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Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies
Open accessAbstract
OBJECTIVE: The authors examined the prospective relationship between physical activity and incident depression and explored potential moderators. METHOD: Prospective cohort studies evaluating incident depression were searched from database inception through Oct. 18, 2017, on PubMed, PsycINFO, Embase, and SPORTDiscus. Demographic and clinical data, data on physical activity and depression assessments, and odds ratios, relative risks, and hazard ratios with 95% confidence intervals were extracted. Random-effects meta-analyses were conducted, and the potential sources of heterogeneity were explored. Methodological quality was assessed using the Newcastle-Ottawa Scale. RESULTS: =0.00). Furthermore, physical activity had a protective effect against the emergence of depression in youths (adjusted odds ratio=0.90, 95% CI=0.83, 0.98), in adults (adjusted odds ratio=0.78, 95% CI=0.70, 0.87), and in elderly persons (adjusted odds ratio=0.79, 95% CI=0.72, 0.86). Protective effects against depression were found across geographical regions, with adjusted odds ratios ranging from 0.65 to 0.84 in Asia, Europe, North America, and Oceania, and against increased incidence of positive screen for depressive symptoms (adjusted odds ratio=0.84, 95% CI=0.79, 0.89) or major depression diagnosis (adjusted odds ratio=0.86, 95% CI=0.75, 0.98). No moderators were identified. Results were consistent for unadjusted odds ratios and for adjusted and unadjusted relative risks/hazard ratios. Overall study quality was moderate to high (Newcastle-Ottawa Scale score, 6.3). Although significant publication bias was found, adjusting for this did not change the magnitude of the associations. CONCLUSIONS: Available evidence supports the notion that physical activity can confer protection against the emergence of depression regardless of age and geographical region.
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“Furthermore, physical exercise for approximately 45 minutes per day can significantly reduce the risk of MDD. 320 , 321”
From Major depressive disorder: hypothesis, mechanism, prevention and treatment (2024) · cites this paper as [321]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Finally, self-reported physical activity or exercise interventions may have potential beneficial effects to lower the incidence of depression20 and lower the severity of obstructive sleep apnea and associated comorbidities21.”
From Association of step counts over time with the risk of chronic disease in the All of Us Research Program (2022) · cites this paper as [20]
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“There are recent large-scale observational [18] and Mendelian randomisation studies [124] suggesting that higher levels of PA can confer protection against mental disorders.”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [18]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Adjusting for baseline depressive symptoms, body mass index, smoking status, age, gender and other confounds did not alter the findings.”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [29]
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“and in children/adolescents (n=3, OR=0.907, 95% CI: 0.836-0.985), adults (n=16, OR=0.787, 95% CI: 0.707-0.877) or older adults (n=16, OR=0.794, 95% CI: 0.726-0.868).”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [29]
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“Although there was indication of publication bias, adjusting for this did not alter overall findings (OR=0.85, 95% CI: 0.81-0.89).”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [29]
In the citing paper
“Longitudinal studies show that this association is bidirectional, 241,242 but with a stronger time-lagged association of marital discord predicting depressive symptoms than viceversa. 243”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [242]
In the citing paper
“The risk of incident depression is estimated to be 21% lower in older adults who engage in PA, especially at moderate to vigorous intensities [442,443].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [443]
In the citing paper
“The risk of incident depression is estimated to be 21% lower in older adults who engage in PA, especially at moderate to vigorous intensities [442,443].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [443]
In the citing paper
“a recent meta-analysis of 49 prospective studies across nearly 267,000 individuals demonstrated that higher levels of PA associated with reduced odds of developing depression [odds ratio (OR) = 0.83, 95% confidence interval (CI) 0.79–0.88] across age groups (2).”
From The Role of Exercise in Management of Mental Health Disorders: An Integrative Review (2021) · cites this paper as [2]
In the citing paper
“Meta-analyses of prospective cohort studies showed that physical activity had a protective effect against the future onset of depression [17], while sedentary time increased the risk of depression [18].”
From Digital Biomarkers for Depression Screening With Wearable Devices: Cross-sectional Study With Machine Learning Modeling (2021) · cites this paper as [17]
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Self-citationFeter, N., Caputo, E., Doring, I. R., Leite, J. S., Cassuriaga, J., Reichert, F., Silva, M. D. D., Coombes, J., & Rombaldi, A. (2020) · Public Health · doi:10.1016/j.puhe.2020.11.013 · Cited by 108
Hallgren, M. Å., Nguyen, T.-T.-D., Owen, N. G., Stubbs, B., Vancampfort, D., Lundin, A., Dunstan, D. W., Bellocco, R., & Lagerros, Y. T. (2019) · The British Journal of Psychiatry · doi:10.1192/bjp.2019.60 · Cited by 134
“2,29 Taken together, and seen in the context of existing research, these findings suggest potential mental health benefits of replacing passive sedentary behaviours with moderate-to-vigorous physical activity.”
Self-citationThe impact of exercise on depression: how moving makes your brain and body feel better
Hossain, M. N., Lee, J., Choi, H., Kwak, Y.-S., & Kim, J. (2024) · Physical Activity and Nutrition · doi:10.20463/pan.2024.0015 · Cited by 137
“Moreover, the high cost of medication and the risk of addiction and dependency are concerns associated with antidepressant medication 2 .”
BackgroundPhysical activity and the prevention of depression: A cohort study
Kim, S. Y., Park, J., Lee, M. Y., Oh, K., Shin, D., & Shin, Y.-C. (2019) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2019.07.010 · Cited by 135
Vancampfort, D., Stubbs, B., Firth, J., Damme, T. V., & Koyanagi, A. (2018) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-018-0708-y · Cited by 129
Self-citationHallgren, M. Å., Owen, N. G., Stubbs, B., Zeebari, Z., Vancampfort, D., Schuch, F. B., Bellocco, R., Dunstan, D. W., & Lagerros, Y. T. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.08.020 · Cited by 131
Self-citationPhysical activity and mental health
Stubbs, B., Vancampfort, D., Smith, L., Rosenbaum, S., Schuch, F. B., & Firth, J. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30343-2 · Cited by 118
Self-citationPhysical Activity and Mental Health in Undergraduate Students
Rodríguez‐Romo, G., Acebes-Sánchez, J., García-Merino, S., Muñoz, M. G., Blanco-García, C., & Díez-Vega, I. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20010195 · Cited by 164
“the other hand, two meta-analyses conclude that PA can confer protection against the emergence of depression [14,15].”
BackgroundImboden, C., Gerber, M., Beck, J., Holsboer-Trachsler, E., Pühse, U., & Hatzinger, M. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.07.052 · Cited by 111
Associations of physical activity with positive mental health: A population-based study
Tamminen, N., Reinikainen, J., Appelqvist‐Schmidlechner, K., Borodulin, K., Mäki-Opas, T. E., & Solin, P. (2020) · Mental health and physical activity · doi:10.1016/j.mhpa.2020.100319 · Cited by 111
Wanjau, M. N., Möller, H., Haigh, F., Milat, A., Hayek, R., Lucas, P., & Veerman, J. L. (2023) · AJPM Focus · doi:10.1016/j.focus.2023.100074 · Cited by 111
Efficacy of Regular Exercise During Pregnancy on the Prevention of Postpartum Depression
Coll, C. V. N., Domingues, M. R., Stein, A. L., da Silva, B. G. C., Bassani, D. G., Hartwig, F. P., Crochemore‐Silva, I., da Silveira, M. F., da Silva, S. G., & Bertoldi, A. D. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2018.6861 · Cited by 108
Lifestyle Behavior and Mental Health in Early Adolescence
Loewen, O. K., Maximova, K., Ekwaru, J. P., Faught, E. L., Asbridge, M., Öhinmaa, A., & Veugelers, P. J. (2019) · PEDIATRICS · doi:10.1542/peds.2018-3307 · Cited by 105
Zhao, Y., Liu, Y., Sahakian, B. J., Langley, C., Zhang, W., Kuo, K., Li, Z., Gan, Y., Li, Y., Zhao, Y. W., et al. (2023) · Nature Mental Health · doi:10.1038/s44220-023-00120-1 · Cited by 103
Deng, C.-H., Wang, J.-Q., Zhu, L.-M., Liu, H.-W., Guo, Y., Peng, X., Shao, J., & Xia, W. (2020) · Journal of Medical Internet Research · doi:10.2196/21301 · Cited by 100
“Strong evidence from a meta-analysis supported that exercise can protect populations from depression regardless of age and geographical region [28], which may also apply to the COVID-19 pandemic.”
BackgroundBriguglio, M., Vitale, J. A., Galentino, R., Banfi, G., Dina, C. Z., Bona, A. R., Panzica, G., Porta, M., Dell’Osso, B. M., & Glick, I. D. (2020) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s229206 · Cited by 118
Ashdown‐Franks, G., Stubbs, B., Koyanagi, A., Schuch, F. B., Firth, J., Veronese, N., & Vancampfort, D. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.09.036 · Cited by 98
Self-citationPhysical activity and prevention of mental health complications: An umbrella review
Rahmati, M., Lee, S., Yon, D. K., Lee, S. W., Udeh, R., McEvoy, M., Oh, H. Y., Butler, L. T., Keyes, H., Barnett, Y., et al. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105641 · Cited by 106
Effects of exercise on symptoms of anxiety in primary care patients: a randomized controlled trial
Henriksson, M., Wall, A., Nyberg, J., Adiels, M., Lundin, K., Bergh, Y., Eggertsen, R., Danielsson, L., Kuhn, H. G., Westerlund, M., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.10.006 · Cited by 91
How does the skeletal muscle communicate with the brain in health and disease?
Isaac, A. R., Lima‐Filho, R. A. S., & Lourenco, M. V. (2021) · Neuropharmacology · doi:10.1016/j.neuropharm.2021.108744 · Cited by 99
Bennie, J. A., Teychenne, M. J., De Cocker, K., & Biddle, S. J. H. (2019) · Preventive Medicine · doi:10.1016/j.ypmed.2019.02.022 · Cited by 95
“Convincing epidemiological evidence shows that physical activity can be used to prevent (Mammen and Faulkner, 2013; Schuch et al., 2018; McDowell et al., 2018a) and treat depression and/or depressive symptoms in clinical and non-clinical populations (Rebar et al.”
BackgroundSmith, L., Jacob, L., Butler, L., Schuch, F. B., Barnett, Y., Grabovac, I., Veronese, N., Caperchione, C. M., Sánchez, G. F. L., Meyer, J. D., et al. (2020) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2020-000850 · Cited by 95
“1 Regular and sustained participation in physical activity is associated with almost every facet of health across the lifespan 2–4 and importantly the prevention of all-cause early mortality.”
Self-citationKandola, A. A., Cruz, B. D. P., Osborn, D., Stubbs, B., Choi, K. W., & Hayes, J. (2021) · BMC Medicine · doi:10.1186/s12916-021-02007-3 · Cited by 105
“88) lower odds of depression than low total physical activity [6], whereas our results demonstrate the importance of considering how the time is replaced as reducing daily sedentary behaviour by an hour was associated with a larger effect size (OR = 0.”
BackgroundResultSelf-citationLv, S., & Ru, S. (2021) · PLoS ONE · doi:10.1371/journal.pone.0259300 · Cited by 93
Pascoe, M. C., & Parker, A. G. (2019) · Early Intervention in Psychiatry · doi:10.1111/eip.12737 · Cited by 91
“depression in young people (Schuch et al., 2018). Brown, Pearson, Braithwaite, Brown, and Biddle (2013) similarly conducted a systematic review and meta-analysis and reported that physical activity interventions resulted in a small but significant reduction in depression”
BackgroundKleppang, A. L., Hartz, I., Thurston, M. N., & Hagquist, C. (2018) · BMC Public Health · doi:10.1186/s12889-018-6257-0 · Cited by 100
Physical Exercise and Health: A Focus on Its Protective Role in Neurodegenerative Diseases
Bonanni, R., Cariati, I., Tarantino, U., D’Arcangelo, G., & Tancredi, V. (2022) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk7020038 · Cited by 101
“In recent years, a growing body of scientific evidence has demonstrated the broad effects of physical exercise on general brain health in animals and humans, especially for learning and memory processes, protection from neurodegeneration, and alleviation of depression [20,21].”
BackgroundHautekiet, P., Saenen, N. D., Demarest, S. S., Keune, H., Pelgrims, I., der Heyden, J. V., Clercq, E. M. D., & Nawrot, T. S. (2022) · Environmental Health · doi:10.1186/s12940-022-00839-x · Cited by 87
The Nature and Treatment of Pandemic-Related Psychological Distress
Sanderson, W. C., Arunagiri, V., Funk, A. P., Ginsburg, K. L., Krychiw, J. K., Limowski, A. R., Olesnycky, O. S., & Stout, Z. (2020) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-020-09463-7 · Cited by 92
“However, physical activity promotes positive moods and can be protective against depression (Schuch et al. 2018) so becoming more active is very important.”
BackgroundCruz, B. D. P., Alfonso‐Rosa, R. M., McGregor, D., CHASTIN, S. F. M., Palarea‐Albaladejo, J., & Cruz, J. D. P. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.01.023 · Cited by 84
Savage, M. J., Hennis, P. J., Magistro, D., Donaldson, J., Healy, L. C., & James, R. M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18062930 · Cited by 96
“Importantly, maintaining or increasing physical activity levels have previously been shown to be a successful strategy to mitigate reductions in physical and mental health [8,9].”
BackgroundCross-sectional and prospective relationship between physical activity and depression symptoms
Marques, A., Bordado, J., Peralta, M., Gouveia, É. R., Tesler, R., Demetriou, Y., & Gómez‐Baya, D. (2020) · Scientific Reports · doi:10.1038/s41598-020-72987-4 · Cited by 97
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“In including these covariates, our aim was to test whether sense of purpose in life could have a unique predictive relationship with physical activity above and beyond these related measures that have been shown to have a significant relationship with physical activity (McDowell et al., 2019; Schuch et al., 2018; Zhan…”
BackgroundHird, E. J., Slanina-Davies, A., Lewis, G., Hamer, M., & Roiser, J. P. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-02922-y · Cited by 79
“…evidence from observational studies indicating that individuals with higher levels of physical activity have lower odds of developing depression [20]; for example, those exercising for at least four hours per week had 18% lower risk of depression, with a 25% reduction in those who exercised for…”
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Effects of exercise on depression and anxiety in persons living with HIV: A meta-analysis
Heißel, A., Zech, P. A., Rapp, M. A., Schuch, F. B., Lawrence, J. B., Kangas, M., & Heinzel, S. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.109823 · Cited by 76
Self-citationBest management of irritable bowel syndrome
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“It is widely accepted that physical exercise plays an important role in maintaining good physical and mental health, 40–42 and that benefit is derived from even small increases in physical activity.”
BackgroundKandola, A. A., Osborn, D., Stubbs, B., Choi, K. W., & Hayes, J. (2020) · BMC Medicine · doi:10.1186/s12916-020-01782-9 · Cited by 79
Self-citationRighi, N. C., Schuch, F. B., Nardi, A. T. D., Pippi, C. M., Righi, G. D. A., Puntel, G. O., da Silva, A. M. V., & Signori, L. U. (2020) · European Journal of Nutrition · doi:10.1007/s00394-020-02215-2 · Cited by 76
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Metadata
- Authors
- Schuch, F. B., Vancampfort, D., Firth, J., Rosenbaum, S., Ward, P. B., Silva, E. S., Hallgren, M., Ponce De Leon, A., Dunn, A. L., Deslandes, A. C., Fleck, M. P., Carvalho, A. F., & Stubbs, B.
- Affiliations
- Universidade Federal do Rio Grande do Sul (BR)
- From La Salle University, Canoas, Brazil; the School of Physical Education, Physiotherapy, and Dance and the Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; KU Leuven–University of Leuven, Department of Rehabilitation Sciences, and University Psychiatric Center, Leuven-Kortenberg, Belgium; the NICM Health Research Institute, School of Science and Health, University of Western Sydney, Sydney, Australia; the School of Psychiatry, University of New South...
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2018-07-01
- Volume
- 175
- Issue
- 7
- Pages
- 631-648
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2803008851
- Semantic Scholar
- 4574bb06e26a873ebb0a8607fd5719c390dbe21e
- Cited by
- 1,763
- References
- 84
- Citations by year
- 2026: 270 · 2025: 282 · 2024: 218 · 2023: 254 · 2022: 240 · 2021: 204 · 2020: 158 · 2019: 104 · 2018: 30
- FWCI
- 16.24
- Type
- journal article
- Language
- en
- Open access
- green
- lirias.kuleuven.be
- Licence
- other-oa
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- Figshare (submittedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- King's College Hospital NHS Foundation Trust
- National Institute for Health and Care Research (ICA-CL-2017-03-001, APP1123336, NIHR-INF-0685)
- Department of Health and Social Care
- King's College London
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Keywords
- physical activity, depression, incident depression, protective effect, youth, adults, older adults, depressive symptoms, major depressive disorder, age differences, geographic region
- MeSH terms
- Adult, Depression, Female, Humans, Male, Prospective Studies, Risk, Exercise, Incidence, Odds Ratio
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