Krogh Jesper, Hjorthøj Carsten, Speyer Helene, Gluud Christian, Nordentoft Merete
Faculty of Health Sciences, Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark.
Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
BMJ Open. 2017 Sep 18;7(9):e014820. doi: 10.1136/bmjopen-2016-014820.
To assess the benefits and harms of exercise in patients with depression.
Systematic review DATA SOURCES: Bibliographical databases were searched until 20 June 2017.
Eligible trials were randomised clinical trials assessing the effect of exercise in participants diagnosed with depression. Primary outcomes were depression severity, lack of remission and serious adverse events (eg, suicide) assessed at the end of the intervention. Secondary outcomes were quality of life and adverse events such as injuries, as well as assessment of depression severity and lack of remission during follow-up after the intervention.
Thirty-five trials enrolling 2498 participants were included. The effect of exercise versus control on depression severity was -0.66 standardised mean difference (SMD) (95% CI -0.86 to -0.46; p<0.001; grading of recommendations assessment, development and evaluation (GRADE): very low quality). Restricting this analysis to the four trials that seemed less affected of bias, the effect vanished into -0.11 SMD (-0.41 to 0.18; p=0.45; GRADE: low quality). Exercise decreased the relative risk of no remission to 0.78 (0.68 to 0.90; p<0.001; GRADE: very low quality). Restricting this analysis to the two trials that seemed less affected of bias, the effect vanished into 0.95 (0.74 to 1.23; p=0.78). Trial sequential analysis excluded random error when all trials were analysed, but not if focusing on trials less affected of bias. Subgroup analyses found that trial size and intervention duration were inversely associated with effect size for both depression severity and lack of remission. There was no significant effect of exercise on secondary outcomes.
Trials with less risk of bias suggested no antidepressant effects of exercise and there were no significant effects of exercise on quality of life, depression severity or lack of remission during follow-up. Data for serious adverse events and adverse events were scarce not allowing conclusions for these outcomes.
The protocol was published in the journal : 2015; 4:40.
评估运动对抑郁症患者的益处和危害。
系统评价
检索书目数据库直至2017年6月20日。
符合条件的试验为随机临床试验，评估运动对被诊断为抑郁症的参与者的影响。主要结局为干预结束时评估的抑郁严重程度、未缓解情况和严重不良事件（如自杀）。次要结局为生活质量和不良事件，如受伤情况，以及干预后随访期间抑郁严重程度和未缓解情况的评估。
纳入了35项试验，共2498名参与者。运动组与对照组相比，对抑郁严重程度的影响为标准化均数差（SMD）-0.66（95%CI -0.86至-0.46；p<0.001；推荐分级评估、制定与评价（GRADE）：极低质量）。将该分析限制在四项似乎受偏倚影响较小的试验中，效应消失为SMD -0.11（-0.41至0.18；p = 0.45；GRADE：低质量）。运动降低了未缓解的相对风险至0.78（0.68至0.90；p<0.001；GRADE：极低质量）。将该分析限制在两项似乎受偏倚影响较小的试验中，效应消失为0.95（0.74至1.23；p = 0.78）。序贯试验分析在分析所有试验时排除了随机误差，但如果关注受偏倚影响较小的试验则未排除。亚组分析发现，试验规模和干预持续时间与抑郁严重程度和未缓解情况的效应大小呈负相关。运动对次要结局无显著影响。
偏倚风险较小的试验表明运动无抗抑郁作用，且运动对生活质量、抑郁严重程度或随访期间未缓解情况无显著影响。严重不良事件和不良事件的数据稀少，无法就这些结局得出结论。
该方案发表于《》杂志：2015；4：40。
