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Published on: November 27, 2019
Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies
Felipe B Schuch1, Davy Vancampfort1, Joseph Firth1
1From La Salle University, Canoas, Brazil; the School of Physical Education, Physiotherapy, and Dance and the Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; KU Leuven-University of Leuven, Department of Rehabilitation Sciences, and University Psychiatric Center, Leuven-Kortenberg, Belgium; the NICM Health Research Institute, School of Science and Health, University of Western Sydney, Sydney, Australia; the School of Psychiatry, University of New South Wales Sydney, Black Dog Institute, and Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Sydney, Australia; the Department of Public Health Sciences, Karolinska Institute, Stockholm; the Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; the Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; the Department of Psychiatry, University of Toronto, and the Centre for Addiction and Mental Health, Toronto; the Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London; and the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London.
Objective:
The authors examined the prospective relationship between physical activity and incident depression and explored potential moderators.
Method:
Prospective cohort studies evaluating incident depression were searched from database inception through Oct. 18, 2017, on PubMed, PsycINFO, Embase, and SPORTDiscus. Demographic and clinical data, data on physical activity and depression assessments, and odds ratios, relative risks, and hazard ratios with 95% confidence intervals were extracted. Random-effects meta-analyses were conducted, and the potential sources of heterogeneity were explored. Methodological quality was assessed using the Newcastle-Ottawa Scale.
Results:
A total of 49 unique prospective studies (N=266,939; median proportion of males across studies, 47%) were followed up for 1,837,794 person-years. Compared with people with low levels of physical activity, those with high levels had lower odds of developing depression (adjusted odds ratio=0.83, 95% CI=0.79, 0.88; I2=0.00). Furthermore, physical activity had a protective effect against the emergence of depression in youths (adjusted odds ratio=0.90, 95% CI=0.83, 0.98), in adults (adjusted odds ratio=0.78, 95% CI=0.70, 0.87), and in elderly persons (adjusted odds ratio=0.79, 95% CI=0.72, 0.86). Protective effects against depression were found across geographical regions, with adjusted odds ratios ranging from 0.65 to 0.84 in Asia, Europe, North America, and Oceania, and against increased incidence of positive screen for depressive symptoms (adjusted odds ratio=0.84, 95% CI=0.79, 0.89) or major depression diagnosis (adjusted odds ratio=0.86, 95% CI=0.75, 0.98). No moderators were identified. Results were consistent for unadjusted odds ratios and for adjusted and unadjusted relative risks/hazard ratios. Overall study quality was moderate to high (Newcastle-Ottawa Scale score, 6.3). Although significant publication bias was found, adjusting for this did not change the magnitude of the associations.
Conclusions:
Available evidence supports the notion that physical activity can confer protection against the emergence of depression regardless of age and geographical region.
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