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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]
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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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“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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Brain-based mechanisms of late-life depression: Implications for novel interventions
Gunning, F. M., Oberlin, L. E., Schier, M. M., & Victoria, L. W. (2021) · Seminars in Cell and Developmental Biology · doi:10.1016/j.semcdb.2021.05.002 · Cited by 49
Reigal, R. E., Páez-Maldonado, J. A., Brincones, J. L. P., Morillo-Baro, J. P., Hernández-Mendo, A., & Morales‐Sánchez, V. (2021) · Sustainability · doi:10.3390/su13105444 · Cited by 51
“The observed relationship between mental health and physical activity throughout the COVID-19 pandemic is also conditioned by the impact of physical exercise on self-esteem [74] and also reduces some inflammatory processes buffered by physical activity [75].”
BackgroundResultHealth impacts of bike-sharing systems in the U.S.
Clockston, R. L. M., & Rojas‐Rueda, D. (2021) · Environmental Research · doi:10.1016/j.envres.2021.111709 · Cited by 56
The impact of technology on promoting physical activities and mental health: a gender-based study
Liu, Y., Zhang, H., & Xu, R. (2023) · BMC Psychology · doi:10.1186/s40359-023-01348-3 · Cited by 53
Leisure engagement in older age is related to objective and subjective experiences of aging
Bone, J. K., Bu, F., Sonke, J. K., & Fancourt, D. E. (2024) · Nature Communications · doi:10.1038/s41467-024-45877-w · Cited by 49
Gómez‐Gómez, I., Bellón, J. Á., Resurrección, D. M., Cuijpers, P. J., Moreno-Peral, P., Rigabert, A., Maderuelo-Fernández, J. Á., & Motrico, E. (2020) · Preventive Medicine · doi:10.1016/j.ypmed.2020.106067 · Cited by 51
Exercise Intervention in Treatment of Neuropsychological Diseases: A Review
Chen, Z., Lan, W., Yang, G., Li, Y., Xiang, J., Chen, L., Zhou, Y. N., & Li, S. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.569206 · Cited by 53
Li, M., Wang, Q., & Shen, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19116584 · Cited by 45
“This is also mainly due to the fact that college students are more susceptible to information about the transmission route, vulnerable groups and cure rate of COVID-19 [36].”
BackgroundClemente‐Suárez, V. J., Martín-Rodríguez, A., Curiel-Regueros, A., Rubio-Zarapuz, A., & Tornero-Aguilera, J. F. (2025) · Bioengineering · doi:10.3390/bioengineering12020208 · Cited by 49
Lifestyles and the risk of depression in the “Seguimiento Universidad de Navarra” cohort
Ruiz-Estigarribia, L., Martínez‐González, M. Á., Díaz‐Gutiérrez, J., Sánchez‐Villegas, A., Lahortiga‐Ramos, F., & Bes‐Rastrollo, M. (2019) · European Psychiatry · doi:10.1016/j.eurpsy.2019.06.002 · Cited by 47
“Concerning the most studied modifiable lifestyle-related factors involved in the pathogenesis of depression; such as smoking [38], physical activity [39] and BMI [40], adherence to the MDS was the only factor in our score that individually showed an inverse and significant association with depression risk.”
BackgroundWerneck, A. O., Stubbs, B., Szwarcwald, C. L., & da Silva, D. R. P. (2020) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2020.01.007 · Cited by 45
Self-citationBueno‐Antequera, J., & Munguía‐Izquierdo, D. (2020) · Advances in experimental medicine and biology · doi:10.1007/978-981-15-1792-1_21 · Cited by 47
Mc Dowell, C. P., Carlin, A., Capranica, L., Dillon, C., Harrington, J. M., Lakerveld, J., Loyen, A., Ling, F. C. M., Brug, J., MacDonncha, C., et al. (2018) · BMC Public Health · doi:10.1186/s12889-018-5702-4 · Cited by 41
“In the context of depression, evidence supports: (i) significantly lower PA levels among adults with depression compared to adults without depression [11, 12]; (ii) inverse associations between PA and onset of depression [13, 14]; and (iii) that habitual PA may moderate treatment response [15].”
Tully, M. A., McMullan, I., Blackburn, N. E., Wilson, J. J., Bunting, B. P., Smith, L., Kee, F., Deidda, M., Giné‐Garriga, M., Coll‐Planas, L., et al. (2020) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.13762 · Cited by 44
Physical Activity as a Clinical Tool against Depression: Opportunities and Challenges
Chen, C., Beaunoyer, E., Guitton, M. J., & Wang, J. (2022) · Journal of Integrative Neuroscience · doi:10.31083/j.jin2105132 · Cited by 59
“The frequency of exercise is inversely associated with depression symptoms and overall well-being [38,108].”
BackgroundPhysical activity and health-related quality of life in older adults: depression as a mediator
Li, X., Wang, P., Jiang, Y., Yang, Y., Wang, F., Yan, F., Li, M., Peng, W., & Wang, Y. (2024) · BMC Geriatrics · doi:10.1186/s12877-023-04452-6 · Cited by 55
“Several studies have shown that PA is a protective factor against depressive symptoms and that even small amounts of PA reduce the incidence of future depressive episodes [31, 32].”
BackgroundDepressed Mood Prediction of Elderly People with a Wearable Band
Choi, J., Lee, S., Kim, S., Kim, D., & Kim, H. (2022) · Sensors · doi:10.3390/s22114174 · Cited by 43
“[40] Pressure, Electrical, Contact Sensors Low Patients (All ages) 340 Comparing between different conditions Adjusted odd ratio 0.”
BackgroundZhao, G., Lu, Z., Sun, Y., Kang, Z., Feng, X., Liao, Y., Sun, J., Zhang, Y., Huang, Y., & Yue, W. (2023) · Translational Psychiatry · doi:10.1038/s41398-023-02492-5 · Cited by 45
“Meta-analyses of prospective cohort studies showed that physical activities are associated with a reduced risk of MDD, regardless of age and geographical region [5, 7].”
BackgroundLi, B., Han, S.-S., Ye, Y.-P., Li, Y.-X., Meng, S., Feng, S., Li, H., Cui, Z.-L., Zhang, Y.-S., Zhang, Y., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-80034-9 · Cited by 49
Physical inactivity amplifies the negative association between sleep quality and depressive symptoms
Cheval, B., Maltagliati, S., Sieber, S., Cullati, S., Sander, D., & Boisgontier, M. P. (2022) · Preventive Medicine · doi:10.1016/j.ypmed.2022.107233 · Cited by 44
“Our findings showing that poorer sleep quality was associated with higher levels of depressive symptoms is in line with the literature (Alvaro et al., 2013; Neckelmann et al., 2007; Baglioni et al., 2011; Li et al., 2017; Lin et al., 2021).”
BackgroundResultInfluentialMüller, C., Paulsen, L., Bucksch, J., & Wallmann-Sperlich, B. (2024) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-024-01598-3 · Cited by 52
“Regular PA reduces the risk of numerous diseases, such as type 2 diabetes, cardiovascular diseases, and cancer, and improves mental health outcomes [3–6].”
BackgroundZhao, Q., Feng, Q., & Seow, W. J. (2024) · Journal of Hazardous Materials · doi:10.1016/j.jhazmat.2024.136507 · Cited by 42
Gerber, M., Cheval, B., Cody, R., Colledge, F., Hohberg, V., Klimentidis, Y. C., Lang, C., Looser, V. N., Ludyga, S., Stults‐Kolehmainen, M., et al. (2025) · Physiological Reviews · doi:10.1152/physrev.00021.2024 · Cited by 59
Exercise Behavior and Mood during the COVID-19 Pandemic in Taiwan: Lessons for the Future
Chang, Y., Hung, C., Timme, S., Nosrat, S., & Chu, C. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17197092 · Cited by 44
“Additionally, alleviation of negative mood states [58], a decrease in trait anxiety [59,60], and a decrease in the emergence of depression [61] have also been observed with exercise.”
BackgroundA review of effects of calorie restriction and fasting with potential relevance to depression
Igwe, O., Sone, M., Matveychuk, D., Baker, G. B., & Dursun, S. M. (2020) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2020.110206 · Cited by 43
Wu, Q., Feng, J., & Pan, C. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.03.062 · Cited by 46
Clustering and Healthcare Costs With Multiple Chronic Conditions in a US Study
Hajat, C., Siegal, Y., & Adler-Waxman, A. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2020.607528 · Cited by 43
Yu, D. J., Yu, A. P., Leung, C. K., Chin, E. C., Fong, D., Cheng, C. P.-W., Yau, S., & Parco Ming-fai, S. I. U. (2022) · European Journal of Sport Science · doi:10.1080/17461391.2022.2079424 · Cited by 42
“Another study conducted by Schuch and coworkers found that high levels of physical activity resulted in 17% lower risk of developing depression, compared with low levels of physical activity (Schuch, 2018).”
BackgroundMahon, C., Howard, E., O’Reilly, A., Dooley, B. A., & Fitzgerald, A. (2022) · Preventive Medicine · doi:10.1016/j.ypmed.2022.107332 · Cited by 44
Depression and Anxiety Are Associated With Cardiovascular Health in Young Adults
Patterson, S., Marcus, M., Goetz, M., Vaccarino, V., & Gooding, H. C. (2022) · Journal of the American Heart Association · doi:10.1161/jaha.122.027610 · Cited by 44
“34 Randomized trials have shown that structured exercise programs can reduce symptoms of both major depression 35 and anxiety disorders.”
Bolzetta, F., Veronese, N., Stubbs, B., Noale, M., Vaona, A., Demurtas, J., Celotto, S., Cacco, C., Cester, A., Caruso, M. G., et al. (2019) · Nutrients · doi:10.3390/nu11040787 · Cited by 40
“…dietary vitamin K intake and depressive symptoms (r = − 0.15; p = 0.03), as confirmed by a linear regression analysis On the other hand, physical activity itself is an important factor in the prevention of development of depression, as suggested by a large literature regarding these topics [25–29].”
BackgroundMethodInfluentialSelf-citationSato, K., Sakata, R., Murayama, C., Yamaguchi, M., Matsuoka, Y., & Kondo, N. (2020) · Occupational and Environmental Medicine · doi:10.1136/oemed-2020-106945 · Cited by 46
Schuch, F. B., Werneck, A. O., Vancampfort, D., Stubbs, B., Teychenne, M. J., Lotufo, P. A., Benseñor, I. M., & Brunoni, A. R. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.05.053 · Cited by 40
Self-citationPardhan, S., Wood, S., Vaughan, M., & Trott, M. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.668808 · Cited by 40
García‐Hermoso, A., Ezzatvar, Y., Ramírez‐Vélez, R., López‐Gil, J. F., & Izquierdo, M. (2022) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-022-01367-0 · Cited by 43
“For instance, it is well known that individuals with depression have decreased levels of markers of neurogenesis and hippocampal volumes [36] and increased levels of inflammatory and oxidant markers [37] and that physical activity could attenuate these problems [34, 38].”
BackgroundHuang, Y., Edwards, J., & Laurel-Wilson, M. A. (2020) · Health & Place · doi:10.1016/j.healthplace.2020.102425 · Cited by 44
Vancampfort, D., Smith, L., Stubbs, B., Swinnen, N., Firth, J., Schuch, F. B., & Koyanagi, A. (2018) · PLoS ONE · doi:10.1371/journal.pone.0203277 · Cited by 38
Self-citationHofman, A., Voortman, T., Ikram, M. A., & Luik, A. I. (2021) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2020-215883 · Cited by 40
Economic burden of low physical activity and high sedentary behaviour in Finland
Kolu, P., Kari, J. T., Raitanen, J. A., Sievänen, H. T., Tokola, K., Havas, E., Pehkonen, J., Tammelin, T., Pahkala, K., Hutri‐Kähönen, N., et al. (2022) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2021-217998 · Cited by 41
Shigdel, R., Stubbs, B., Sui, X., & Ernstsen, L. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.04.016 · Cited by 40
Self-citationPhysical activity as an adjunct treatment for erectile dysfunction
Allen, M. S. (2019) · Nature Reviews Urology · doi:10.1038/s41585-019-0210-6 · Cited by 38
Salman, D., Beaney, T. E., Robb, C. E., Loots, C. A. D. J., Giannakopoulou, P., Udeh‐Momoh, C. T., Ahmadi‐Abhari, S., Majeed, A., Middleton, L. T., & McGregor, A. H. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-050680 · Cited by 37
Anyan, F., Hjemdal, O., Ernstsen, L., & Havnen, A. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.598481 · Cited by 37
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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