Summary:
Depression and anxiety are among the most common mental health conditions globally and contribute significantly to reduced quality of life and increased healthcare burden. While pharmacological and psychological treatments are widely used, exercise has been recognised as a non-pharmacological strategy to support mental health. Exercise may influence mental wellbeing through several mechanisms, including improvements in mood-regulating neurotransmitters, reductions in stress hormones, and positive effects on sleep, social interaction, and self-efficacy. This meta-meta-analysis synthesised findings from multiple meta-analyses of randomised controlled trials examining the effects of exercise on symptoms of depression and anxiety. The study analysed 81 meta-analyses, representing 1,079 individual trials and a total of 79,551 participants. The findings showed that exercise was associated with reductions in both depression and anxiety symptoms. Aerobic exercise, such as running, cycling, or brisk walking, produced the most consistent improvements in mental health outcomes. The effectiveness of exercise also varied across population groups. The largest reductions in depressive symptoms were observed among emerging adults aged 18-30 years and among postnatal women. Exercise programs conducted in supervised or group settings were also associated with greater improvements in depressive symptoms compared with unsupervised programs. In contrast, reductions in anxiety were more strongly associated with shorter exercise interventions performed at lower intensity levels. Overall, this meta-meta-analysis indicates that exercise can reduce symptoms of both depression and anxiety across a wide range of populations. The results support the use of exercise as a practical and cost-effective strategy that may complement existing mental health treatments.
Abstract:
Objective To synthesise meta-analytic outcomes from randomised controlled trials examining exercise effects on depression and anxiety across all population groups, including children and adults with both clinically diagnosed and subclinical symptoms, excluding those with pre-existing chronic physiological conditions. Design Meta-meta-analysis (Preferred Reporting Items for Overviews of Reviews (PRIOR) framework). Data sources Five electronic databases were searched for eligible meta-analyses published from inception to 31 July 2025. Eligibility criteria for selecting studies Meta-analyses of randomised controlled trials examining exercise interventions for the management of depression and anxiety symptoms were included. To avoid contamination effects, meta-analyses exclusively focused on populations in which chronic physiological conditions were excluded. Study selection was undertaken in duplicate by two independent reviewers. Results 63 studies (81 meta-analyses, 1079 component studies and 79 551 participants) were included. Exercise reduced depression (standardised mean difference (SMD)=−0.61, 95% CI −0.69 to −0.54) and anxiety (SMD=−0.47, 95% CI −0.59 to −0.36) symptoms, with aerobic exercise demonstrating the most substantial impact on both depression and anxiety symptoms. The greatest benefits by population group for depression were seen in emerging adults aged 18–30 and postnatal women. Greater reductions in depression were associated with exercise in group and supervised settings. Exercise of shorter duration and at lower intensity was most strongly associated with anxiety reduction. Conclusion and relevance The findings of the study support that exercise based interventions, in all formats and parameters, can help mitigate depression and anxiety symptoms across all population categories. These results can help health professionals provide targeted, cost effective, evidence based support that aligns with individual profiles and preferences.
Article Publication Date: 15/10/2025
DOI: 10.1136/bjsports-2025-110301
