Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.
Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway.
Child Adolesc Ment Health. 2021 Nov;26(4):347-356. doi: 10.1111/camh.12438. Epub 2020 Dec 5.
The objective of this systematic review was to examine the treatment effects of exercise on children and adolescents with depression compared to either other nonexercise treatments or no treatment. A study protocol was registered in PROSPERO (CRD42018101982).
Cochrane Central Register of Controlled Trials (CENTRAL), Medline (Ovid), Embase (Ovid), PsycINFO (Ovid), AMED (Ovid), SPORTDiscus, PEDro, CINAHL (EBSCO), ERIC (EBSCO), Web of Science, and databases for grey literature and dissertations were searched from their inception through 30 August 2020 for randomized controlled trials. Varieties of search terms for depression, children and adolescents, exercise, and study design were applied. No limits were placed on publication year, language or publication type. Registers for ongoing trials were also searched. Two authors independently screened references, extracted data and assessed risk of bias in the included trials. The effect sizes for depression postintervention were pooled in a meta-analysis, and the certainty of the evidence was assessed using GRADE (Grading of Recommendations Assessments, Development, and Evaluation).
13,307 references were screened. Four trials were included (n = 159). Participants were between 12 and 18 years old, and predominantly female. A meta-analysis with a random-effects model was performed, and a moderate effect in favour of exercise on postintervention depression severity was identified (SMD = -0.59, 95% CI = -1.08 to -0.10, p = .02). However, the overall certainty of the evidence for this outcome was low. One trial found a nonsignificant decrease in depression severity at six-month follow-up (n = 42, SMD = -0.59, 95% CI = -1.22 to 0.04, p = 0.07), and the overall certainty of the evidence for this outcome was very low. One trial found no statistically significant differences between the exercise and control groups on quality of life. Other outcomes, including adverse events, psychological well-being and social functioning, were not evaluated.
Low certainty evidence suggests that exercise interventions may be associated with a decrease in adolescent depression severity. However, our confidence in the effect estimate is limited, and the true effect may be substantially different. Thus, large, high-quality trials including follow-up periods are needed.
本系统评价的目的是研究运动对患有抑郁症的儿童和青少年的治疗效果，与其他非运动治疗或不治疗相比。本研究方案已在 PROSPERO（CRD42018101982）中注册。
Cochrane 对照试验中心注册库（CENTRAL）、医学文献在线数据库（Ovid）、Embase（Ovid）、心理文献数据库在线（Ovid）、AMED（Ovid）、SportDiscus、PEDro、CINAHL（EBSCO）、ERIC（EBSCO）、Web of Science 以及灰色文献和学位论文数据库自成立以来，对 2020 年 8 月 30 日的随机对照试验进行了搜索。使用了各种用于抑郁症、儿童和青少年、运动和研究设计的搜索词。未对出版年份、语言或出版类型设置限制。还对正在进行的试验注册进行了搜索。两位作者独立筛选参考文献、提取数据并评估纳入试验的偏倚风险。对干预后抑郁的效应大小进行了荟萃分析，并使用 GRADE（推荐评估、制定与评价）评估证据的确定性。
共筛选出 13307 条参考文献。纳入了 4 项试验（n=159）。参与者年龄在 12 至 18 岁之间，主要为女性。进行了随机效应模型的荟萃分析，结果表明运动对干预后抑郁严重程度有中度影响（SMD=-0.59，95%CI=-1.08 至-0.10，p=0.02）。然而，该结局的证据总体确定性水平较低。一项试验发现，在 6 个月随访时，抑郁严重程度有下降趋势，但无统计学意义（n=42，SMD=-0.59，95%CI=-1.22 至 0.04，p=0.07），且该结局的证据总体确定性水平极低。一项试验发现，运动组与对照组在生活质量方面无统计学差异。其他结局，包括不良事件、心理健康和社会功能，未进行评估。
低确定性证据表明，运动干预可能与青少年抑郁严重程度的降低有关。然而，我们对效应估计的信心有限，实际效应可能有很大差异。因此，需要开展包括随访期的大型高质量试验。
