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Clinician Article

Effect of exercise on depressive symptoms in adults with neurologic disorders: a systematic review and meta-analysis.



  • Adamson BC
  • Ensari I
  • Motl RW
Arch Phys Med Rehabil. 2015 Jul;96(7):1329-38. doi: 10.1016/j.apmr.2015.01.005. Epub 2015 Jan 13. (Review)
PMID: 25596001
Read abstract Read evidence summary
Disciplines
  • Psychiatry
    Relevance - 6/7
    Newsworthiness - 6/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 4/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 4/7
  • Internal Medicine
    Relevance - 5/7
    Newsworthiness - 6/7
  • FM/GP/Mental Health
    Relevance - 5/7
    Newsworthiness - 4/7
  • Neurology
    Relevance - 5/7
    Newsworthiness - 4/7

Abstract

OBJECTIVES: To review and quantify the effect of exercise on depression in adults with neurologic disorders.

DATA SOURCES: CINAHL, Cochrane Register of Controlled Clinical Trials, EMBASE, ERIC, MEDLINE, PsycINFO, PubMed, and SPORTDiscus were searched, with the last search performed in May 2014.

STUDY SELECTION: Included were randomized controlled trials conducted in adults with a diagnosed neurologic disorder that compared an exercise intervention group with a control group and used depression as an outcome measure.

DATA EXTRACTION: Depression data were extracted independently by 2 authors. Methodological quality was assessed independently by 2 authors.

DATA SYNTHESIS: Forty-three full-length articles were reviewed, and 26 trials met our inclusion criteria. These trials represented 1324 participants with 7 different neurologic disorders: Alzheimer disease (n=4 trials), migraine (n=1), multiple sclerosis (n=13), Parkinson disease (n=2), spinal cord injury (n=1), stroke (n=2), and traumatic brain injury (n=3). Data measuring depression were extracted and effect sizes were computed for 23 trials. Results from a meta-analysis yielded an overall effect size of .28 (SE=.07; 95% confidence interval, .15-.41; P=.00) favoring a reduction in depression outcomes after an exercise intervention compared with the control condition. Of note, interventions that met physical activity guidelines yielded an overall effect of .38 compared with .19 for studies that did not meet physical activity guidelines.

CONCLUSIONS: This review provides evidence that exercise, particularly when meeting physical activity guidelines, can improve depressive symptoms in adults with neurologic disorders.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

Exercise helps lessen depressive symptoms across a range of neurological conditions including dementia.

FM/GP/Mental Health

Evidence to support exercise as a therapeutic maneuver in multiple diseases is increasing. This is very helpful in working with patients to give appropriate alternatives or adjunctive therapies.

General Internal Medicine-Primary Care(US)

This is an interesting article that adds to literature on exercise and depression. The "neurological disorders" they aggregated are too diverse to draw general conclusions about that entire population but this is nonetheless encouraging regarding the general benefits of exercise.

Neurology

I am afraid that the intention of this meta analysis might not be achieved because the majority of the collected data were based along the study of MS (multiple sclerosis), and the research targeting other neurologic disorders are small in number. Besides the type of intervention, frequency, intensity and duration are quite variable between the accepted papers. It seems appropriate that we might take these results to be reasonable in our clinical practice at the moment.

Psychiatry

Well described study. Having 'dose' of exercise as a variable is useful, although it seems to be a post hoc analysis. I do start getting nervous when authors start inventing their own statistics (ES), and using it to report significance, but this seemed fair in this paper. I might change my mind though once I've digested what it is and what they've done! If people stick with relative risk etc., I'm more reassured. NNTs and NNHs would add to that reassurance.

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