本文由小咖机器人翻译整理

期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-075847

摘要内容如下：

客观

与心理治疗、抗抑郁药和对照条件相比，确定运动治疗重度抑郁症的最佳剂量和方式。

设计

系统综述和网络荟萃分析。

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。对初步分析进行了基于贝叶斯臂的多层次网络荟萃分析。使用网络置信度荟萃分析（CINEMA）在线工具对每组的证据质量进行分级。

数据源

Cochrane图书馆、MEDLINE、EMBASE、SportDiscus和PsycInfo数据库。

选择研究的资格标准

对达到重度抑郁症临床临界值的参与者进行的任何随机试验。

结果

共纳入218项独立研究，共计495个分支和14170名参与者。与积极对照组（如常规护理、安慰剂片剂）相比，散步或慢跑（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）和太极或气功（n=343，κ=12，G-0.42，-0.65至-0.21）。锻炼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。结果似乎对发表偏倚是稳健的，但只有一项研究符合低偏倚风险的Cochrane标准。结果，对于散步或慢跑，与电影一致的信心很低，对于其他治疗，信心也很低。

结论

运动是治疗抑郁症的有效方法，散步或慢跑、瑜伽和力量训练比其他运动更有效，尤其是在剧烈运动时。与其他治疗相比，瑜伽和力量训练的耐受性良好。锻炼似乎对患有和未患有合并症以及具有不同基线抑郁水平的人同样有效。为了减轻预期效应，未来的研究可以针对失明的参与者和工作人员。这些形式的运动可以与心理疗法和抗抑郁药一起作为抑郁症的核心治疗方法。

系统评价注册

普洛斯彼罗CRD42018118040。

英文原文如下：

Abstracts

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.

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