Exercise in prevention and treatment of anxiety and depression among children and young people

BACKGROUND: Depression and anxiety are common psychological disorders for children and adolescents. Psychological (e.g. psychotherapy), psychosocial (e.g. cognitive behavioral therapy) and biological (e.g. SSRIs or tricyclic drugs) treatments are the most common treatments being offered. The large variety of therapeutic interventions give rise to questions of clinical effectiveness and side effects. Physical exercise is inexpensive with few, if any, side effects. OBJECTIVES: To assess the effects of exercise interventions in reducing or preventing anxiety or depression in children and young people up to 20 years of age. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (latest issue available), MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC and Sportdiscus up to August 2005. SELECTION CRITERIA: Randomised trials of vigorous exercise interventions for children and young people up to the age of 20, with outcome measures for depression and anxiety. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion, assessed methodological quality and extracted data. The trials were combined using meta-analysis methods. A narrative synthesis was performed when the reported data did not allow statistical pooling. MAIN RESULTS: Sixteen studies with a total of 1191 participants between 11 and 19 years of age were included.Eleven trials compared vigourous exercise versus no intervention in a general population of children. Six studies reporting anxiety scores showed a non-significant trend in favour of the exercise group (standard mean difference (SMD) (random effects model) -0.48, 95% confidence interval (CI) -0.97 to 0.01). Five studies reporting depression scores showed a statistically significant difference in favour of the exercise group (SMD (random effects model) -0.66, 95% CI -1.25 to -0.08). However, all trials were generally of low methodological quality and they were highly heterogeneous with regard to the population, intervention and measurement instruments used. One small trial investigated children in treatment showed no statistically significant difference in depression scores in favour of the control group (SMD (fixed effects model) 0.78, 95% CI -0.47 to 2.04). No studies reported anxiety scores for children in treatment. Five trials comparing vigorous exercise to low intensity exercise show no statistically significant difference in depression and anxiety scores in the general population of children. Three trials reported anxiety scores (SMD (fixed effects model) -0.14, 95% CI -0.41 to 0.13). Two trials reported depression scores (SMD (fixed effects model) -0.15, 95% CI -0.44 to 0.14). Two small trials found no difference in depression scores for children in treatment (SMD (fixed effects model) -0.31, 95% CI -0.78 to 0.16). No studies reported anxiety scores for children in treatment. Four trials comparing exercise with psychosocial interventions showed no statistically significant difference in depression and anxiety scores in the general population of children. Two trials reported anxiety scores (SMD (fixed effects model) -0.13, 95% CI -0.43 to 0.17). Two trials reported depression scores (SMD (fixed effects model) 0.10, 95% CI-0.21 to 0.41). One trial found no difference in depression scores for children in treatment (SMD (fixed effects model) -0.31, 95% CI -0.97 to 0.35). No studies reported anxiety scores for children in treatment. AUTHORS' CONCLUSIONS: Whilst there appears to be a small effect in favour of exercise in reducing depression and anxiety scores in the general population of children and adolescents, the small number of studies included and the clinical diversity of participants, interventions and methods of measurement limit the ability to draw conclusions. It makes little difference whether the exercise is of high or low intensity. The effect of exercise for children in treatment for anxiety and depression is unknown as the evidence base is scarce.