A systematic review of cognitive effects of exercise in depression

Brondino, Natascia; Rocchetti, Matteo; Fusar-Poli, Laura; Codrons, Erwan; Correale, Luca; Vandoni, Matteo; Barbui, Corrado; Politi, Pierluigi

doi:10.1111/acps.12690

Cited by 66 publications

(65 citation statements)

References 49 publications

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“…1). Overall, 20 systematic reviews and meta-analyses were included in this guidelines document, which included studies that provided effect sizes for the benefit of exercise for SMI [51] (N = 1), schizophreniaspectrum disorders [67][68][69][70][71][72][73] (N = 7), BD [74,75](N = 2) and MDD [76][77][78][79][80][81][82][83][84][85] (N = 10).…”

Section: Search Results and Included Studiesmentioning

confidence: 99%

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EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH)

et al. 2018

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Physical activity (PA) may be therapeutic for people with severe mental illness (SMI) who generally have low PA and experience numerous life style-related medical complications. We conducted a meta-review of PA interventions and their impact on health outcomes for people with SMI, including schizophrenia-spectrum disorders, major depressive disorder (MDD) and bipolar disorder. We searched major electronic databases until January 2018 for systematic reviews with/without meta-analysis that investigated PA for any SMI. We rated the quality of studies with the AMSTAR tool, grading the quality of evidence, and identifying gaps, future research needs and clinical practice recommendations. For MDD, consistent evidence indicated that PA can improve depressive symptoms versus control conditions, with effects comparable to those of antidepressants and psychotherapy. PA can also improve cardiorespiratory fitness and quality of life in people with MDD, although the impact on physical health outcomes was limited. There were no differences in adverse events versus control conditions. For MDD, larger effect sizes were seen when PA was delivered at moderate-vigorous intensity and supervised by an exercise specialist. For schizophrenia-spectrum disorders, evidence indicates that aerobic PA can reduce psychiatric symptoms, improves cognition and various subdomains, cardiorespiratory fitness, whilst evidence for the impact on anthropometric measures was inconsistent. There was a paucity of studies investigating PA in bipolar disorder, precluding any definitive recommendations. No cost effectiveness analyses in any SMI condition were identified. We make multiple recommendations to fill existing research gaps and increase the use of PA in routine clinical care aimed at improving psychiatric and medical outcomes.

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Section: Search Results and Included Studiesmentioning

confidence: 99%

“…In total 10 systematic reviews and meta-analyses reported the benefits of exercise for MDD [76][77][78][79][80][81][82][83][84][85]. The mean AMSTAR score for the included reviews was 9.1 (range 3-10).…”

Section: Major Depressionmentioning

confidence: 99%

EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH)

et al. 2018

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“…The results of this meta-analysis contradict at the first glance the comprehensive review of Malchow et al [74], who reported positive effects of physical exercise on schizophrenia and affective disorders, thereby recommending physical exercise as part of a multimodal intervention program to improve neurocognition and psychopathology. However, the results of Brondino et al [77] should be taken with caution because of several methodological limitations, already mentioned by authors: None of the included studies recruited patients with subjective cognitive complaints. Patients were only slightly cognitive impaired at baseline, and therefore had a small potential for cognitive improvement.…”

Section: Physical Exercise Interventionsmentioning

confidence: 96%

“…A recently published systematic review and metaanalysis of Brondino et al [77], addressing possible effects of physical exercise on cognitive functioning in depression, including eight randomized controlled trials, showed no improvement of cognition in MDD through physical exercise (one study used yoga as physical exercise intervention [78]). Neither the duration of the intervention, nor the number of sessions per week or the intensity of exercise impacted the outcome significantly.…”

Section: Physical Exercise Interventionsmentioning

confidence: 99%

Cognitive Impairment Along the Course of Depression: Non-Pharmacological Treatment Options

et al. 2018

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Major Depressive Disorder (MDD) is one of the most common psychiatric disorders, with a large global impact on both the individual and the society. In this narrative review, we summarize neurocognitive deficits during acute and (partially) remitted states of depression. Furthermore, we outline the potential negative effect of cognitive impairment (CI) on functional recovery, and discuss the role of several variables in the development of CI for MDD patients. Though there is cumulating evidence regarding persistent CI in unipolar depression, research on treatment options specific for this patient group is still scarce. Hence the central aim of our review is to present non-pharmacological interventions, which are thought to reduce CI in affected MDD patients. We discuss cognitive remediation therapy (CRT), physical exercise, yoga, mindfulness-based therapy, and modern neuromodulation approaches like neurostimulation and neurofeedback training. In conclusion, we propose future directions for research on CI in depression. Looking further ahead, we suggest creative interventional designs that include a direct comparison of different non-pharmacological treatment approaches on neurocognition and functional outcome of MDD. Furthermore, additive and synergistic effects of CRT with other treatment approaches should be examined and compared to create multimodal and even personalized intervention programs.

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“…In contrast, research on the efficacy of physical exercise in treatment of other brain disorders is still in its infancy and therefore not part of the standard care. Although several studies have investigated the effect of physical exercise in different chronic brain disorders such as Alzheimer's disease (AD) [17,18], multiple sclerosis (MS) [19][20][21], Parkinson's disease (PD) [22,23], Schizophrenia (Sz) [24,25] and unipolar depression (UD) [26][27][28], results and mainly recommendations for clinical practice have been highly diverse [29]. As a consequence, current evidence for efficacy of exercise therapy is still disputed and exercise is not part of the regular care offer for patients with aforementioned disorders in most countries.…”

Section: Introductionmentioning

confidence: 99%

Physical exercise improves quality of life, depressive symptoms, and cognition across chronic brain disorders: a transdiagnostic systematic review and meta-analysis of randomized controlled trials

et al. 2019

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We performed a meta-analysis to synthesize evidence on the efficacy and safety of physical exercise as an add-on therapeutic intervention for quality of life (QoL), depressive symptoms and cognition across six chronic brain disorders: Alzheimer's disease, Huntington's disease, multiple sclerosis, Parkinson's disease, schizophrenia and unipolar depression. 122 studies (= k) (n = 7231) were included. Exercise was superior to treatment as usual in improving QoL (k = 64, n = 4334, ES = 0.40, p < 0.0001), depressive symptoms (k = 60, n = 2909, ES = 0.78, p < 0.0001), the cognitive domains attention and working memory (k = 21, n = 1313, ES = 0.24, p < 0.009), executive functioning (k = 14, n = 977, ES = 0.15, p = 0.013), memory (k = 12, n = 994, ES = 0.12, p = 0.038) and psychomotor speed (k = 16, n = 896, ES = 0.23, p = 0.003). Meta-regression showed a dose-response effect for exercise time (min/week) on depressive symptoms (β = 0.007, p = 0.012). 69% of the studies that reported on safety, found no complications. Exercise is an efficacious and safe add-on therapeutic intervention showing a medium-sized effect on QoL and a large effect on mood in patients with chronic brain disorders, with a positive dose-response correlation. Exercise also improved several cognitive domains with small but significant effects.

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A systematic review of cognitive effects of exercise in depression

Abstract: Our meta-analysis did not observe a substantial benefit of physical exercise on cognitive symptoms in depression.

Cited by 66 publications

References 49 publications

EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH)

EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH)

Cognitive Impairment Along the Course of Depression: Non-Pharmacological Treatment Options

Physical exercise improves quality of life, depressive symptoms, and cognition across chronic brain disorders: a transdiagnostic systematic review and meta-analysis of randomized controlled trials

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