Effectiveness of Exercise-Based Interventions on Depressive Symptoms in Older Adults: A Systematic Review and Network Meta-Analysis

Objective

To compare and rank the effectiveness of exercise-based interventions for improving depressive symptoms in older adults.

Design

Systematic review with a network meta-analysis of randomized controlled trials.

Setting and Participants

Older adults.

Methods

Eleven databases were systematically searched from inception to March 16, 2024, and the search was last updated August 21, 2024. Randomized controlled trials which examined the effectiveness of exercise-based interventions for older adults were included. Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Random effect network meta-analysis within a frequentist framework was conducted for the primary analyses. A protocol for this systematic review was registered in the International Prospective Register of Systematic Review (registration number CRD42024542830).

Results

A total of 65 studies with 5536 participants were included in the network meta-analysis. Compared with waitlist controls and active controls, positive effects on depression symptoms were found for exercises (standardized mean difference [SMD], −0.69; 95% CI, 0.90 to −0.48; P < .001; SMD, −0.42; 95% CI, 0.48 to −0.36; P < .001). Pairwise analysis indicated that there were statistically significant differences between exercise types: neuromotor exercise vs waitlist control (SMD, −0.82; 95% CI, 1.57 to −0.07), aerobic exercise vs active control (SMD, −0.67; 95% CI, 1.05 to −0.28), flexibility exercise vs active control (SMD, −0.76; 95% CI, 1.46 to −0.06), neuromotor exercise vs active control (SMD, −0.86; 95% CI, 1.34 to −0.38), and multicomponent exercise vs active control (SMD, −0.58; 95% CI, 1.03 to −0.14). However, there were no statistically significant differences between exercise types: flexibility exercise vs waitlist control, aerobic exercise vs waitlist control, multicomponent exercise vs waitlist control, resistance vs waitlist control, resistance vs active control, and any 2 comparisons of the 5 exercise types. Neuromotor exercise training appeared to have the highest probability of being the most effective exercise type in improving depressive symptoms with a surface under cumulative ranking (SUCRA) value of 82.7%, followed by flexibility exercise (SUCRA, 71.8%; mean rank, 2.7), aerobic exercise (SUCRA, 66.4%; mean rank, 3.0), multicomponent exercise (SUCRA, 58.5%; mean rank, 3.5), and resistance exercise (SUCRA, 42.4%; mean rank, 4.5). Results appeared robust to publication bias; however, 2 studies met the Cochrane criteria for high risk of bias. The confidence in accordance with Confidence in Network Meta-Analysis was very low to moderate.

Conclusions and Implications

Exercise-based interventions have proven to be an effective treatment for depressive symptoms, with neuromotor exercise training showing the highest likelihood of being the most effective type of exercise for improving depressive symptoms, followed by flexibility, aerobic, multicomponent, and resistance exercise. However, because of higher attrition rates, a limited number of studies, and loop inconsistency, the conclusion regarding effectiveness should be interpreted with caution.