Optimal modalities and doses of mind–body exercise for depressive symptoms in adults: A systematic review of paired analyses, network analyses and dose–response meta-analyses

Abstract

The relative efficacy of various mind–body exercises in the treatment of depressive symptoms remains uncertain. We examined the optimal modalities (Tai Chi, qigong, yoga) and dose of mind–body exercise to improve depressive symptoms in adults. A systematic search of six electronic databases for randomized controlled trials on the relationship between exercise and depression was carried out, encompassing data from their inception up to November 2023. Pairwise analyses, network analyses and dose–response meta-analyses using random-effects models were performed to analyse the effect of exercise on depression. Forty studies were included. Results showed that Yoga [standardised mean difference (SMD) = −0.55; 95% confidence interval (CI): (−0.76, −0.35)] was the most effective form of exercise for improving depressive symptoms, followed by Qigong (SMD = −0.52; 95%CI: −0.92, −0.11) and Tai Chi exercise (SMD = −0.42; 95%CI: −0.71, −0.13). In addition, a non-linear dose–response relationship was found between overall mind–body exercise dose and depression levels and a significant response was observed after 260 METs-min. Our study examined the effectiveness of different types of mind–body exercise in improving depression and found that yoga may be the most effective adjunctive intervention. There was a non-linear dose–response relationship between total exercise and depression levels. However, caution should be exercised in interpreting and applying these results.