 12.Dunn AL, Trivedi MH, Kampert JB, Clark CG, Chambliss HO. Exercise treatment for depression: efficacy and dose response. Am J Prev Med. 2005;28(1):1–8.Google Scholar
- 14.Strohle A. Physical activity, exercise, depression and anxiety disorders. J Neural Transm. 2009;116(6):777–84. PubMed PMID: ISI:000266926100017. English.Google Scholar
- 16.Calfas KJ. Effects of physical activity on psychological variables in adolescents. Pediatr Exerc Sci. 1994;6:406–23.Google Scholar
- 17.Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, et al. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol. 1998;51(12):1235–41. PubMed PMID: 10086815. Epub 1999/03/23. eng.Google Scholar
- 18.Borenstein M, Hedges L, Higgins J, Rothstein H. Comprehensive meta-analysis: a computer program for research synthesis. Englewood: Biostat; 2005.Google Scholar
- 20.Field AP. Meta-analysis of correlation coefficients: a Monte Carlo comparison of fixed- and random-effects methods. Psychol Methods. 2001;6(2):161–80. PubMed PMID: 11411440. Epub 2001/06/20. eng.Google Scholar
- 21.Hedges LV, Olkin, I. Statistical methods for meta-analysis. New York: Academic Press; 1985.Google Scholar
- 22.Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Erlbaum; 1988.Google Scholar
- 24.Brown SA, Upchurch SL, Acton GJ. A framework for developing a coding scheme for meta-analysis. Western J Nurs Res. 2003;25(2):205–22. PubMed PMID: 12666644. Epub 2003/04/02. eng.Google Scholar
- 28.Duval S, Tweedie R. A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis. J Am Stat Assoc. 2000;95(449):89–98. PubMed PMID: ISI:000087845100013. English.Google Scholar
- 29.Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–63. PubMed PMID: ISI:000087677500019. English.Google Scholar
- 30.Daley AJ, Copeland RJ, Wright NP, Roalfe A, Wales JKH. Exercise therapy as a treatment for psychopathologic conditions in obese and morbidly obese adolescents: A randomized, controlled trial. Pediatrics. 2006;118(5):2126–34. PubMed PMID: ISI:000241731700039. English.Google Scholar
- 31.Hilyer JC, Wilson DG, Dillon C, Caro L, Jenkins C, Spencer WA, et al. Physical-fitness training and counseling as treatment for youthful offenders. J Couns Psychol. 1982;29(3):292–303. PubMed PMID: ISI:A1982NP30500010. English.Google Scholar
- 32.Petty KH, Davis CL, Tkacz J, Young-Hyman D, Waller JL. Exercise effects on depressive symptoms and self-worth in overweight children: a randomized controlled trial. J Pediatr Psychol. 2009;34(9):929–39. PubMed PMID: 19223278. Pubmed Central PMCID: 2744328. Epub 2009/02/19. eng.Google Scholar
- 33.Melnyk BM, Jacobson D, Kelly S, O’Haver J, Small L, Mays MZ. Improving the mental health, healthy lifestyle choices, and physical health of hispanic adolescents: a randomized controlled pilot study. J School Health. 2009;79(12):575–84. PubMed PMID: ISI:000271711400002. English.Google Scholar
- 34.Mendelson T, Greenberg MT, Dariotis JK, Gould LF, Rhoades BL, Leaf PJ. Feasibility and preliminary outcomes of a school-based mindfulness intervention for urban youth. J Abnorm Child Psych. 2010;38(7):985–94. PubMed PMID: ISI:000282268900009. English.Google Scholar
- 36.Bonhauser M, Fernandez G, Puschel K, Yanez F, Montero J, Thompson B, et al. Improving physical fitness and emotional well-being in adolescents of low socioeconomic status in Chile: results of a school-based controlled trial. Health Promot Int. 2005;20(2):113–22. PubMed PMID: 15788528. Epub 2005/03/25. eng.Google Scholar
- 37.MacMahon JR, Gross RT. Physical and psychological effects of aerobic exercise in delinquent adolescent males. Am J Dis Child. 1988;142(12):1361–6. PubMed PMID: 3195535. Epub 1988/12/01. eng.Google Scholar
- 38.Annesi JJ. Correlations of depression and total mood disturbance with physical activity and self-concept in preadolescents enrolled in an after-school exercise program. Psychol Rep. 2005;96(3 Pt 2):891–8. PubMed PMID: 16173355. Epub 2005/09/22. eng.Google Scholar
- 41.Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B, et al. Evidence based physical activity for school-age youth. J Pediatr. 2005;146(6):732–7. PubMed PMID: 15973308. Epub 2005/06/24. eng.Google Scholar
- 42.Washington RL. Does increasing physical activity really make a difference? Show me the evidence. Pediatrics. 2005;146(6):A2.Google Scholar
- 43.Fox KR. The effects of exercise on self-perceptions and self-esteem. In: Biddle SJH, editor. Physical activity and psychological well-being. London: Routledge; 2000. p. 88–117.Google Scholar