Clinical Question

Is an exercise program effective in older patients with depressive symptoms?

Bottom Line

An organized exercise program for older patients, which may include strength training, endurance training, or both, may be helpful for some patients with symptoms of depression. The results will not be striking, but exercise is an option for patients willing to participate. (Level of Evidence = 1a)

Synopsis

The authors searched many databases, including the Cochrane Central Register of Controlled Trials, and reference lists of relevant articles for unpublished and published randomized controlled trials of exercise programs in patients 60 years or older. Two authors independently selected articles for inclusion. One author abstracted the data, which were checked by a second author. The nine studies enrolled a total of 667 patients and used a variety of exercise programs, including endurance and strength training, and tai chi and qigong. Risk of bias was assessed independently by two authors and was low for most studies (except for the studies of tai chi and qigong, which were excluded from the meta-analysis). Publication bias was not formally assessed. Four studies did not clearly analyze results by intention to treat, making it more difficult to extrapolate the results to everyday practice. Exercise programs lowered depression severity scores by a small to medium degree (standardized mean difference = −0.34; 95% confidence interval, −0.52 to −0.17); translated, this means that 13% of the patients in the exercise group did better than expected and had an approximately 20% reduction in the severity of their depression symptoms.

Study design: Meta-analysis (randomized controlled trials)

Setting: Various (meta-analysis)

Funding source: Unknown/not stated

Reference: BridleCSpanjersKPatelSAthertonNMLambSEEffect of exercise on depression severity in older people: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry.2012; 201( 3): 180– 185.