Intervention effects of multiple exercise methods on depression and anxiety in children and adolescents: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Song ^1,2 ,  LIU Mingyi ^1,2 , JING Yan ¹

1. Youth Sports and Integration of Sport and Education Public Policy Research Center, Wuhan Sports University, Wuhan 430079, P. R. China;
2. College of sports trainin , Wuhan Sports University , Wuhan 430079, P. R. China;

Corresponding author：

LIU Mingyi, Email: mingyi84@aliyun.com

Keywords：

Exercise; Ahildren and adolescents; Depression; Anxiety; Network meta-analysis

DOI：

10.7507/1672-2531.202307091

Video：

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Objective To compare the effects of aerobic exercise, resistance exercise, aerobic combined with resistance exercise, routine nursing and no intervention on depression and anxiety in adolescents by means of network meta-analysis. Methods A computer search was conducted in CNKI, WanFang Data, VIP, CBM, Web of Science, EBSCO, PubMed, Cochrane Library and Embase to collect randomized controlled trials (RCTs) related to exercise intervention for depression and anxiety in children and adolescents from the establishment of the database to April 2023. After two researchers independently screened the literature, extracted data and evaluated the methodological quality of the included studies, Stata 14.0 and RevMan 5.3 software were used for statistical analysis. Results Finally 27 randomized controlled trials were included, covering 3 210 children and adolescents. The results of the network meta-analysis showed that in terms of improving depression, resistance exercise (SMD=−0.37, 95%CI −0.64 to −0.10, P<0.05) and aerobic exercise (SMD=−0.19, 95%CI −0.34 to −0.04, P<0.01) were significantly better than the no intervention group; in relieving anxiety, aerobic exercise (SMD=−0.29, 95%CI −0.54 to −0.03, P<0.05) was significantly better than the no intervention group. In improving self-worth, aerobic combined with resistance exercise (SMD=0.26, 95%CI 0.01 to 0.52, P<0.05) was statistically different from the no intervention group. The results of SUCRA probability sequence showed that in reducing depression, resistance exercise (95.0%) > aerobic exercise (64.4%) > aerobic combined with resistance exercise (60.7%) > routine nursing (22.9%) > no intervention (7.0%). In relieving anxiety, aerobic exercise (72.4%) > routine nursing (69.0%) > aerobic combined with resistance exercise (55.3%) > no intervention (3.4%). In improving self-worth, aerobic combined with resistance exercise (94.0%) > resistance exercise (67.3%) > aerobic exercise (35.1%) > no intervention (32.7%) > routine nursing (21.0%). Conclusion Limited evidence suggests that resistance exercise has advantages in improving depression in children and adolescents, aerobic exercise has advantages in relieving anxiety in children and adolescents, and aerobic combined with resistance exercise has advantages in improving self-worth in children and adolescents. Due to the limitation of the number and quality of included studies, more high-quality studies are needed to verify the above conclusions.

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2. World Health Organization. Mental Disorders. 2022.
3. Charlson F, van Ommeren M, Flaxman A, et al. New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet, 2019, 394(10194): 240-248.
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6. Li F, Cui Y, Li Y, et al. Prevalence of mental disorders in school children and adolescents in China: diagnostic data from detailed clinical assessments of 17, 524 individuals. J Child Psychol Psychiatry, 2022, 63(1): 34-46.
7. 傅小兰, 张侃. 《我国老年人的心理健康现状》蓝皮书. 保健与生活, 2021(17): 48-49.
8. Lu J, Xu X, Huang Y, et al. Prevalence of depressive disorders and treatment in China: a cross-sectional epidemiological study. Lancet Psychiatry, 2021, 8(11): 981-990.
9. Guideline Development Panel for the Treatment of Depressive Disorders. Summary of the clinical practice guideline for the treatment of depression across three age cohorts. Am Psychol, 2022, 77(6): 770-780.
10. MacQueen GM, Frey BN, Ismail Z, et al. Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 6. Special populations: youth, women, and the elderly. Can J Psychiatry, 2016, 61(9): 588-603.
11. 张佩, 夏勉. 抑郁症患者的服药依从性及影响因素. 心理科学进展, 2015, 34(6): 1009-1020.
12. Strawn JR, Mills JA, Poweleit EA, et al. Adverse effects of antidepressant medications and their management in children and adolescents. Pharmacotherapy, 2023, 43(7): 675-690.
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14. Patel V, Chisholm D, Parikh R, et al. Addressing the burden of mental, neurological, and substance use disorders: key messages from disease control priorities, 3rd edition. Lancet, 2016, 387(10028): 1672-1685.
15. Schuch FB, Vancampfort D, Richards J, et al. Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J Psychiatr Res, 2016, 77: 42-51.
16. Kvam S, Kleppe CL, Nordhus IH, et al. Exercise as a treatment for depression: a meta-analysis. J Affect Disord, 2016, 202: 67-86.
17. Stubbs B, Vancampfort D, Hallgren M, et al. EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and position statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH). Eur Psychiatry, 2018, 54: 124-144.
18. 刘阳, 李雪宁, 王协顺, 等. 新型冠状病毒肺炎疫情期间运动干预对居家学生负面情绪调节自我效能感的中介作用. 北京体育大学学报, 2020, 43(3): 76-83.
19. 姜媛, 张力为, 毛志雄. 体育锻炼与心理健康: 情绪调节自我效能感与情绪调节策略的作用. 心理与行为研究, 2018, 16(4): 570-576.
20. Knapen J, Van de Vliet P, Van Coppenolle H, et al. Comparison of changes in physical self-concept, global self-esteem, depression and anxiety following two different psychomotor therapy programs in nonpsychotic psychiatric inpatients. Psychother Psychosom, 2005, 74(6): 353-361.
21. Tapia-Arancibia L, Rage F, Givalois L, et al. Physiology of BDNF: focus on hypothalamic function. Front Neuroendocrinol, 2004, 25(2): 77-107.
22. Trejo JL, Llorens-Martín MV, Torres-Alemán I. The effects of exercise on spatial learning and anxiety-like behavior are mediated by an IGF-I-dependent mechanism related to hippocampal neurogenesis. Mol Cell Neurosci, 2008, 37(2): 402-411.
23. Hortobágyi T, Vetrovsky T, Balbim GM, et al. The impact of aerobic and resistance training intensity on markers of neuroplasticity in health and disease. Ageing Res Rev, 2022, 80: 101698.
24. Smith PJ, Merwin RM. The role of exercise in management of mental health disorders: an integrative review. Annu Rev Med, 2021, 72: 45-62.
25. Philippot A, Dubois V, Lambrechts K, et al. Impact of physical exercise on depression and anxiety in adolescent inpatients: a randomized controlled trial. J Affect Disord, 2022, 301: 145-153.
26. Schmitter M, Spijker J, Smit F, et al. Exercise enhances: study protocol of a randomized controlled trial on aerobic exercise as depression treatment augmentation. BMC Psychiatry, 2020, 20(1): 585.
27. 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(2): 132-140.
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