Orygen, The National Centre of Excellence in Youth Mental Health,Melbourne,Australia.
School of Psychiatry,Faculty of Medicine,UNSW,Sydney,Australia.
Psychol Med. 2018 May;48(7):1068-1083. doi: 10.1017/S0033291717002653. Epub 2017 Oct 10.
We aimed to establish the treatment effect of physical activity for depression in young people through meta-analysis. Four databases were searched to September 2016 for randomised controlled trials of physical activity interventions for adolescents and young adults, 12-25 years, experiencing a diagnosis or threshold symptoms of depression. Random-effects meta-analysis was used to estimate the standardised mean difference (SMD) between physical activity and control conditions. Subgroup analysis and meta-regression investigated potential treatment effect modifiers. Acceptability was estimated using dropout. Trials were assessed against risk of bias domains and overall quality of evidence was assessed using GRADE criteria. Seventeen trials were eligible and 16 provided data from 771 participants showing a large effect of physical activity on depression symptoms compared to controls (SMD = -0.82, 95% CI = -1.02 to -0.61, p < 0.05, I2 = 38%). The effect remained robust in trials with clinical samples (k = 5, SMD = -0.72, 95% CI = -1.15 to -0.30), and in trials using attention/activity placebo controls (k = 7, SMD = -0.82, 95% CI = -1.05 to -0.59). Dropout was 11% across physical activity arms and equivalent in controls (k = 12, RD = -0.01, 95% CI = -0.04 to 0.03, p = 0.70). However, the quality of RCT-level evidence contributing to the primary analysis was downgraded two levels to LOW (trial-level risk of bias, suspected publication bias), suggesting uncertainty in the size of effect and caution in its interpretation. While physical activity appears to be a promising and acceptable intervention for adolescents and young adults experiencing depression, robust clinical effectiveness trials that minimise risk of bias are required to increase confidence in the current finding. The specific intervention characteristics required to improve depression remain unclear, however best candidates given current evidence may include, but are not limited to, supervised, aerobic-based activity of moderate-to-vigorous intensity, engaged in multiple times per week over eight or more weeks. Further research is needed. (Registration: PROSPERO-CRD 42015024388).
我们旨在通过荟萃分析确定体育活动对年轻人抑郁的治疗效果。我们检索了四个数据库，以确定截至 2016 年 9 月的针对 12-25 岁青少年和年轻成年人的体育活动干预的随机对照试验，这些人患有或处于抑郁诊断或阈症状。使用随机效应荟萃分析来估计体育活动与对照条件之间的标准化均数差（SMD）。亚组分析和荟萃回归调查了潜在的治疗效果调节剂。使用辍学率来估计可接受性。根据偏倚域评估试验，并使用 GRADE 标准评估整体证据质量。有 17 项试验符合条件，其中 16 项试验提供了来自 771 名参与者的数据，表明与对照组相比，体育活动对抑郁症状的影响很大（SMD=-0.82，95%CI=-1.02 至-0.61，p<0.05，I2=38%）。该效果在具有临床样本的试验中仍然稳健（k=5，SMD=-0.72，95%CI=-1.15 至-0.30），并且在使用注意力/活动安慰剂对照的试验中也稳健（k=7，SMD=-0.82，95%CI=-1.05 至-0.59）。体育活动组的辍学率为 11%，与对照组相当（k=12，RD=-0.01，95%CI=-0.04 至 0.03，p=0.70）。然而，对主要分析有贡献的 RCT 级证据的质量被降级两级至低（试验水平的偏倚风险，可疑的发表偏倚），这表明对效应大小的不确定性和对其解释的谨慎性。虽然体育活动似乎是一种有前途和可接受的干预措施，适用于患有抑郁症的青少年和年轻成年人，但需要进行更具临床有效性的试验，以降低偏倚风险，从而提高对当前研究结果的信心。然而，目前尚不清楚改善抑郁所需的具体干预特征，但根据当前证据，最有希望的候选者可能包括但不限于监督的、中等至剧烈强度的有氧运动，每周进行多次，持续 8 周以上。需要进一步的研究。（注册：PROSPERO-CRD 42015024388）。
