Effect and acceptability of different exercise modes on adult patients with clinically diagnosed depression: a network meta-analysis

The global prevalence of depression continues to rise, making it a leading cause of suicide. Although evidence-based treatments for mental disorders exist, over 75% of affected individuals in low- and middle-income countries lack access to care. Consequently, cost-effective exercise interventions are increasingly recognized as viable therapeutic options. However, conclusive evidence comparing the relative efficacy and acceptability of different exercise modalities for alleviating depressive symptoms remains lacking. Therefore, this study employed a network meta-analysis to directly compare the relative efficacy and acceptability of various exercise interventions for individuals with depression. Adhering to PRISMA-NMA guidelines, a comprehensive literature search was conducted across seven electronic databases (PubMed, Cochrane Library, PsycINFO, Embase, CNKI, MEDLINE, and Web of Science) to identify randomized controlled trials (RCTs) examining exercise interventions for depression.Studies meeting the predefined inclusion criteria were selected for analysis.Methodological quality and risk of bias of the included studies were evaluated using the Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1).The quality of evidence derived from the network meta-analysis was assessed using the Confidence in Network Meta-Analysis (CINeMA) framework. Network meta-analysis was performed using Stata software (version 17.0). The final analysis included 58 articles (encompassing 62 RCTs) with a total of 3,751 participants, evaluating three exercise categories: aerobic exercise, mind-body exercise, and resistance training. All three exercise modalities showed significantly greater antidepressant efficacy than control conditions (routine control, control condition, waiting list), with statistical significance (P < 0.05). Notably, mind-body exercise (SMD: -0.43, 95% CI [-0.82, -0.04], P < 0.05) demonstrated superior efficacy in alleviating adult depression compared to aerobic exercise. The efficacy ranking for depression relief was: mind-body exercise (94.1%) > resistance training (81.0%) > aerobic exercise (63.9%). Regarding acceptability, the ranking was aerobic exercise (67.1%) > mind-body exercise (61.5%) > resistance training (39.3%). Subgroup analysis indicated that mind-body exercise consistently ranked highest in efficacy for depression intervention, regardless of intervention duration. Specifically, mind-body exercise ranked first across all durations: >4 to ≤ 8 weeks (86.9%), > 9 to ≤ 12 weeks (83.2%), and > 12 weeks (98.5%). Mind-body exercises demonstrated superior efficacy relative to other interventions for individuals with depression, yet its acceptability was marginally lower than that of aerobic exercise. Further rigorous studies are necessary to confirm this finding.