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. 2022 Oct 29;8(1):135.
doi: 10.1186/s40798-022-00529-5.

Comparative Effectiveness of Multiple Exercise Interventions in the Treatment of Mental Health Disorders: A Systematic Review and Network Meta-Analysis

Qian Yu  1 , Ka-Kit Wong  1 , On-Kei Lei  1 , Jinlei Nie  2 , Qingde Shi  2 , Liye Zou  3 , Zhaowei Kong  4
Affiliations

Comparative Effectiveness of Multiple Exercise Interventions in the Treatment of Mental Health Disorders: A Systematic Review and Network Meta-Analysis

Qian Yu et al. Sports Med Open. .

Abstract

Background: The efficacy of exercise interventions in the treatment of mental health disorders is well known, but research is lacking on the most efficient exercise type for specific mental health disorders.

Objective: The present study aimed to compare and rank the effectiveness of various exercise types in the treatment of mental health disorders.

Methods: The PubMed, Web of Science, PsycINFO, SPORTDiscus, CINAHL databases, and the Cochrane Central Register of Controlled Trials as well as Google Scholar were searched up to December 2021. We performed pairwise and network meta-analyses as well as meta-regression analyses for mental health disorders in general and each type of mental health disorder, with alterations in symptom severity as the primary outcome.

Results: A total of 6456 participants from 117 randomized controlled trials were surveyed. The multimodal exercise (71%) had the highest probability of being the most efficient exercise for relieving depressive symptoms. While resistance exercise (60%) was more likely to be the most effective treatment for anxiety disorder, patients with post-traumatic stress disorder (PTSD) benefited more from mind-body exercise (52%). Furthermore, resistance exercise (31%) and multimodal exercise (37%) had more beneficial effects in the treatment of the positive and negative symptoms of schizophrenia, respectively. The length of intervention and exercise frequency independently moderated the effects of mind-body exercise on depressive (coefficient = 0.14, p = .03) and negative schizophrenia (coefficient = 0.96, p = .04) symptoms.

Conclusion: Multimodal exercise ranked best for treating depressive and negative schizophrenic symptoms, while resistance exercise seemed to be more beneficial for those with anxiety-related and positive schizophrenic symptoms. Mind-body exercise was recommended as the most promising exercise type in the treatment of PTSD. However, the findings should be treated with caution due to potential risk of bias in at least one dimension of assessment and low-to-moderate certainty of evidence. Trial Registration This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42022310237).

Keywords: Anxiety disorder; Depression; Exercise; Post-traumatic stress disorder; Schizophrenia; Training.

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Conflict of interest statement

Qian Yu, Ka-Kit Wong, On-Kei Lei, Jinlei Nie, Qingde Shi, Liye Zou and Zhaowei Kong declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram for systematic reviews which included searches of databases, registers, and other sources [27]
Fig. 2
Fig. 2
Risk of Bias Assessment. Notes: Domain 1: Bias from randomization process; Domain 2: Bias due to deviations from intended interventions; Domain 3: Bias due to missing outcome data; Domain 4: Bias in measurement of outcome; and Domain 5: Bias in selection of reported result
Fig. 3
Fig. 3
Network meta-analyses of eligible comparisons for a mental health disorders in general, b depression, c anxiety disorder, d post-traumatic stress disorder, e overall, f positive and g negative schizophrenic symptoms. The network diagram was generated according to network meta-analyses, where each node referred to intervention type and the line referred to studies in which interventions were compared directly. Node size was weighted by the number of participants receiving the specific intervention, while the line’s thickness was weighted by the number of RCTs. Abbreviations: A, aerobic exercise; R, resistance exercise; B, mind–body exercise; S, stretching; M, multimodal exercise; O, other types of exercise; and C, control
Fig. 4
Fig. 4
Rank probabilities for treatment of a mental health disorders in general, b depression, c anxiety disorder, d post-traumatic stress disorder, e overall schizophrenic symptom, f positive schizophrenic symptom, and g negative schizophrenic symptom. Notes: Rank 1 is the worst, and rank last is the best. AE, aerobic exercise; RE, resistant exercise; MBE, mind–body exercise; and ME, multimodal exercise
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