Vancampfort Davy, Firth Joseph, Stubbs Brendon, Schuch Felipe, Rosenbaum Simon, Hallgren Mats, Deenik Jeroen, Ward Philip B, Mugisha James, Van Damme Tine, Werneck André O
Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
University Psychiatric Center KU Leuven, Leuven, Belgium.
World Psychiatry. 2025 Jun;24(2):227-239. doi: 10.1002/wps.21314.
Research examining physical activity interventions for mental disorders has grown exponentially in the past decade. At this critical juncture, there is a need to synthesize the best evidence to guide researchers, clinicians and people with lived experience. This meta-review aimed to systematically identify and comprehensively evaluate the current evidence about: a) the efficacy of physical activity interventions on mental, cognitive and physical outcomes for individuals with mental disorders; b) the potential neurobiological, psychosocial and behavioral mechanisms underlying the observed effects; and c) the barriers and facilitators for individuals to successfully engage in these interventions. Our systematic search identified 13 meta-analyses of high methodological quality (i.e., A Measurement Tool to Assess Systematic Reviews, AMSTAR score ≥8) assessing outcomes of physical activity as an adjunctive treatment, which included 256 randomized clinical trials (RCTs) and 12,233 individuals. Large effect sizes were found for adjunctive physical activity interventions in improving attention in children and adolescents with attention-deficit/hyperactivity disorder (ADHD); reducing depressive symptoms in children, adolescents and adults with depressive disorders; and reducing body mass index in adults with schizophrenia. Moderate effect sizes were found for reductions of hyperactivity, impulsivity and anxiety, and improvements of executive and social functioning in children and adolescents with ADHD; reduction of anxiety symptoms in adults with anxiety disorders; improved physical and psychological quality of life and cardiovascular fitness in adults with depressive disorders; improved daily living skills, overall quality of life and cardiorespiratory fitness in adults with schizophrenia; reduction of depressive symptoms in older people with depressive disorders; and improvements in cognition and functional mobility in older people with dementia. There is, to date, no meta-analytic evidence for physical activity as a first-line treatment for people with a mental disorder. Five meta-analyses, including 89 RCTs and 4,575 individuals, investigated potential underlying mechanisms. There is a very preliminary evidence for an effect of physical activity on circulating levels of kynurenine, growth hormone, tumor necrosis factor-alpha and brain-derived neurotrophic factor in people with major depressive disorder. No meta-analytic evidence could be found for psychosocial or behavioral mechanisms. Based on 15 umbrella or systematic reviews, covering 432 studies and 48 guidelines, six implementation strategies, along with the most evidence-based behavioral change techniques to support them, were identified. Recommendations to support implementation research in this area were finally formulated.
在过去十年中，研究身体活动干预对精神障碍影响的研究呈指数级增长。在这一关键时刻，需要综合最佳证据来指导研究人员、临床医生和有实际经验的人。本综述旨在系统地识别并全面评估有关以下方面的现有证据：a）身体活动干预对精神障碍患者的心理、认知和身体结局的疗效；b）观察到的效果背后潜在的神经生物学、心理社会和行为机制；c）个体成功参与这些干预的障碍和促进因素。我们的系统检索确定了13项方法学质量高的荟萃分析（即用于评估系统评价的测量工具，AMSTAR评分≥8），评估身体活动作为辅助治疗的结局，其中包括256项随机临床试验（RCT）和12,233名个体。发现辅助身体活动干预对改善注意力缺陷多动障碍（ADHD）儿童和青少年的注意力有显著效果；减轻患有抑郁症的儿童、青少年和成人的抑郁症状；降低精神分裂症成人的体重指数。发现适度效果的有：减少ADHD儿童和青少年的多动、冲动和焦虑，改善其执行功能和社交功能；减轻焦虑症成人的焦虑症状；改善抑郁症成人的身体和心理生活质量以及心血管健康；改善精神分裂症成人的日常生活技能、总体生活质量和心肺健康；减轻患有抑郁症的老年人的抑郁症状；改善患有痴呆症的老年人的认知和功能活动能力。迄今为止，尚无荟萃分析证据表明身体活动可作为精神障碍患者的一线治疗方法。五项荟萃分析，包括89项RCT和4,575名个体，研究了潜在的潜在机制。有非常初步的证据表明，身体活动对重度抑郁症患者的犬尿氨酸、生长激素、肿瘤坏死因子-α和脑源性神经营养因子的循环水平有影响。未发现心理社会或行为机制的荟萃分析证据。基于15项伞状综述或系统评价，涵盖432项研究和48项指南，确定了六项实施策略以及支持它们的最具循证依据的行为改变技术。最后制定了支持该领域实施研究的建议。
