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Introduction
Mental health disorders are among the leading causes of the global health-related burden, with substantial individual and societal costs.1 2 In 2019, one in eight people (970 million) worldwide were affected by a mental health disorder3 and almost one in two (44%) will experience a mental health disorder in their lifetime.4 The annual global costs of mental health disorders have been estimated at $2.5 trillion (USD), which is projected to increase to $6 trillion (USD) by 2030.5 Depression is the leading cause of mental health-related disease burden,6 while anxiety is the most prevalent mental health disorder.3 Additionally, the COVID-19 pandemic has been associated with increased rates of psychological distress, with prevalence ranging between 35% and 38% worldwide.7–9
The role of lifestyle management approaches, such as exercise, sleep hygiene and a healthy diet, varies between clinical practice guidelines in different countries. In US clinical guidelines,10 psychotherapy or pharmacotherapy is recommended as the initial treatment approaches, with lifestyle approaches considered as ‘complementary alternative treatments’ where psychotherapy and pharmacotherapy are ‘ineffective or unacceptable’. In other countries such as Australia, lifestyle management is recommended as the first-line treatment approach,11 12 though in practice, pharmacotherapy is often provided first.
There have been hundreds of research trials examining the effects of physical activity (PA) on depression, anxiety and psychological distress, many of which suggest that PA may have similar effects to psychotherapy and pharmacotherapy (and with numerous advantages over psychotherapy and pharmacotherapy, in terms of cost, side-effects and ancillary health benefits).13–18 Despite the evidence for the benefits of PA, it has not been widely adopted therapeutically. Patient resistance, the difficulty of prescribing and monitoring PA in clinical settings, as well as the huge volume of largely incommensurable studies, have probably impeded a wider take-up in practice.13 14 17
Results Ninety-seven reviews (1039 trials and 128 119 participants) were included. Populations included healthy adults, people with mental health disorders and people with various chronic diseases. Most reviews (n=77) had a critically low A MeaSurement Tool to Assess systematic Reviews score. Physical activity had medium effects on depression (median effect size=−0.43, IQR=−0.66 to –0.27), anxiety (median effect size=−0.42, IQR=−0.66 to –0.26) and psychological distress (effect size=−0.60, 95% CI −0.78 to –0.42), compared with usual care across all populations. The largest benefits were seen in people with depression, HIV and kidney disease, in pregnant and postpartum women, and in healthy individuals. Higher intensity physical activity was associated with greater improvements in symptoms. Effectiveness of physical activity interventions diminished with longer duration interventions.
Conclusion and relevance Physical activity is highly beneficial for improving symptoms of depression, anxiety and distress across a wide range of adult populations, including the general population, people with diagnosed mental health disorders and people with chronic disease. Physical activity should be a mainstay approach in the management of depression, anxiety and psychological distress.
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tldr: Exercise is the most successful intervention for depression, anxiety, and psychological distress, and has virtually no negative side effects.
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