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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.
In the citing paper
“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]
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
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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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In the citing paper
“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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“A meta-analysis of a prospective study reported that individuals with higher levels of PA were 17% less likely to develop depression compared to those with lower PA levels (15).”
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Kompf, J. M., & Rhodes, R. E. (2023) · Measurement in Physical Education and Exercise Science · doi:10.1080/1091367x.2023.2258869 · Cited by 3
“…Fransen et al., 2015), cancer (Renzende, Sa, Markozannes et al., 2018), diabetes (Lao, Deng, Liu et al., 2019), myocardial infarction (Yusuf et al., 2004), depression (Schuch, Vancampfort & Firth et al., 2018), and all-cause mortality (Saint-Maurice et al., 2020; Wen, Wai, Tsai et al., 2011).”
BackgroundMaciel, G. P., da Costa, B. G. G., Bezerra, I. N., da Silva, K. S., Lopes, I. E., de Castro, V. H. S., & Filho, V. C. B. (2023) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2023.10.027 · Cited by 3
Barham, W. T., Dillman, K. M., Hebert, J. D., Kerut, C. K., Klapper, R. J., Ahmadzadeh, S., Shekoohi, S., Cornett, E. M., & Kaye, A. D. (2024) · SN Comprehensive Clinical Medicine · doi:10.1007/s42399-024-01649-7 · Cited by 3
“One surface protein located on both proinflammatory and anti-inflammatory B cells and a small subset of T cells is CD20, whose exact function is unknown [9].”
Nascimento, M. D. M., Marques, A., Gouveia, É. R., Marconcin, P., Peralta, M., & Ihle, A. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13061697 · Cited by 3
“Physical exercise practices have different underlying mechanisms (i.e., neurobiological, behavioral) that can promote physical and mental health [78,79].”
BackgroundHaryanto, H., Saputra, A., & Muzaffar, A. (2024) · JOURNAL SPORT AREA · doi:10.25299/sportarea.2024.vol9(1).14526 · Cited by 3
“Depression levels would peak if small problems were never addressed, and over time, they would peak (Ranjbar et al., 2015; Schuch et al., 2018).”
BackgroundFNDC5/Irisin in dementia and cognitive impairment: update and novel perspective
Guo, X., Huang, X., Yang, Y., Dong, L., Kong, D., & Zhang, J. (2024) · Brazilian Journal of Medical and Biological Research · doi:10.1590/1414-431x2024e13447 · Cited by 5
“Regular physical exercise was associated with reduced incidence and severity of MDD and AD (59).”
BackgroundHänggi, J. M., Lovison, G., Jeong, A., Schaffner, E., Njihuis, E., Studer, F., Taube, W., Kayser, B., Suggs, L. S., Bringolf‐Isler, B., et al. (2024) · Swiss Medical Weekly · doi:10.57187/s.3778 · Cited by 3
“…in physical activity in children, adolescents and adults has been consistently associated with broad health benefits, including reduced risk of chronic diseases [3], improved mental health [4, 5], enhanced quality of life and improved cognitive function, including academic achievement [6–8].”
BackgroundEsposito, E., Lemes, Í. R., Salimei, P. S., Morelhao, P. K., Marques, L. B. F., Martins, M. D. D. S., Cynthia, G., Franco, M. R., & Pinto, R. Z. (2024) · Experimental Aging Research · doi:10.1080/0361073x.2024.2397322 · Cited by 3
“In addition, considering the benefits of physical activity promotion on musculoskeletal health and depressive symptoms (Schuch et al., 2018), we hypothesize that involvement in regular exercise programs with increasing levels of physical activity may attenuate, or even eliminate, this association.”
Pitta, R. M., Kaufmann, O. G., Luz, J., Ritti‐Dias, R. M., Queiroga, L. D. L., & Wolosker, N. (2024) · Einstein (São Paulo) · doi:10.31744/einstein_journal/2024ao1063 · Cited by 3
“A recent meta-analysis by Schuch et al. (27) demonstrated that higher levels of physical activity are associated with lower odds of developing depression compared to a sedentary lifestyle, even after adjustments were made (adjusted odds ratio=0.83, 95 %CI=0.79-0.88, p =0.001; I²=0.00).”
InfluentialNon-modifiable and modifiable factors affecting anxiety and depressive symptoms in young athletes
Vieira, M. M., Neves, L. M., Felisberto, P., Fernandes, R. A., Xavier, R. L. D. S., Rossi, P. A. Q., Juday, V., Deslandes, A. C., Lastella, M., & Rossi, F. E. (2025) · The Physician and Sportsmedicine · doi:10.1080/00913847.2025.2466415 · Cited by 3
“In the general population, the positive effect of physical exercise on mental well-being has been widely documented [1,2].”
Self-citationThe Mental Game of Tennis: A Scoping Review and the Introduction of the Resilience Racket Model
Konstantinou, G., Kloiber, S. M., & Blumberger, D. M. (2025) · Sports · doi:10.3390/sports13050130 · Cited by 3
“A meta-analysis of 11 prospective studies involving over 69,000 participants found that higher physical activity levels significantly reduced the risk of developing depression by 26%, anxiety by 26%, and psychotic disorders by 27% [13].”
Depression and Inflammation in Women With Breast Cancer: Risk and Resilience Factors
Korecki, J. R., Slavich, G. M., Ganz, P. A., Irwin, M. R., Cole, S. W., Crespi, C. M., & Bower, J. E. (2025) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001398 · Cited by 3
Shah, B. B., Thomas, M. L., McCarthy, M. J., & Meruelo, A. D. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119889 · Cited by 3
“…circadian misalignment (Barandas et al., 2015), chronic low-grade inflammation (Dowlati et al., 2010), and adverse health behaviors—including reduced physical activity, poor dietary intake, cigarette smoking, and excessive alcohol use (Kunugi, 2023; Schuch et al., 2018; Selvaraj et al., n.d.).”
Bourke, M., Judge-Mears, B., Guo, B., & Fortnum, K. (2025) · Health Psychology Review · doi:10.1080/17437199.2025.2590489 · Cited by 4
“Results from multiple meta-analyses have demonstrated that physical activity is associated with fewer symptoms of depression (Pearce et al., 2022; Schuch et al., 2018) and anxiety (McDowell et al., 2019; Schuch et al., 2019), while spending more time sedentary increases the risk of depression and…”
Hátlová, B., Ségard, M. A., Probst, M., Chytrý, V., & Chalupová, E. (2020) · Acta Gymnica · doi:10.5507/ag.2020.009 · Cited by 3
“While some studies and reviews (Faulkner, 2005; Hölter, 2011; Probst, Knapen, Poot, & Vancampfort, 2010; Sampogna et al., 2018; Schuch et al., 2018; Stubbs et al., 2018; Vancampfort et al., 2012) have demonstrated that mental changes may also be achieved through physical activity as a result of…”
BackgroundMethodInfluentialDesai, R., Valaparla, V. L., Fong, H. K., Gandhi, Z., Varma, Y., Varma, K., Khan, M. Z. A., Dawood, B., Desai, V., Savani, S., et al. (2020) · Cureus · doi:10.7759/cureus.10640 · Cited by 3
“The relationship of a sedentary lifestyle and lack of exercise among patients with mental health disorders and possible health consequences are well discussed in the literature [9-11].”
BackgroundZitz, V., Wölfel, M., & Hoffmann, R. (2021) · International Conference on Cyberworlds (CW) · doi:10.1109/cw52790.2021.00034 · Cited by 3
Brierley, M., Albertella, L., Rotaru, K., Destrée, L., Thompson, E. M., Liu, C., Christensen, E., Lowe, A., Segrave, R. A., Richardson, K. E., et al. (2021) · CNS Spectrums · doi:10.1017/s1092852921001048 · Cited by 3
Werneck, A. O., Kandola, A. A., Barboza, L. L. S., Araújo, R. H. D. O., Szwarcwald, C. L., Stubbs, B., & da Silva, D. R. P. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.02.018 · Cited by 3
Self-citationAssociations between Depression Symptoms and Leisure Behavior during the COVID-19 State of Emergency
Kulbin, K., & Kask, K. (2022) · Leisure Sciences · doi:10.1080/01490400.2022.2036275 · Cited by 3
“Systematic reviews and meta-analyses of longitudinal studies have established a causal relationship between PA and decreased risk of developing depression (Mammen & Faulkner, 2013; Schuch et al., 2018; Teychenne et al., 2008).”
BackgroundResultSahrakorpi, N., Engberg, E., Stach‐Lempinen, B., Tammelin, T., Kulmala, J., Roine, R. P., & Koivusalo, S. B. (2022) · BMC Women s Health · doi:10.1186/s12905-022-01664-7 · Cited by 6
“People with depression also tend to live more sedentary lives [51], and PA has been reported to diminish depressive symptoms [51].”
BackgroundLiu, Y. H., Yun, Q., Zhang, L. C., Zhang, X., Lin, Y., Liu, F. J., Zheng, Z. J., & Chang, C. J. (2022) · PubMed Central · doi:10.19723/j.issn.1671-167x.2022.03.014 · Cited by 3
Pengpid, S., & Peltzer, K. (2022) · South African Journal of Psychology · doi:10.1177/00812463221113413 · Cited by 3
“However, contrary to systematic review evidence (Dishman et al., 2021; Matison et al., 2021; Schuch et al., 2018), in our study, alcohol dependence, inadequate fruit and vegetable intake, physical activity, and sedentary behaviour were not associated with incident DS.”
BackgroundResultThe Potential Role of Exercise-Induced Neurotrophic Factors for Mental Health
Bırıncı, Y. Z. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.106867 · Cited by 3
Greenberg, E. M., Greenberg, E., Lawrence, J. T. R., & Ganley, T. J. (2022) · International Journal of Sports Physical Therapy · doi:10.26603/001c.40372 · Cited by 3
Stress, Anxiety and Depression
Baloh, R. W. (2022) · Springer eBooks · doi:10.1007/978-3-031-13924-6_7 · Cited by 3
Zeitoun, T., Plante, A., Sabiston, C. M., Dieudé, M., & Doré, I. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032099 · Cited by 3
“Physical activity is a tool shown to be effective in reducing anxiety [4,5] and depressive symptoms [4], stress [6] and fatigue [7,8], not only in the general population, but also in immunosuppressed individuals [9,10].”
Divecha, A. A., Bialek, A., Kumar, D. S., Garn, R. M., Currie, L. E. J., Campos, T., & Friel, K. M. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-065032 · Cited by 3
Suner-Keklik, S., & Barğı, G. (2023) · Online Türk Sağlık Bilimleri Dergisi · doi:10.26453/otjhs.1193870 · Cited by 4
Pienaar, H., Boer, P., van Rensburg, A. J., Ramagole, D., & van Rensburg, D. C. J. (2023) · South African Journal for Research in Sport Physical Education and Recreation · doi:10.36386/sajrsper.v45i2.234 · Cited by 3
“Other studies (some within lockdown) investigating the interplay of PA and mental health showed that decreased PA had deleterious effects on mental health (Stubbs et al., 2017; Schuch et al., 2018; Reardon et al., 2019; Schuch et al., 2020; Jakobsson et al., 2020; Wilke et al., 2021).”
Liddelow, C., White, B., Arnold, E., & Vella, S. A. (2023) · Mental health and physical activity · doi:10.1016/j.mhpa.2023.100555 · Cited by 4
Zou, Y., Meng, F., & Yan, X. (2023) · BMC Public Health · doi:10.1186/s12889-023-17063-y · Cited by 3
“%] higher odds ratio (OR) of developing depression compared to those with high levels of physical activity [11].”
BackgroundIsoflavone intake and depressive symptoms among workers
Nanri, A., Yamamoto, S., Suetsugu, M., Kochi, T., Kabe, I., & Mizoue, T. (2023) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2023.11.005 · Cited by 3
Lee, Y., Hauck, J. L., & Brooks, D. R. (2023) · Physical Activity and Health · doi:10.5334/paah.305 · Cited by 3
Kreiml, V., Sauter, A., Abu‐Omar, K., Eickmann, S., & Herrmann-Johns, A. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1339556 · Cited by 3
Psychological Benefits of Physical Education
Bamta, S., Misra, P. A., & Peter, V. F. (2023) · JOURNAL GLOBAL VALUES · doi:10.31995/jgv.2023.v14is3.009 · Cited by 8
Aksoy, S. (2024) · Özgür Yayınları eBooks · doi:10.58830/ozgur.pub453.c1934 · Cited by 3
Sporda Motivasyon Kuram ve Uygulamalarına Bibliyometri ile Güncel Bakış
Kara, N. Ş., & Kara, M. (2024) · Özgür Yayınları eBooks · doi:10.58830/ozgur.pub453.c1938 · Cited by 3
Benkwitz, A., Ogundipe, E., & Spencer, K. (2024) · Mental Health and Social Inclusion · doi:10.1108/mhsi-06-2024-0100 · Cited by 5
Bourke, M., Phillips, S. M., Gilchrist, J. D., & Pila, E. (2024) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2024.102724 · Cited by 3
McGrath, A., Matthews, E., Murphy, N. M., Oostveen, I., Wagemakers, A., & Verkooijen, K. T. (2024) · Mental health and physical activity · doi:10.1016/j.mhpa.2024.100638 · Cited by 5
Association of ‘weekend warrior’ physical activity pattern and depressive symptoms
de Victo, E. R., Pitta, R. M., Ferrari, G., Schuch, F. B., Queiroga, L. D. L., Kaufmann, O. G., & Wolosker, N. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119911 · Cited by 4
Self-citationSporttherapie als adjuvante oder alternative Behandlung bei Depression
Heißel, A. (2020) · Psychotherapeut · doi:10.1007/s00278-020-00425-x · Cited by 3
Hartung, T. J., Moustsen‐Helms, I. R., Larsen, S. B., Andersen, E. W., Suppli, N. P., Johansen, C., Tjønneland, A. M., Friberg, A. S., Kjær, S. K., Brasso, K., et al. (2020) · Journal of Cancer Survivorship · doi:10.1007/s11764-020-00947-y · Cited by 3
“Although a recent meta-analysis found convincing evidence that physical exercise is a protective factor against incident depression [46], we were not able to observe this effect.”
Ahn, J. H., & Nam, J. Y. (2022) · Journal of Physical Activity and Health · doi:10.1123/jpah.2022-0049 · Cited by 3
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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