运动对抑郁症的影响：随机对照试验的系统评价和网络荟萃分析。

OBJECTIVE: To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions. DESIGN: Systematic review and network meta-analysis. METHODS: Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool. DATA SOURCES: Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression. RESULTS: 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges' g -0.62, 95% credible interval -0.80 to -0.45), yoga (n=1047, κ=33, g -0.55, -0.73 to -0.36), strength training (n=643, κ=22, g -0.49, -0.69 to -0.29), mixed aerobic exercises (n=1286, κ=51, g -0.43, -0.61 to -0.24), and tai chi or qigong (n=343, κ=12, g -0.42, -0.65 to -0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments. CONCLUSIONS: Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018118040.

目的：与心理疗法、抗抑郁药和对照条件相比，确定治疗重度抑郁症的最佳运动剂量和方式。

设计：系统评价和网络荟萃分析。

方法：独立且重复进行筛选、数据提取、编码和偏倚风险评估。对主要分析进行基于贝叶斯臂的多层次网络荟萃分析。使用在线置信网络荟萃分析（CINeMA）工具对每个臂的证据质量进行分级。

数据来源：Cochrane 图书馆、Medline、Embase、SPORTDiscus 和 PsycINFO 数据库。

入选研究的标准：任何针对符合重度抑郁症临床标准的参与者的运动臂的随机试验。

结果：纳入了 218 项具有 495 个臂和 14170 名参与者的独特研究。与活性对照（例如常规护理、安慰剂片）相比，发现散步或慢跑（n=1210，κ=51，Hedges'g-0.62，95%可信区间-0.80 至-0.45）、瑜伽（n=1047，κ=33，g-0.55，-0.73 至-0.36）、力量训练（n=643，κ=22，g-0.49，-0.69 至-0.29）、混合有氧运动（n=1286，κ=51，g-0.43，-0.61 至-0.24）和太极或气功（n=343，κ=12，g-0.42，-0.65 至-0.21）的抑郁程度有中度降低。运动的效果与规定的强度成正比。力量训练和瑜伽似乎是最可接受的方式。结果似乎不受发表偏倚的影响，但只有一项研究符合 Cochrane 低偏倚风险标准。因此，根据 CINeMA，散步或慢跑的置信度较低，而其他治疗方法的置信度非常低。

结论：运动是治疗抑郁症的有效方法，散步或慢跑、瑜伽和力量训练比其他运动更有效，尤其是在高强度运动时。瑜伽和力量训练比其他治疗方法更能被患者接受。运动对伴有或不伴有合并症以及不同基线抑郁水平的患者同样有效。为了减轻预期效应，未来的研究可以尝试对参与者和工作人员进行盲法。这些形式的运动可以与心理疗法和抗抑郁药一起作为抑郁症的核心治疗方法。

系统评价注册：PROSPERO CRD42018118040。