August 4, 2025Open Access

Effectiveness of different therapeutic measures combined with aerobic exercise as an intervention in patients with depression: a systematic review and network meta-analysis

Key Points

Combined aerobic exercise interventions are more effective than monotherapy in treating depression.
The study included 37 randomized controlled trials with a total of 3,362 patients diagnosed with depression.
The strongest therapeutic combination was found to be SSRI combined with aerobic exercise, based on multiple depression scales.
Findings highlight the need for further high-quality studies to validate the effectiveness of other aerobic exercise combinations.

Abstract

Background Aerobic exercise (AE), as a non-pharmacological therapy, is an effective supplement to conventional depression treatments. However, a comprehensive assessment of combined AE interventions remains insufficient. This study aims to systematically evaluate the intervention effects of different therapies combined with AE in depression patients via network meta-analysis (NMA). Methods Following the PICOS framework, literature was searched in PubMed, Web of Science, Cochrane Library, Embase, Scopus, CNKI, Wanfang, and CBM for randomized controlled trials (RCTs) until June 2024. Independent screening and data extraction were conducted. NMA utilized Stata 15.0 and R 4.4.1, with bias risk assessed by the Cochrane Risk of Bias tool and evidence quality assessed by CINeMA. Results A total of 37 RCTs involving 3,362 patients with depression were included, evaluating five combined AE interventions. Results based on the area under the cumulative ranking curve indicated: (1) Hamilton Depression Rating Scale (HAMD): Electroconvulsive therapy + AE (ECT+AE) repetitive transcranial magnetic stimulation + AE (rTMS+AE) Traditional Chinese Medicine + AE (TCM+AE) Selective Serotonin Reuptake Inhibitors + AE (SSRI+AE) Cognitive Behavioral Therapy + AE (CBT+AE) Physical Therapy (PT) Exercise (EX) CBT TCM Control Treatment (CT); (2) Beck Depression Inventory (BDI): SSRI+AE ECT+AE CBT+AE EX CBT CT PT; (3) Self-rating Depression Scale (SDS): TCM+AE CBT+AE CT CBT. Conclusions Current evidence suggests that combined aerobic exercise interventions are superior to monotherapy in the treatment of depression. Of these, SSRI+AE is the most recommended combination, with strong RCT evidence and high-quality evidence ratings. For other AE combination therapies, further validation in large, high-quality trials is necessary in the future. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD42024594873.

Effectiveness of different therapeutic measures combined with aerobic exercise as an intervention in patients with depression: a systematic review and network meta-analysis

Key Points

Abstract

Cite This Study

Also Consider

Also Consider