Exercise for depression in older adults: a meta-analysis of randomized controlled trials adjusting for publication bias.
OBJECTIVE
To evaluate the antidepressant effects of exercise in older adults, using randomized controlled trial (RCT) data.


METHODS
We conducted a meta-analysis of exercise in older adults, addressing limitations of previous works. RCTs of exercise interventions in older people with depression (≥ 60 years) comparing exercise vs. control were eligible. A random-effects meta-analysis calculating the standardized mean difference (SMD) (95% confidence interval [95%CI]), meta-regressions, and trim, fill, and fail-safe number analyses were conducted.


RESULTS
Eight RCTs were included, representing 138 participants in exercise arms and 129 controls. Exercise had a large and significant effect on depression (SMD = -0.90 [95%CI -0.29 to -1.51]), with a fail-safe number of 71 studies. Significant effects were found for 1) mixed aerobic and anaerobic interventions, 2) at moderate intensity, 3) that were group-based, 4) that utilized mixed supervised and unsupervised formats, and 5) in people without other clinical comorbidities.


CONCLUSIONS
Adjusting for publication bias increased the beneficial effects of exercise in three subgroup analysis, suggesting that previous meta-analyses have underestimated the benefits of exercise due to publication bias. We advocate that exercise be considered as a routine component of the management of depression in older adults.
Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.|Programa de Pós-Graduação em Ciências Médicas, Psiquiatria, UFRGS, Porto Alegre, RS, Brazil.
Felipe B
FB
Schuch
Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium.|Z.org Leuven, University of Leuven, Kortenberg, Belgium.
Davy
D
Vancampfort
School of Psychiatry, University of New South Wales, Sydney, Australia.|Ingham Institute for Applied Medical Research, Liverpool, Australia.
Simon
S
Rosenbaum
Charles Perkins Centre, School of Public Health, University of Sydney, Sydney, Australia.
Justin
J
Richards
School of Psychiatry, University of New South Wales, Sydney, Australia.|Ingham Institute for Applied Medical Research, Liverpool, Australia.
Philip B
PB
Ward
Geriatrics Section, Department of Medicine, Università degli Studi di Padova, Padova, Italy.
Nicola
N
Veronese
ULSS 17 Mental Health Department, Department of Neurosciences, Università degli Studi di Padova, Padova, Italy.
Marco
M
Solmi
Departamento de Educação Física, UFRGS, Porto Alegre, RS, Brazil.
Eduardo L
EL
Cadore
Department of Physiotherapy, South London and Maudsley NHS Foundation Trust, London, United Kingdom.|Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom.
Brendon
B
Stubbs
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003865:Major Depressive Disorder / Q000628:therapy*; D005081:Exercise Therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome