The Effects of Various Types of Physical Exercise on Health Outcomes in Older Adults with Depression: A Systematic Review and Meta-Analysis of Controlled Trials

Background and Purpose. The number of older adults and the occurrence of concomitant health issues continue to grow. One of the most prevalent mental health issues in this population is depression. Physical exercise (PE) is widely acknowledged as a method to alleviate the associated health burdens of aging, including depression; however, there is no collated evidence regarding the effectiveness of specific types of exercise on a range of health outcomes. To address this, we conducted a systematic review to evaluate exercise benefits for this specific subgroup. Methods. An electronic search of five databases was used to retrieve controlled studies investigating health-related outcomes associated with any type of PE, in adults over 65 years with depression. Where possible, data were analyzed in meta-analyses or else reported narratively. Results and Discussion. Fifteen studies were included in the review. All 15 studies had data available for meta-analysis, yet heterogeneity in exercise types and outcome measures limited synthesis. When data for all types of exercise were pooled together, significant improvements were found in depression (SMD=0.52; CI=0.07,0.97; p=0.02), physical health and function (SMD=0.44, CI=0.14,0.74; p=0.004), anxiety (SMD=0.23; CI=0.04,0.42; p=0.02), and self-efficacy (SMD=0.97; CI=0.32,1.61; p=0.003). When data were pooled according to exercise type, positive effects were demonstrated for aerobic exercise on depression (SMD=0.49; CI=-0.16,0.8; p=0.003), tai chi/qigong on depression (SMD=0.89; CI=-0.14,1.63; p=0.02), and self-efficacy (SMD=6.70; CI=-0.90,12.50; p=0.02) and multicomponent exercise demonstrated positive effects on physical function (SMD=0.49; CI=0.12,0.87; p=0.009) and the physical health component of quality of life (SMD=0.88; CI=0.10,1.65; p=0.03). No health-related benefits were revealed from the combined findings of the two studies investigating strengthening exercises. Conclusion. Lack of consistency regarding exercise types, dosage, and outcomes presents challenges in the evidence. In general, exercise is beneficial across a range of health-related variables. Multicomponent, aerobic, and tai chi forms of exercise appear most likely to reap benefits in depressed older adults; however, the type of benefit is determined by the type of exercise and should be considered when recommending a regime. This trial is registered with CRD42020173465.