SYSTEMATIC REVIEW article
Front. Psychiatry
Sec. Mood Disorders
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1573557
Effectiveness of different therapeutic measures combined with aerobic exercise as an intervention in patients with depression: a systematic review and network meta-analysis
Provisionally accepted
- Hainan Normal University, Haikou, China
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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) > Placebo Treatment (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.
Keywords: Depression, aerobic exercise, combination therapy, Network meta-analysis, Systematic review
Received: 09 Feb 2025; Accepted: 30 Jun 2025.
Copyright: © 2025 Chen, Li, Zhou, Chen and Kou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Aichun Li, Hainan Normal University, Haikou, China
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