Comparative effects of structured exercise protocols on depression and anxiety symptoms: a network meta-analysis

Area of Science:

• Mental Health
• Exercise Science
• Clinical Psychology

Background:

• Depression and anxiety symptoms significantly impact adult well-being.
• Structured exercise modalities are increasingly recognized for their therapeutic potential.
• A need exists to systematically compare the efficacy of various exercise types for mental health.

Purpose of the Study:

• To systematically compare the intervention effects of eight common structured exercise modalities on depressive and anxiety symptoms in adults.
• To provide evidence-based insights for developing precision exercise prescriptions in mental health.
• To conduct a network meta-analysis to rank the efficacy of different exercise interventions.

Main Methods:

• Systematic literature search across PubMed, Web of Science, Embase, and Cochrane Library up to March 31, 2026.
• Inclusion of 23 randomized controlled trials (1,830 participants) comparing eight exercise modalities.
• Network meta-analysis using standardized mean difference (SMD), node splitting for consistency, and SUCRA for ranking.

Main Results:

• All eight exercise modalities demonstrated significant improvements in depressive and anxiety symptoms compared to control groups.
• Yoga ranked highest in SUCRA for both depression (68.8%) and anxiety (72.2%) symptom improvement.
• No statistically significant differences in efficacy were found between yoga, MICT, and HIIT, suggesting comparable benefits.

Conclusions:

• Exercise modalities, particularly yoga, MICT, and HIIT, are effective in alleviating depression and anxiety symptoms.
• Clinical practice should prioritize individualized exercise selection based on patient-specific factors.
• Further research is needed to validate the independent effects of less-studied modalities like Pilates.