'El Palo' Health Centre, Health District of Primary Care Málaga-Guadalhorce, Andalusian Health Service (SAS); Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III (ISCIII); Biomedical Research Institute of Malaga (IBIMA); and Faculty of Medicine, Department of Public Health and Psychiatry, University of Málaga (UMA), Spain.
Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III (ISCIII); and Biomedical Research Institute of Malaga (IBIMA), Spain.
Br J Psychiatry. 2021 Nov;219(5):578-587. doi: 10.1192/bjp.2021.5.
In most trials and systematic reviews that evaluate exercise-based interventions in reducing depressive symptoms, it is difficult to separate treatment from prevention.
To evaluate the effectiveness of exercise-based interventions in reducing depressive symptoms in people without clinical depression.
We searched PubMed, PsycINFO, Embase, WOS, SPORTDiscus, CENTRAL, OpenGrey and other sources up to 25 May 2020. We selected randomised controlled trials (RCTs) that compared exclusively exercise-based interventions with control groups, enrolling participants without clinical depression, as measured using validated instruments, and whose outcome was reduction of depressive symptoms and/or incidence of new cases of people with depression. Pooled standardised mean differences (SMDs) were calculated using random-effect models (registration at PROSPERO: CRD42017055726).
A total of 14 RCTs (18 comparisons) evaluated 1737 adults without clinical depression from eight countries and four continents. The pooled SMD was -0.34 (95% CI -0.51 to -0.17; P < 0.001) and sensitivity analyses confirmed the robustness of this result. We found no statistical evidence of publication bias and heterogeneity was moderate (I2 = 54%; 95% CI 22-73%). Only two RCTs had an overall low risk of bias and three had long-term follow-up. Multivariate meta-regression found that a larger sample size, country (Asia) and selective prevention (i.e. people exposed to risk factors for depression) were associated with lower effectiveness, although only sample size remained significant when adjustment for multiple tests was considered. According to the Grading of Recommendations Assessment, Development and Evaluation tool, the quality of evidence was low.
Exercise-based interventions have a small effect on the reduction of depressive symptoms in people without clinical depression. It could be an alternative to or complement psychological programmes, although further higher-quality trials with larger samples and long-term follow-up are needed.
在大多数评估基于运动干预对减轻抑郁症状的试验和系统评价中，很难将治疗与预防分开。
评估仅基于运动的干预措施对减少无临床抑郁人群抑郁症状的有效性。
我们检索了 PubMed、PsycINFO、Embase、WOS、SPORTDiscus、CENTRAL、OpenGrey 和其他资源，截至 2020 年 5 月 25 日。我们选择了仅比较基于运动的干预与对照组的随机对照试验（RCT），纳入了使用经过验证的工具测量无临床抑郁的参与者，且其结果是减少抑郁症状和/或新发生抑郁症患者的病例。使用随机效应模型（在 PROSPERO 注册：CRD42017055726）计算汇总标准化均数差（SMD）。
共有来自 8 个国家和 4 个大洲的 14 项 RCT（18 项比较）评估了 1737 名无临床抑郁的成年人。汇总 SMD 为-0.34（95%CI-0.51 至-0.17；P<0.001），敏感性分析证实了这一结果的稳健性。我们未发现发表偏倚的统计学证据，异质性为中度（I2=54%；95%CI 22-73%）。只有 2 项 RCT 整体的偏倚风险较低，3 项 RCT 有长期随访。多变量荟萃回归发现，样本量较大、国家（亚洲）和选择性预防（即暴露于抑郁风险因素的人群）与疗效降低相关，但当考虑到多次检验的调整时，只有样本量仍然具有统计学意义。根据推荐评估、制定与评价工具，证据质量为低。
基于运动的干预措施对减少无临床抑郁人群的抑郁症状有较小的影响。它可能是心理干预的替代或补充方法，但需要更多高质量的、有较大样本量和长期随访的试验。
