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Effect of exercise as adjuvant to energy-restricted diets on quality of life and depression outcomes: a meta-analysis of randomized controlled trials

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Abstract

Background and aim

Obesity and related co-morbidities lead to a decrease in health-related quality of life (HRQOL) and mood. Lifestyle strategies may improve these outcomes. However, the efficacy of exercise in conjunction with a weight-loss diet on HRQOL and mood is unclear. The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to examine whether the addition of exercise to energy-restricted dietary programs improves HRQOL and mood status when compared with energy-restricted diets alone in overweight and obese adults.

Methods

Eligible RCTs were identified by searching PubMed/MEDLINE, EMBASE, ISI (Web of sciences), Scopus, and Google Scholar up to April 2021. Summary effects were derived using a random-effects model. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.

Results

The meta-analysis revealed that an energy-restricted diet plus exercise compared with an energy-restricted diet alone had no significant effects on depression (n = 6, hedges’g = − 0.04, 95% CI: − 0.28,0.20), MOS 36-Item Short-Form Health Survey (SF-36)-physical component summary scores (n = 8, weighted mean difference (WMD) = 1.51, 95% CI: − 0.16, 3.18), SF36-mental component summary scores (n = 7, WMD = 0.64, 95% CI: − 1.00, 2.28), and HRQOL disease-specific questionnaire scores (n = 5, hedges’g = 0.16, 95% CI: − 0.09, 0.40). The GRADE revealed that the quality of evidence was low for disease-specific HRQOL scores, and depression status; and high for physical and mental health assessed by SF-36.

Conclusion

In our sample of overweight and obese adults, no beneficial effect of adding exercise to an energy-restricted diet was found in terms of HRQOL and Depression.

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Data availability

The studies included in the review will be available upon request.

Code availability

Not applicable.

Abbreviations

HRQOL:

Health-related quality of life

RCTs:

Randomized control trials

GRADE:

Grading of Recommendations Assessment, Development, and Evaluation

SF-36:

MOS 36-Item Short-Form Health Survey

WMD:

Weighted mean difference

NWCR:

National Weight Control Registry

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

PROSPERO:

International prospective register of systematic reviews

MeSH:

Medical Subject Headings

SDs:

Standard deviations

IVhet:

Inverse variance heterogeneity

SF36-MCS:

SF36-Mental component summary

SF36-PCS:

SF36-physical component summary

I2 :

I-squared

POMS:

Profile of Mood States

HADS:

Hospital Anxiety and Depression Scale

GDS:

Geriatric Depression Scale

T2DM:

Type 2 Diabetes Mellitus

PCOS:

Polycystic ovarian syndrome

BDI:

Beck Depression Inventory

BSI-18:

Brief Symptom Inventory-18

CES-D:

Center for Epidemiologic Studies Depression Scale

KCCQ:

Kansas City Cardiomyopathy Questionnaire

IWQOL:

Impact of Weight on Quality of Life–Lite

AQLQ:

Juniper Asthma Quality of Life Questionnaire

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Acknowledgements

We would like to thank the research council of Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences for their close cooperation and funding for the present study.

Funding

The current systematic review and meta-analysis was supported by the Research Council of the Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Author information

Authors and Affiliations

  1. Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, PO Code, Yazd, 8915173160, Iran

    Seyede Hamide Rajaie, Zeinab Yazdanpanah, Tayebeh Zohrabi, Sara Beigrezaei, Sahar Mohseni-Takalloo & Amin Salehi-Abargouei

  2. Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

    Seyede Hamide Rajaie, Zeinab Yazdanpanah, Tayebeh Zohrabi, Sara Beigrezaei & Amin Salehi-Abargouei

  3. Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

    Sepideh Soltani

  4. Noncommunicable Diseases Research Center, Bam University of Medical Sciences, Bam, Iran

    Sahar Mohseni-Takalloo

  5. School of Nutrition and Dietetics, Faculty of Pure & Applied Science, Acadia University, Wolfville, NS, Canada

    Mojtaba Kaviani

  6. Department of Physical Education Studies, Faculty of Education, Brandon University, Brandon, MB, Canada

    Scott C. Forbes

  7. Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong

    Julien S. Baker

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  1. Seyede Hamide Rajaie
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  10. Amin Salehi-Abargouei
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Contributions

The authors’ responsibilities were as follow: designing the study: ASA; managing the study: ASA and ZY; conducting the research: ZY; conducting the statistical analyses: SS; screening, data extraction, and assessment of the risk of bias within studies: ZY, SS, SHR, SB, SMT, and TZ; writing the manuscript: SHR, JSB, and S.S. All authors contributed to the study design and drafting of the manuscript.

Corresponding author

Correspondence to Amin Salehi-Abargouei.

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There is no conflict of interest to report.

Ethical approval

We will follow the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) for reporting the present systematic review and meta-analysis. The protocol is undergoing registration in the International Prospective Register of Systematic Reviews (PROSPERO) database.

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Rajaie, S.H., Soltani, S., Yazdanpanah, Z. et al. Effect of exercise as adjuvant to energy-restricted diets on quality of life and depression outcomes: a meta-analysis of randomized controlled trials. Qual Life Res 31, 3123–3137 (2022). https://doi.org/10.1007/s11136-022-03146-7

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