Summary of findings
| Exercise compared with control or treatment as usual for depression Patient or population: depression Setting: inpatients or outpatients Intervention: exercise Comparison: control or treatment as usual | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with control or treatment as usual | Risk with exercise | |||||
| Severity of depression | - | 0.66 SMD lower (0.46 lower to 0.86 lower) | – | 2498 (35 RCTs) | ⨁◯◯◯ Very low† | Lower depression scores indicate improvement. SMD of 0.3 is considered clinically relevant. |
| Lack of remission | Study population | RR 0.78 (0.68 to 0.90) | 1639 (19 RCTs) | ⨁◯◯◯ Very low‡ | Remission is, with minor variations, defined as not fulfilling the criteria for depression. | |
| 646 per 1000 | 504 per 1000 (426 to 594) | |||||
| Serious adverse events | Study population | RR 2.21 (0.24 to 20.21) | 335 (3 RCTs) | ⨁⨁◯◯ Low§ | ||
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| Quality of life | – | 0.40 SMD higher (0.03 lower to 0.83 higher) | – | 827 (9 RCTs) | ⨁◯◯◯ Very low¶ | Quality of life was assessed using a number of different methods. Higher score indicates improved quality of life. Seven of 24 trials reported on this outcome. |
| Depression severity after the intervention | – | 0.06 SMD lower (0.25 lower to 0.14 higher) | – | 713 (7 RCTs) | ⨁⨁◯◯ Low** | Lower depression scores indicate improvement. SMD of 0.3 is considered clinically relevant. |
| Lack of remission after the intervention | Study population | RR 0.95 (0.82 to 1.11) | 777 (5 RCTs) | ⨁⨁◯◯ Low†† | ||
| 469 per 1000 | 446 per 1000 (385 to 521) | |||||
| Depression severity. Restricted to trials with less than high risk of bias | – | 0.11 SMD lower (0.41 lower to 0.18 higher) | – | 530 (4 RCTs) | ⨁⨁◯◯ Lo‡‡ | Lower depression scores indicate improvement. SMD of 0.3 is considered clinically relevant. |
GRADE Working Group grades on evidence: high quality: we are very confident that the true effect lies close to that of the estimate of the effect; moderate quality: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different; low quality: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect; very low: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of the effect.
†Downgraded by 3: risk of bias, inconsistency and publication bias.
‡Downgraded by 3: risk of bias, inconsistency and publication bias.
§Downgraded by 2: imprecision and publication bias.
Downgraded by 3: risk of bias, inconsistency and imprecision.
**Downgraded by 2: risk of bias and imprecision.
††Downgraded by 2: risk of bias and imprecision.
‡‡Downgraded by 2: inconsistency and imprecision.
**The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
RCT, randomised clinical trial; RR, risk ratio; SMD, standardised mean difference.