Objective To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions. Design Systematic review and network meta-analysis. Methods Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool. Data sources Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases. Eligibility criteria for selecting studies Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression. Results 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges’ g −0.62, 95% credible interval −0.80 to −0.45), yoga (n=1047, κ=33, g −0.55, −0.73 to −0.36), strength training (n=643, κ=22, g −0.49, −0.69 to −0.29), mixed aerobic exercises (n=1286, κ=51, g −0.43, −0.61 to −0.24), and tai chi or qigong (n=343, κ=12, g −0.42, −0.65 to −0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments. Conclusions Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression. Systematic review registration PROSPERO CRD42018118040.

中文翻译：

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运动对抑郁症的影响：随机对照试验的系统回顾和网络荟萃分析

目的 与心理治疗、抗抑郁药物和对照条件相比，确定治疗重度抑郁症的最佳运动剂量和方式。设计系统回顾和网络荟萃分析。方法 筛选、数据提取、编码和偏倚风险评估均独立进行，一式两份。初步分析采用基于贝叶斯臂的多级网络荟萃分析。使用网络荟萃分析 (CINeMA) 在线工具的置信度对每个组的证据质量进行评级。数据来源 Cochrane Library、Medline、Embase、SPORTDiscus 和 PsycINFO 数据库。选择研究的资格标准 任何针对符合重度抑郁症临床临界值的参与者使用运动臂的随机试验。结果 纳入了 218 项独特研究，共计 495 个组和 14 170 名参与者。与主动对照组（例如常规护理、安慰剂片剂）相比，步行或慢跑的抑郁程度适度减轻（n=1210，κ=51，Hedges' g -0.62，95%可信区间-0.80至-0.45），瑜伽（n=1047，κ=33，g -0.55，-0.73 至 -0.36），力量训练（n=643，κ=22，g -0.49，-0.69 至 -0.29），混合有氧运动（n=1286） ，κ=51，g -0.43，-0.61 至 -0.24），以及太极或气功（n=343，κ=12，g -0.42，-0.65 至 -0.21）。运动的效果与规定的强度成正比。力量训练和瑜伽似乎是最可接受的方式。结果似乎不受发表偏倚影响，但只有一项研究符合 Cochrane 低偏倚风险标准。因此，根据 CINeMA，步行或慢跑的信心很低，而其他治疗的信心也很低。结论 运动是治疗抑郁症的有效方法，步行或慢跑、瑜伽和力量训练比其他运动更有效，尤其是在剧烈运动时。与其他治疗方法相比，瑜伽和力量训练的耐受性良好。运动对于患有和不患有合并症以及具有不同抑郁基线水平的人来说似乎同样有效。为了减轻预期影响，未来的研究可能旨在让参与者和工作人员失明。这些形式的锻炼可以与心理治疗和抗抑郁药物一起视为抑郁症的核心治疗方法。系统审评注册PROSPERO CRD42018118040。