Zhang Yihan, Li Geng, Liu Chengzhen, Guan Jinliang, Zhang Yuantong, Shi Zhifu
School of Educational Science, Hunan Normal University, Changsha, China.
College of Physical Education, Hunan Normal University, Changsha, China.
Front Psychiatry. 2023 Jun 2;14:1199510. doi: 10.3389/fpsyt.2023.1199510. eCollection 2023.
Depression disorder is the most commonly diagnosed type of mental illness among youths. Although a plethora of evidence suggests a positive relationship between exercise and lower levels of depression in youths, the findings regarding the variation in magnitude of this relationship are inconclusive with respect to the preventive and therapeutic effects of different types of exercise. This network meta-analysis aimed to determine the best type of exercise for the treatment and prevention of depression in youths.
A comprehensive search of databases, including PubMed, EMBASE, The Cochrane Library, Web of Science, PsychINFO, ProQuest, Wanfang, and CNKI, was conducted to identify relevant research on exercise interventions for depression in youth populations. The risk of bias in the included studies was evaluated using Cochrane Review Manager 5.4 according to the Cochrane Handbook 5.1.0 Methodological Quality Evaluation Criteria. The network meta-analysis was performed using STATA 15.1 to calculate the standardized mean difference (SMD) of all concerned outcomes. The node-splitting method was used to test the local inconsistency of the network meta-analysis. Funnel plots were used to evaluate the potential impact of bias in this study.
Utilizing data extracted from 58 studies (10 countries, 4,887 participants), we found that for depressed youths, exercise is significantly better than usual care in reducing anxiety (SMD = -0.98, 95% CI [-1.50, -0.45]). For non-depressed youths, exercise is significantly better than usual care in reducing anxiety (SMD = -0.47, 95% CI [ -0.66, -0.29]). In the treatment of depression, resistance exercise (SMD = -1.30, 95% CI [ -1.96, -0.64]), aerobic exercise (SMD = -0.83, 95% CI [-1.10 -0.72]), mixed exercise (SMD = -0.67, 95% CI [-0.99, -0.35]), and mind-body exercise (SMD = -0.61, 95% CI [-0.84, -0.38]) all showed significant efficacy over usual care. For the prevention of depression, resistance exercise (SMD = -1.18, 95% CI [-1.65, -0.71]), aerobic exercise (SMD = -0.72, 95% CI [-0.98, -0.47]), mind-body exercise (SMD = -0.59, 95% CI [-0.93, -0.26]), and mixed exercise (SMD = -1.06, 95% CI [-1.37 to -0.75]) were all significantly effective compared to usual care. According to the test of the surface under the cumulative ranking score (SUCRA), the ranking of exercises for the treatment of depression in depressed youths is as follows: resistance exercise (94.9%) > aerobic exercise (75.1%) > mixed exercise (43.8%) > mind-body exercise (36.2%) > usual care (0%). For the prevention of depression in non-depressed youths, resistance exercise (90.3%) > mixed exercise (81.6%) > aerobic exercise (45.5%) > mind-body exercise (32.6%) > usual care (0%). Resistance exercise thus had the best comprehensive effect on both the treatment and prevention of depression in youths (clusterank value = 1914.04). Subgroup analyses show that a frequency of 3-4 times per week, a duration of 30-60 min, and a length of more than 6 weeks were found to be the most effective interventions for depression ( > 0.001).
This study provides compelling evidence that exercise is a viable intervention for improving depression and anxiety in young individuals. In addition, the study emphasizes the importance of selecting the appropriate type of exercise to optimize treatment and prevention. Specifically, the results suggest that resistance exercise, performed 3-4 times per week, with sessions lasting 30-60 min and a length of more than 6 weeks, yields optimal results for the treatment and prevention of depression in young individuals. These findings have significant implications for clinical practice, particularly given the challenges associated with implementing effective interventions and the economic burden of treating and preventing depression in young people. However, it is worth noting that additional head-to-head studies are necessary to confirm these findings and strengthen the evidence base. Nevertheless, this study provides valuable insights into the role of exercise as a potential treatment and preventative measure for depression in young people.
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=374154, identifier: 374154.
抑郁症是青少年中最常被诊断出的精神疾病类型。尽管大量证据表明运动与青少年较低的抑郁水平之间存在正相关关系，但关于这种关系强度变化的研究结果在不同类型运动的预防和治疗效果方面尚无定论。这项网络荟萃分析旨在确定治疗和预防青少年抑郁症的最佳运动类型。
全面检索包括PubMed、EMBASE、Cochrane图书馆、Web of Science、PsychINFO、ProQuest、万方和知网在内的数据库，以识别有关青少年运动干预治疗抑郁症的相关研究。根据Cochrane手册5.1.0方法学质量评估标准，使用Cochrane Review Manager 5.4评估纳入研究的偏倚风险。使用STATA 15.1进行网络荟萃分析，以计算所有相关结局的标准化均值差（SMD）。采用节点拆分法检验网络荟萃分析的局部不一致性。使用漏斗图评估本研究中偏倚的潜在影响。
利用从58项研究（10个国家，4887名参与者）中提取的数据，我们发现，对于抑郁的青少年，运动在减轻焦虑方面显著优于常规护理（SMD = -0.98，95% CI [-1.50, -0.45]）。对于未患抑郁症的青少年，运动在减轻焦虑方面显著优于常规护理（SMD = -0.47，95% CI [-0.66, -0.29]）。在抑郁症治疗中，抗阻运动（SMD = -1.30，95% CI [-1.96, -0.64]）、有氧运动（SMD = -0.83，95% CI [-1.10 -0.72]）、混合运动（SMD = -0.67，95% CI [-0.99, -0.35]）和身心运动（SMD = -0.61，95% CI [-0.84, -0.38]）在减轻焦虑方面均显著优于常规护理。在预防抑郁症方面，抗阻运动（SMD = -1.18，95% CI [-1.65, -0.71]）、有氧运动（SMD = -0.72，95% CI [-0.98, -0.47]）、身心运动（SMD = -0.59，95% CI [-0.93, -0.26]）和混合运动（SMD = -1.06，95% CI [-1.37至-0.75]）在预防抑郁症方面均显著优于常规护理。根据累积排序分数下的曲面（SUCRA）检验，抑郁青少年抑郁症治疗运动的排名如下：抗阻运动（94.9%）>有氧运动（75.1%）>混合运动（43.8%）>身心运动（36.2%）>常规护理（0%）。对于未患抑郁症的青少年预防抑郁症，抗阻运动（90.3%）>混合运动（81.6%）>有氧运动（45.5%）>身心运动（32.6%）>常规护理（0%）。因此，抗阻运动对青少年抑郁症的治疗和预防均具有最佳综合效果（聚类排名值 = 1914.04）。亚组分析表明，每周3 - 4次、每次持续时长30 - 60分钟以及持续时间超过6周的运动被发现是治疗抑郁症最有效的干预措施（>0.001）。
本研究提供了有力证据，证明运动是改善青少年抑郁和焦虑的可行干预措施。此外，该研究强调了选择合适运动类型以优化治疗和预防的重要性。具体而言，结果表明，每周进行3 - 4次、每次持续30 - 60分钟且持续时间超过6周的抗阻运动，对青少年抑郁症的治疗和预防效果最佳。这些发现对临床实践具有重要意义，特别是考虑到实施有效干预措施所面临的挑战以及治疗和预防青少年抑郁症的经济负担。然而，值得注意的是，需要更多的直接比较研究来证实这些发现并加强证据基础。尽管如此，本研究为运动作为青少年抑郁症潜在治疗和预防措施的作用提供了有价值的见解。
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=374154，标识符：374154 。
