Universität zu Köln

Oberste, Max, Medele, Marie, Javelle, Florian ORCID: 0000-0003-4240-2588, Wunram, Heidrun, Walter, Daniel, Bloch, Wilhelm, Bender, Stephan, Fricke, Oliver, Joisten, Niklas, Walzik, David ORCID: 0000-0002-9577-1435, Grossheinrich, Nicola and Zimmer, Philipp (2020). Physical Activity for the Treatment of Adolescent Depression: A Systematic Review and Meta-Analysis. Front. Physiol., 11. LAUSANNE: FRONTIERS MEDIA SA. ISSN 1664-042X

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Abstract

Background: A noticeable proportion of adolescents with depression do not respond to guideline recommended treatment options. This systematic review and meta-analysis investigated the effectiveness of physical activity interventions as an alternative or complementary treatment for adolescents (12-18 years) with depression. The characteristics of the physical activity treatment that were most effective in reducing symptoms in adolescents with depression and the impact of methodological shortcomings in the existing research were also examined. Methods: Medline, PsycINFO, SPORTDiscus, ProQuest, and CENTRAL were searched for eligible records. Effect size estimates were pooled based on the application of a random-effects model. Potential moderation by physical activity characteristics (i.e., intensity, type, context, and time frame) and methodological features (i.e., type of control group and diagnostic tool to identify depression at baseline) was investigated by means of subgroup analyses and meta-regressions. The certainty of evidence was assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The primary outcome was the antidepressant effect of physical activity at postintervention measurement time point. As secondary outcomes, the sustainability of effects after the end of physical activity treatment and the acceptability of physical activity treatments were assessed. Overall, 10 studies were included in the qualitative synthesis and 9 studies involving 431 patients were included in the quantitative synthesis. Results: A moderate, significant antidepressant effect of physical activity was found (Hedges' g = -0.47, 95% CI = -0.71 to -0.24). Heterogeneity was small (T-2 = 0.0313, I-2 = 27%, p = 0.18). However, the certainty of evidence was downgraded to low because the included studies contained serious methodological limitations. Moderator analyses revealed that session intensity significantly moderated the antidepressant effect of physical activity. Moreover, noticeably smaller effect sizes were found in studies that used non-physical activity sham treatments as control treatments (e.g., playing board games), compared to studies that used no control group treatments. Only three studies assessed the sustainability of effects after the end of physical activity treatment. The results suggest that the antidepressant effects further increase after the end of physical activity interventions. There was no significant difference in dropout risk between the physical activity and control groups. Conclusions: This review suggests that physical activity is effective in treating depression in adolescents. Physical activity sessions should be at least moderately intense [rate of perceived exertion (RPE) between 11 and 13] to be effective. Furthermore, our results suggest that physical activity treatments are well accepted. However, the low methodological quality in included studies might have led to effect overestimation. Therefore, more studies with higher methodological quality are needed to confirm the recommendation for physical activity treatments in adolescents with depression.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Oberste, Max UNSPECIFIED UNSPECIFIED UNSPECIFIED Medele, Marie UNSPECIFIED UNSPECIFIED UNSPECIFIED Javelle, Florian UNSPECIFIED orcid.org/0000-0003-4240-2588 UNSPECIFIED Wunram, Heidrun UNSPECIFIED UNSPECIFIED UNSPECIFIED Walter, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Bloch, Wilhelm UNSPECIFIED UNSPECIFIED UNSPECIFIED Bender, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Fricke, Oliver UNSPECIFIED UNSPECIFIED UNSPECIFIED Joisten, Niklas UNSPECIFIED UNSPECIFIED UNSPECIFIED Walzik, David UNSPECIFIED orcid.org/0000-0002-9577-1435 UNSPECIFIED Grossheinrich, Nicola UNSPECIFIED UNSPECIFIED UNSPECIFIED Zimmer, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-340547
DOI:	10.3389/fphys.2020.00185
Journal or Publication Title:	Front. Physiol.
Volume:	11
Date:	2020
Publisher:	FRONTIERS MEDIA SA
Place of Publication:	LAUSANNE
ISSN:	1664-042X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language EXERCISE; CHILDREN; PREDICTORS; SEVERITY; SYMPTOMS; EFFICACY; THERAPY; SUICIDE; FITNESS; RISK Multiple languages Physiology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/34054