Adherence to Physical Activity Interventions in Major Depressive Disorder: A Systematic Review and Meta-Analysis

Non-adherence is a barrier to the effectiveness of physical activity (PA) interventions for major depressive disorder (MDD). This systematic review and meta-analysis identified reported adherence-related outcomes, compared adherence rates of PA and non-PA interventions in MDD, and determined predictors of adherence.

MEDLINE, APA PsycINFO, CINAHL Plus, and SPORTDiscus were searched until September 5, 2024. Pooled estimated risk differences (RDs) and 95% confidence intervals (CIs) were calculated using fixed-effects or random-effects models. Meta-regression explored predictors of adherence.

Ninety-seven studies were included in this review, and 91 studies in the meta-analysis. Adherence-related outcomes for analyses included rates of intervention receipt, retention, protocol adherence, and session attendance. Retention was the most commonly reported outcome, with no significant difference between PA and non-PA interventions. Similarly, there were no significant differences in intervention receipt and session attendance. However, PA interventions had significantly lower protocol adherence than non-PA interventions (RD = -0.15; 95% CI: -0.23, -0.08). Severe baseline depressive symptoms, longer intervention durations, and in-person delivery predicted retention rates. Longer PA sessions predicted intervention receipt and supervision of activities predicted attendance rates.

Participants with MDD demonstrate lower protocol adherence to PA interventions than to interventions without a PA component. This result was based on a paucity of studies. Rates of intervention receipt, retention, and attendance were comparable in PA and non-PA interventions. Studies could benefit from including individuals with greater depressive symptom severity and supervised activity. With replication, findings could improve the design of, and increase adherence to, PA interventions in MDD.