Optimal exercise modality and dose to improve depression in children and adolescents: a systematic review and...

To determine the comparative efficacy of different exercise interventions on depressive symptoms in children and adolescents and to explore the precise non-linear dose-response relationship using Bayesian model-based network meta-analysis.

A systematic search of four major databases (PubMed, Web of Science, PsycINFO, and Scopus) was conducted up to October 2024 for randomized controlled trials (RCTs). We employed pairwise, network, and dose-response meta-analyses to synthesize evidence regarding exercise modalities and dosage. Risk of bias was assessed using the Cochrane tool.

A total of 26 RCTs involving 3,507 participants were included. Network meta-analysis revealed that Group Training (SMD = -1.58, 95% CI: -2.54 to -0.62) and Aerobic Exercise (SMD = -0.60, 95% CI: -1.10 to -0.10) were effective interventions for alleviating depressive symptoms. In contrast, no statistically significant effects were observed for Mixed Training or Mind-Body Exercise, and the evidence for these modalities remained inconclusive. Dose-response modeling indicated a nonlinear curvilinear pattern rather than evidence of symptom worsening at higher doses. The minimum dose associated with a statistically significant effect was 360 METs-min/week, the estimated peak benefit occurred at 660 METs-min/week, and the effect attenuated and became statistically uncertain beyond 980 METs-min/week.

Group Training and Aerobic Exercise are the optimal intervention modalities, demonstrating high therapeutic potency and intervention efficiency, respectively. The identified therapeutic window (360-980 METs-min/week) supports a "low-dose initiation and moderation" prescription strategy. However, due to the heterogeneity of the included studies, these findings should be interpreted with caution, and future high-quality trials are warranted.

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024596771, Registration number: CRD42024596771.