New Analysis Shows Exercise Can Alleviate Symptoms of Depression in Children and Adolescents

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Physical activity interventions were associated with significant reductions in depressive symptoms compared with control conditions in children and adolescents, according to new research published in JAMA Pediatrics.

Greater reductions in depressive symptoms were observed in participants aged ≥13 years and in those with a mental illness and/or depression diagnosis.

“The findings of this systematic review and meta-analysis strengthen the role of physical activity for depressive symptom management and highlight the potential of structured physical education programs in primary and secondary schools for improving the mental health of children and adolescents,” wrote first author Francesco Recchia, MSc, Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China, and colleagues.

Depression is the second most prevalent mental disorder among children and adolescents; however, pediatric depression is often underdiagnosed and untreated. Research shows that only 50% of children and adolescents with depression receive an adequate diagnosis before they reach adulthood, noted the research team. Moreover, the incidence of depressive symptoms at a young age is a strong predictor of future mental health disorders.

Physical activity interventions, such as running and jumping, hold promise as complementary or alternative treatments for depression in children and adolescents. Recchia and colleagues aimed to identify a wide range of studies to provide critical insight into the association between exercise and depressive symptoms in youth. Further, they examined possible participant- and trial-related characteristics that might moderate the overall treatment effect.

Investigators searched PubMed, PsychINFO, and other databases for studies that assessed the effects of aerobic-type physical activity interventions on depressive symptoms in children and adolescents aged <19 years compared with a control condition (eg, no treatment, waiting list, education/attention control, or treatment as usual). Researchers performed a random-effects meta-analysis using Hedges g and used meta-regressions and sensitivity analyses to substantiate the overall findings.

The primary outcome was depressive symptoms as measured by validated depression scales at postintervention and follow-up. Overall, 21 studies involving 2441 participants (47% boys, 53% girls) were included in the analysis. At baseline, the mean age of participants was 14 years.

The mean duration of the prescribed physical activity program was 22 weeks and the frequency of the exercise sessions ranged from 2 to 5 days per week, with 3 days each week being the most used frequency. The mean duration of the physical activity sessions was 50 minutes, and most were fully supervised (16 studies), with 2 studies not reporting any supervision.

When the research team conducted a meta-analysis of the postintervention differences, they found that physical activity was associated with a reduction in depressive symptoms compared with the control condition (g=-0.29, 95% CI, -0.47 to -0.10; P=.004).

An analysis of the follow-up outcomes in 4 studies showed no differences between the physical activity cohorts and control groups (g=-0.39, 95% CI, -1.01 to 0.24; P=.14). The primary moderator analysis—which accounted for total physical activity volume, study design, participant health status, and allocation and/or assessment concealment—did not moderate the main treatment effect, according to the study results.

Secondary analyses demonstrated that 3 physical activity sessions per week and interventions that were <12 weeks in duration induced greater benefits on depressive symptoms compared with other frequencies and durations. The investigators also found that reductions in depressive symptoms were greater in participants aged ≥13 years and in those with a mental illness and/or depression diagnosis at baseline.

“We found differences in the effect sizes of studies involving female-only participants and studies with unsupervised interventions compared with studies on both males and females and studies with supervised or partially supervised interventions,” noted authors. “These findings are surprising and may be attributed to a discrepancy among the number of studies used to assess each moderator.”

Limitations of the current study were that investigators did not screen for study quality in the inclusion criteria, so poorly conducted studies may have influenced the results. Also, information on the blinding of participants and assessors, exercise intensity, exercise type, and degree of supervision was often excluded and had to be obtained from the article, requested from authors, or absent from the analyses.

“Future studies should investigate the influence of physical activity parameters such as frequency, duration, and supervision of the sessions to determine the optimal dose and mode of delivery of the intervention for depressive symptom management,” concluded Recchia et al.

Reference: Recchia F, Bernal JDK, Fong DY, et al. Physical activity interventions to alleviate depressive symptoms in children and adolescents: A systematic review and meta-analysis. JAMA Pediatr. 2023;177:132-140.