Chen Lei, Li Aichun, Zhou Junlai, Chen Wenhao, Kou Yujia
School of Physical Education, Hainan Normal University, Haikou, Hainan, China.
Front Psychiatry. 2025 Jul 25;16:1573557. doi: 10.3389/fpsyt.2025.1573557. eCollection 2025.
Aerobic exercise (AE), as a non-pharmacological therapy, is an effective supplement to conventional depression treatments. However, a comprehensive assessment of combined AE interventions remains insufficient. This study aims to systematically evaluate the intervention effects of different therapies combined with AE in depression patients via network meta-analysis (NMA).
Following the PICOS framework, literature was searched in PubMed, Web of Science, Cochrane Library, Embase, Scopus, CNKI, Wanfang, and CBM for randomized controlled trials (RCTs) until June 2024. Independent screening and data extraction were conducted. NMA utilized Stata 15.0 and R 4.4.1, with bias risk assessed by the Cochrane Risk of Bias tool and evidence quality assessed by CINeMA.
A total of 37 RCTs involving 3,362 patients with depression were included, evaluating five combined AE interventions. Results based on the area under the cumulative ranking curve indicated: (1) Hamilton Depression Rating Scale (HAMD): Electroconvulsive therapy + AE (ECT+AE) > repetitive transcranial magnetic stimulation + AE (rTMS+AE) > Traditional Chinese Medicine + AE (TCM+AE) > Selective Serotonin Reuptake Inhibitors + AE (SSRI+AE) > Cognitive Behavioral Therapy + AE (CBT+AE) > Physical Therapy (PT) > Exercise (EX) > CBT > TCM > Control Treatment (CT); (2) Beck Depression Inventory (BDI): SSRI+AE > ECT+AE > CBT+AE > EX > CBT > CT > PT; (3) Self-rating Depression Scale (SDS): TCM+AE > CBT+AE > CT > CBT.
Current evidence suggests that combined aerobic exercise interventions are superior to monotherapy in the treatment of depression. Of these, SSRI+AE is the most recommended combination, with strong RCT evidence and high-quality evidence ratings. For other AE combination therapies, further validation in large, high-quality trials is necessary in the future.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024594873.
有氧运动（AE）作为一种非药物疗法，是传统抑郁症治疗的有效补充。然而，对联合AE干预措施的综合评估仍然不足。本研究旨在通过网络荟萃分析（NMA）系统评价不同疗法联合AE对抑郁症患者的干预效果。
按照PICOS框架，在PubMed、Web of Science、Cochrane图书馆、Embase、Scopus、中国知网、万方和中国生物医学文献数据库中检索截至2024年6月的随机对照试验（RCT）。进行独立筛选和数据提取。NMA使用Stata 15.0和R 4.4.1，采用Cochrane偏倚风险工具评估偏倚风险，采用CINeMA评估证据质量。
共纳入37项涉及3362例抑郁症患者的RCT，评估了五种联合AE干预措施。基于累积排序曲线下面积的结果表明：（1）汉密尔顿抑郁量表（HAMD）：电休克治疗+AE（ECT+AE）>重复经颅磁刺激+AE（rTMS+AE）>中医+AE（TCM+AE）>选择性5-羟色胺再摄取抑制剂+AE（SSRI+AE）>认知行为疗法+AE（CBT+AE）>物理治疗（PT）>运动（EX）>CBT>TCM>对照治疗（CT）；（2）贝克抑郁量表（BDI）：SSRI+AE>ECT+AE>CBT+AE>EX>CBT>CT>PT；（3）自评抑郁量表（SDS）：TCM+AE>CBT+AE>CT>CBT。
目前证据表明，联合有氧运动干预在抑郁症治疗中优于单一疗法。其中，SSRI+AE是最推荐的组合，有强有力的RCT证据和高质量的证据评级。对于其他AE联合疗法，未来有必要在大型高质量试验中进一步验证。
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