Comparative efficacy of various exercise types and doses for depression in older adults: a systematic review of paired, network and dose–response meta-analyses

OBJECTIVES: We assessed the effects of different exercise modalities and doses on depression levels in older adults. METHODS: Systematic searches of the PubMed, Web of Science, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases were conducted from the start of database construction until December 2023. Studies were included if they were randomised controlled trials (RCTs) of exercise interventions in older adults. Pairwise, network and dose-network meta-analyses were conducted using random-effects models for the outcome of depression in older adults. RESULTS: A total of 80 RCTs with 5536 participants were included in this study. Network meta-analyses showed that resistance exercise [standardized mean difference (SMD) = - 0.68, 95% confidence interval (CI): - 0.90, - 0.46] and mind-body exercise (MBE; SMD = - 0.54, 95% CI: - 0.72, - 0.37) were the most effective forms of exercise for improving depression in older adults, followed by aerobic exercise (SMD = - 0.31, 95% CI: - 0.50, - 0.13) and mixed exercise (SMD = - 0.23, 95% CI: - 44, - 0.01). In addition, a U-shaped dose-response relationship was found between overall exercise dose and depression levels in older adults, and a significant response was seen after 390 metabolic equivalent (MET)-min/week. CONCLUSIONS: Our study determined the effectiveness of different exercises in improving levels of older adults and found that resistance exercise and MBE were more effective adjunctive treatments. By providing the most effective treatments, older adults can reap the benefits of improving depression in older adults at doses lower than the World Health Organization guidelines.