Effects of exercise on depression and anxiety in patients with chronic pain: A systematic review and meta-analysis of randomized controlled trials

Background: Chronic pain encompasses both physiological and psychological dimensions, often manifesting alongside anxiety and depression. Exercise interventions have been identified as potential strategies for addressing these psychological concerns. Accordingly, this meta-analysis seeks to systematically evaluate the effects of exercise on anxiety and depression among individuals with chronic pain. Methods: A comprehensive search across four electronic databases was conducted to identify randomized controlled trials that assessed the impact of exercise interventions on these psychological outcomes. A random-effects model was employed to synthesize the data from the identified studies. Results: The meta-analysis included 28 studies, comprising 2265 participants with chronic pain. Of these, 22 studies contributed to the analysis of anxiety outcomes, while all 28 studies contributed to the analysis of depression outcomes. The findings revealed that anxiety scores in the exercise intervention group were significantly lower than those in the control group [SMD = -0.39, 95 % CI (-0.55, -0.23), P < 0.0011, and depression scores also showed a significant reduction [SMD = -0.33, 95 % CI (-0.44, -0.21), P < 0.0011. Furthermore, notable subgroup differences emerged concerning exercise modalities and types of chronic pain. Conclusions: The meta-analysis findings suggest that exercise interventions can alleviate anxiety and depressive symptoms among chronic pain patients. Further high-quality studies are required to refine the comparison of different exercise modalities across diverse chronic pain populations.