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Association of Efficacy of Resistance Exercise Training With Depressive SymptomsMeta-analysis and Meta-regression Analysis of Randomized Clinical Trials

Educational Objective
To estimate the association of efficacy of resistance exercise training (RET) with depressive symptoms and determine the extent to which logical, theoretical, and/or prior empirical variables are associated with depressive symptoms and whether the association of efficacy of RET with depressive symptoms accounts for variability in the overall effect size.
1 Credit CME
Key Points

Question  What is the overall association of efficacy of resistance exercise training with depressive symptoms, and which logical, theoretical, and/or prior empirical variables are associated with depressive symptoms?

Findings  In this meta-analysis of 33 clinical trials including 1877 participants, resistance exercise training was associated with a significant reduction in depressive symptoms, with a moderate-sized mean effect. Total volume of resistance exercise training, health status, and strength improvements were not associated with the antidepressant effect; however, smaller reductions in depressive symptoms were derived from trials with blinded allocation and/or assessment.

Meaning  The available empirical evidence supports resistance exercise training as an alternative and/or adjuvant therapy for depressive symptoms.

Abstract

Importance  The physical benefits of resistance exercise training (RET) are well documented, but less is known regarding the association of RET with mental health outcomes. To date, no quantitative synthesis of the antidepressant effects of RET has been conducted.

Objectives  To estimate the association of efficacy of RET with depressive symptoms and determine the extent to which logical, theoretical, and/or prior empirical variables are associated with depressive symptoms and whether the association of efficacy of RET with depressive symptoms accounts for variability in the overall effect size.

Data Sources  Articles published before August 2017, located using Google Scholar, MEDLINE, PsycINFO, PubMed, and Web of Science.

Study Selection  Randomized clinical trials included randomization to RET (n = 947) or a nonactive control condition (n = 930).

Data Extraction and Synthesis  Hedges d effect sizes were computed and random-effects models were used for all analyses. Meta-regression was conducted to quantify the potential moderating influence of participant and trial characteristics.

Main Outcomes and Measures  Randomized clinical trials used validated measures of depressive symptoms assessed at baseline and midintervention and/or postintervention. Four primary moderators were selected a priori to provide focused research hypotheses about variation in effect size: total volume of prescribed RET, whether participants were healthy or physically or mentally ill, whether or not allocation and/or assessment were blinded, and whether or not the RET intervention resulted in a significant improvement in strength.

Results  Fifty-four effects were derived from 33 randomized clinical trials involving 1877 participants. Resistance exercise training was associated with a significant reduction in depressive symptoms with a moderate-sized mean effect ∆ of 0.66 (95% CI, 0.48-0.83; z = 7.35; P < .001). Significant heterogeneity was indicated (total Q = 216.92, df = 53; P < .001; I2 = 76.0% [95% CI, 72.7%-79.0%]), and sampling error accounted for 32.9% of observed variance. The number needed to treat was 4. Total volume of prescribed RET, participant health status, and strength improvements were not significantly associated with the antidepressant effect of RET. However, smaller reductions in depressive symptoms were derived from randomized clinical trials with blinded allocation and/or assessment.

Conclusions and Relevance  Resistance exercise training significantly reduced depressive symptoms among adults regardless of health status, total prescribed volume of RET, or significant improvements in strength. Better-quality randomized clinical trials blinding both allocation and assessment and comparing RET with other empirically supported treatments for depressive symptoms are needed.

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Article Information

Accepted for Publication: February 12, 2018.

Corresponding Author: Brett R. Gordon, MSc, Department of Physical Education and Sport Sciences, University of Limerick, P-1039, The Physical Education and Sport Sciences Bldg, Limerick V94 T9PX, Ireland (brett.gordon@ul.ie).

Published Online: May 9, 2018. doi:10.1001/jamapsychiatry.2018.0572

Author Contributions: Mr Gordon had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Gordon, Herring.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Gordon, McDowell, Herring.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Gordon, McDowell, Meyer, Herring.

Administrative, technical, or material support: McDowell, Hallgren, Herring.

Study supervision: Meyer, Lyons, Herring.

Conflict of Interest Disclosures: None reported.

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