Psychiatric Center Bispebjerg, Bispebjerg University Hospital, DK-2400, Denmark.
J Clin Psychiatry. 2011 Apr;72(4):529-38. doi: 10.4088/JCP.08r04913blu. Epub 2010 Oct 19.
To assess the effectiveness of exercise in adults with clinical depression.
The databases CINAHL, Embase, Cochrane Database of Systematic reviews, Cochrane Controlled Trials Register, MEDLINE, and PsycINFO were searched (1806-2008) using medical subject headings (MeSH) and text word terms depression, depressive disorder and exercise, aerobic, non-aerobic, physical activity, physical fitness, walk*, jog*, run*, bicycling, swim*, strength, and resistance.
Randomized trials including adults with clinical depression according to any diagnostic system were included.
Two investigators evaluated trials using a prepiloted structured form.
Thirteen trials were identified that fulfilled the inclusion criteria. Eight had adequate allocation concealment, 6 had a blinded outcome, and 5 used intention-to-treat analyses. The pooled standardized mean difference (SMD) calculated using a random-effects model was -0.40 (95% CI, -0.66 to -0.14), with evidence of heterogeneity between trials (I(2) = 57.2%, P = .005). There was an inverse association between duration of intervention and the magnitude of the association of exercise with depression (P = .002). No other characteristics were related to between-study heterogeneity. Pooled analysis of 5 trials with long-term follow-up (ie, that examined outcomes beyond the end of the intervention) suggested no long-term benefit (SMD, -0.01; 95% CI, -0.28 to 0.26), with no strong evidence of heterogeneity in this pooled analysis (I(2) = 23.4%, P = .27). There was no strong statistical evidence for small study bias (P > .27). Only 3 studies were assessed as high quality (adequately concealed random allocation, blinded outcome assessment, and intention-to-treat analysis). When we pooled results from these, the estimated beneficial effect of exercise was more modest (SMD, -0.19; 95% CI, -0.70 to 0.31) than the pooled result for all 13 studies, with no strong evidence of benefit.
Our results suggest a short-term effect of exercise on depression: on average, depression scores 0.4 of a standard deviation lower in clinically depressed patients randomly assigned to an exercise intervention at the end of that intervention compared to those randomly assigned to a none exercise group. There is little evidence of a long-term beneficial effect of exercise in patients with clinical depression.
评估运动对有临床抑郁的成年人的效果。
检索了 CINAHL、Embase、Cochrane 系统评价数据库、Cochrane 对照试验登记处、MEDLINE 和 PsycINFO 数据库（1806-2008），使用医学主题词(MeSH)和文本词抑郁、抑郁障碍和运动、有氧、非有氧、体力活动、身体适应性、散步*、慢跑*、跑步*、骑自行车、游泳*、力量和阻力。
纳入了符合任何诊断系统的有临床抑郁的成年人的随机试验。
两名研究者使用预制定的结构化表格评估试验。
确定了 13 项符合纳入标准的试验。其中 8 项有充分的分配隐藏，6 项有盲法结局，5 项采用意向治疗分析。使用随机效应模型计算的合并标准化均数差值(SMD)为-0.40（95%CI，-0.66 至-0.14），试验间存在异质性（I²=57.2%，P=0.005）。干预持续时间与运动与抑郁的关联强度之间存在反比关系（P=0.002）。其他特征与研究间的异质性无关。对 5 项有长期随访（即，检查干预结束后结局）的试验进行的合并分析提示无长期获益（SMD，-0.01；95%CI，-0.28 至 0.26），此合并分析中无明显的异质性（I²=23.4%，P=0.27）。小样本研究偏倚的统计学证据不强（P＞0.27）。只有 3 项研究被评为高质量（充分的随机分配隐藏、盲法结局评估和意向治疗分析）。当我们合并这些研究的结果时，运动的有益效果估计较为温和（SMD，-0.19；95%CI，-0.70 至 0.31），低于所有 13 项研究的合并结果，且无明显获益证据。
我们的结果提示运动对抑郁有短期效果：与随机分配到运动干预组的患者相比，随机分配到非运动组的有临床抑郁的患者在干预结束时抑郁评分平均低 0.4 个标准差。在有临床抑郁的患者中，运动的长期有益效果证据很少。
