Summary:
Large numbers of adults experience depression and anxiety at some point in their lives. Lifestyle-based approaches including physical activity and diet are recognised in many clinical guidelines, although recommendations differ between countries. Many trials suggest that physical activity can produce effects similar to those of psychotherapy or pharmacotherapy, while also offering additional benefits such as lower cost, fewer side effects and improvements in physical health. Despite this evidence, physical activity has not been consistently integrated into routine mental health care. This study synthesised evidence from systematic reviews that looked at the effects of all forms of physical activity on symptoms of depression, anxiety and psychological distress in adults. Studies were included if they evaluated interventions designed to increase physical activity and measured mental health outcomes. More than 128,000 participants across diverse populations were included, including healthy adults, people with mental health conditions and those with chronic diseases. Overall, physical activity was associated with reductions in symptoms of depression, anxiety and psychological distress compared with usual care. Benefits were observed across all population groups, with particularly strong effects in people with depression, pregnant and postpartum women, individuals with HIV or kidney disease, and healthy adults. Higher intensity activity was linked to greater symptom improvement. In summary, this study shows that physical activity is an effective intervention for reducing symptoms of depression, anxiety and psychological distress in adults across a wide range of settings and health conditions. These findings support the inclusion of physical activity as a core component of mental health management, rather than solely as an adjunct to traditional treatments.
Abstract:
Objective To synthesise the evidence on the effects of physical activity on symptoms of depression, anxiety and psychological distress in adult populations. Design Umbrella review. Data sources Twelve electronic databases were searched for eligible studies published from inception to 1 January 2022. Eligibility criteria for selecting studies Systematic reviews with meta-analyses of randomised controlled trials designed to increase physical activity in an adult population and that assessed depression, anxiety or psychological distress were eligible. Study selection was undertaken in duplicate by two independent reviewers. Results Ninety-seven reviews (1039 trials and 128 119 participants) were included. Populations included healthy adults, people with mental health disorders and people with various chronic diseases. Most reviews (n=77) had a critically low A MeaSurement Tool to Assess systematic Reviews score. Physical activity had medium effects on depression (median effect size=−0.43, IQR=−0.66 to –0.27), anxiety (median effect size=−0.42, IQR=−0.66 to –0.26) and psychological distress (effect size=−0.60, 95% CI −0.78 to –0.42), compared with usual care across all populations. The largest benefits were seen in people with depression, HIV and kidney disease, in pregnant and postpartum women, and in healthy individuals. Higher intensity physical activity was associated with greater improvements in symptoms. Effectiveness of physical activity interventions diminished with longer duration interventions. Conclusion and relevance Physical activity is highly beneficial for improving symptoms of depression, anxiety and distress across a wide range of adult populations, including the general population, people with diagnosed mental health disorders and people with chronic disease. Physical activity should be a mainstay approach in the management of depression, anxiety and psychological distress.
Article Publication Date: 29/09/2023
DOI: 10.1136/bjsports-2022-106195
