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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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“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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“adolescent depression and anxiety Numerous meta-analyses have shown that regular physical activity can improve various physiological and psychological factors in patients with depression (Kvam et al., 2016; Schuch et al., 2018).”
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“Moreover, several studies have confirmed that physical exercise positively impacts psychological and social adaptation (Hooker and Masters, 2018; Schuch et al., 2018; Yemiscigil and Vlaev, 2021).”
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“Both aerobic PA and RT have been shown to independently benefit mental health via antidepressive and anxiolytic effects [27-31], however an association between ‘RT only’ and depression or anxiety was not identified in the current study.”
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Liu, C., Li, C., Kung, S.-F., Kuo, H., Huang, N.-C., Sun, Y., & Hu, S. C. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16162828 · Cited by 29
“Physical activity, exercise, and social network are all contributors to the build-up of cognition reserve [17] and enhancing mental health [31,32] to prevent or delay the development of AD [1,2].”
BackgroundPROMOTING PHYSICAL ACTIVITY FOR MENTAL WELL-BEING
Cooper, S. L. (2020) · ACSMʼs Health & Fitness Journal · doi:10.1249/fit.0000000000000569 · Cited by 23
“Specifically, meeting the weekly recommended physical activity levels of 150 minutes of moderateto vigorous-intensity physical activity was associated with 22% and 21% reduced risk of incident depression in adults and older adults, respectively (4).”
Backgroundvon Zimmermann, C., Winkelmann, M., Richter‐Schmidinger, T., Mühle, C., Kornhuber, J., & Lenz, B. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00494 · Cited by 31
“On the one hand, physical activity reduces the risk of future depression (29, 30).”
BackgroundPhysical Activity Reduces Clinical Symptoms and Restores Neuroplasticity in Major Depression
Brüchle, W., Schwarzer, C., Berns, C., Scho, S., Schneefeld, J., Koester, D., Schack, T., Schneider, U., & Rosenkranz, K. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.660642 · Cited by 32
Brain FNDC5/Irisin Expression in Patients and Mouse Models of Major Depression
Lima‐Filho, R. A. S., Fortuna, J. T. S., Cozachenco, D., Isaac, A. R., Silva, N. M. L. E., Saldanha, A., Santos, L. E., Ferreira, S. T., Lourenco, M. V., & Felice, F. G. D. (2023) · eNeuro · doi:10.1523/eneuro.0256-22.2023 · Cited by 31
“Exercise has antidepressant effects in MDD patients, notably in mild to moderate cases (Schuch et al., 2016, 2018).”
BackgroundPhysical activity: associations with health and summary of guidelines
Borodulin, K., & Anderssen, S. A. (2023) · Food & Nutrition Research · doi:10.29219/fnr.v67.9719 · Cited by 41
“Feels Good to Get Wet”: The Unique Affordances of Surf Therapy Among Australian Youth
McKenzie, R. J., Chambers, T. P., Nicholson-Perry, K., Pilgrim, J., & Ward, P. B. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.721238 · Cited by 29
Self-citationMcKeon, G., Steel, Z., Wells, R., Newby, J., Hadzi-Pavlovic, D., Vancampfort, D., & Rosenbaum, S. (2021) · JMIR Formative Research · doi:10.2196/23432 · Cited by 29
“A review of existing studies suggests that regular physical activity is associated with a reduction in 17% of incident cases of depression [16].”
BackgroundSelf-citationRegular physical activity across the lifespan to build resilience against rising global temperatures
Deshayes, T. A., & Périard, J. D. (2023) · EBioMedicine · doi:10.1016/j.ebiom.2023.104793 · Cited by 31
Harada, K., Masumoto, K., & Kondo, N. (2019) · Journal of Physical Activity and Health · doi:10.1123/jpah.2018-0366 · Cited by 31
“Thus, the present study examined 4 models in total: (1) a cross-lagged effects model for mental well-being, (2) a simultaneous effects model for mental well-being, (3) a cross-lagged effects model for mental distress, and (4) a simultaneous effects model for mental distress.”
MethodOpdal, I. M., Morseth, B., Handegård, B. H., Lillevoll, K. R., Ask, H., Nielsen, C. S., Horsch, A., Furberg, A., Rosenbaum, S., & Rognmo, K. (2019) · BMC Public Health · doi:10.1186/s12889-019-7271-6 · Cited by 30
“Physical activity seems to be related to mental health problems, such as anxiety and depression [3].”
BackgroundSelf-citationBennie, J. A., Teychenne, M. J., & Tittlbach, S. A. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.01.172 · Cited by 29
Isaksson, J., Selinus, E. N., Åslund, C., & Nilsson, K. W. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.09.008 · Cited by 32
Mobility performance predicts incident depression: A systematic review and meta-analysis
Chan, L. L. Y., Okubo, Y., Brodie, M. A. D., & Lord, S. R. (2020) · Experimental Gerontology · doi:10.1016/j.exger.2020.111116 · Cited by 31
Building Better Schools with Evidence-based Policy
Allen, K., Reupert, A., & Oades, L. G. (2021) · Routledge eBooks · doi:10.4324/9781003025955 · Cited by 35
Carvalho, J., Borges‐Machado, F., Pizarro, A. I. N., Bohn, L., & Barros, D. G. M. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.643832 · Cited by 29
Physical Inactivity From Childhood to Adolescence and Incident Depression
Redig, L., Feter, N., Dumith, S. C., Domingues, M. R., & Rombaldi, A. J. (2021) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2021.09.001 · Cited by 29
O’Neill, S., Minehan, M., Knight-Agarwal, C. R., & Turner, M. R. (2022) · Nutrients · doi:10.3390/nu14071398 · Cited by 34
“Depression interacts with factors including gender [49], race [50], physical activity [51], sleep [52], alcohol consumption [52] and smoking [53].”
BackgroundImpact on adolescent mental health of replacing screen-use with exercise: A prospective cohort study
Kandola, A., del Pozo Cruz, B., Hayes, J. F., Owen, N., Dunstan, D. W., & Hallgren, M. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.12.064 · Cited by 30
“Higher physical activity volumes are also associated with a lower incidence of depression in the population (32).”
BackgroundSelf-citationLv, Q., & Zhao, H.-S. (2024) · Annals of Medicine · doi:10.1080/07853890.2024.2306192 · Cited by 33
“…to two stars) [21]. the cohort study was evaluated using three modules with eight items. specifically, it includes population selection, comparability, and exposure/outcome evaluation, and has a maximum score of 9.0, with 7.0–9.0 indicating high quality and 4.0–6.0 indicating medium quality [22].”
MethodInfluentialBrooke, L. E., Gucciardi, D. F., Ntoumanis, N., & Lin, A. P. (2019) · Early Intervention in Psychiatry · doi:10.1111/eip.12854 · Cited by 28
“…recovery include: (a) physical activ- ity (PA) to promote mental health and well-being (Rosenbaum, Tiedemann, Sherrington, Curtis, & Ward, 2014; Schuch et al., 2018), and combat the cardiometabolic problems associated with psychotic illness and medication (Correll et al., 2017; Vancampfort…”
BackgroundMarathon running improves mood and negative affect
Roeh, A., Lembeck, M., Papazova, I., Pross, B., Hansbauer, M., Schoenfeld, J., Haller, B., Halle, M., Falkai, P., Scherr, J., et al. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.08.005 · Cited by 29
Werneck, A. O., Hoare, E., Stubbs, B., van Sluijs, E. M. F., & Corder, K. L. (2021) · Preventive Medicine · doi:10.1016/j.ypmed.2021.106436 · Cited by 29
Self-citationCocker, K. A. D., Biddle, S., Teychenne, M. J., & Bennie, J. A. (2021) · Depression and Anxiety · doi:10.1002/da.23157 · Cited by 30
“Meta‐analytic evidence has suggested that physical activity can confer protected effects for depression (Schuch et al., 2018), as well as be an effective add‐on treatment to usual care (Ashdown‐Franks et al., 2020).”
BackgroundImproving Mental Health through Physical Activity: A Narrative Literature Review
Giandonato, J. A., Tringali, V., & Thoms, R. C. (2021) · Physical Activity and Health · doi:10.5334/paah.108 · Cited by 37
“Correlations between physical activity behavior and odds of developing depression were extrapolated from an examination of 49 prospective cohort studies comprising 266,939 participants (Schuch et al., 2018).”
MethodPhysical activity for the treatment and prevention of depression: a rapid review of meta-analyses
Imboden, C., Claussen, M., Seifritz, E., & Gerber, M. (2021) · German Journal of Sports Medicine · doi:10.5960/dzsm.2021.499 · Cited by 34
Exploration of Cognitive Outcomes and Risk Factors for Cognitive Decline Shared by Couples
Yang, H. W., Bae, J. B., Oh, D. J., Moon, D. G., Lim, E., Shin, J. Y., Kim, B., Lee, D. W., Kim, J. L., Jhoo, J. H., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.39765 · Cited by 28
Socio-economic inequalities in physical activity among Japanese adults during the COVID-19 pandemic
Kyan, A., & Takakura, M. (2022) · Public Health · doi:10.1016/j.puhe.2022.03.006 · Cited by 28
Exercise and yoga during pregnancy and their impact on depression: a systematic literature review
Jarbou, N. S., & Newell, K. A. (2022) · Archives of Women s Mental Health · doi:10.1007/s00737-021-01189-2 · Cited by 33
Hoveling, L. A., Liefbroer, A. C., Schweren, L., Bültmann, U., & Smidt, N. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.06.018 · Cited by 29
Accardo, A. L., Pontes, N. M. H., & Pontes, M. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-023-06117-0 · Cited by 32
“Meta-analyses of randomized control trials have shown increased physical activity is significantly related to lower anxiety (Carter et al., 2021) or depression (Carter et al., 2016; Morres et al., 2019; Schuch et al., 2018; Schuch, Vancampfort, Richards, Schuch et al., 2016a; Schuch et al., 2016a).”
Duncan, M. J., Murphy, L., Oftedal, S., Fenwick, M. J., Vincent, G. E., & Fenton, S. (2023) · Journal of Activity Sedentary and Sleep Behaviors · doi:10.1186/s44167-023-00026-4 · Cited by 28
“Study Design Eligible studies were prospective observational cohort studies, with at least a 12-month follow-up [32].”
BackgroundYu, C., Wang, T., Gao, Y., Jiao, Y., Jiang, H., Bian, Y., Wang, W., Lin, H., Xin, L., & Wang, L. (2024) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2024.03.007 · Cited by 31
“21,81 These psychological factors may play a role in reducing the prevalence of GERD through gut-brain peptides.”
Jie, S., Fu, A., Wang, C., & Rajabi, S. (2025) · Behavioral and Brain Functions · doi:10.1186/s12993-025-00273-2 · Cited by 41
“Regular physical activity increases serotonin levels, which helps regulate mood, emotions, and sleep, thereby reducing depressive symptoms [57].”
Hu, Y., & Liu, B. (2025) · Scientific Reports · doi:10.1038/s41598-025-18352-9 · Cited by 36
Jackson, S. E., Brown, J., USSHER, M. H., Shahab, L., Steptoe, A., & Smith, L. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-032852 · Cited by 29
Velázquez, J. A. M., Gómez‐Baya, D., & Delmar, J. L. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.566517 · Cited by 30
Parra-Rizo, M. A., & Sanchís-Soler, G. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18136926 · Cited by 29
“In this sense, there is evidence that physical activity protects against depression [14,15], in addition to producing improvements in psychological well-being and quality of life related to health, although it has a greater impact among individuals who practice team sports [16].”
BackgroundGrocke-Dewey, M., Hardison‐Moody, A., Haynes‐Maslow, L., Maras, S. A., Webber, E. J., Andress, L., Houghtaling, B., Patton-López, M. M., Shanks, J. D., & Shanks, C. B. (2021) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2021.101537 · Cited by 27
“Research has demonstrated that physical activity (PA) could be protective for MH. PA (Jordan, 2021) is linked with antidepressant effects and a relationship to improved MH (Schuch et al., 2018; Kandola et al., 2019; White et al., 2017).”
OLIVE, L. S., Sciberras, E., Berkowitz, T. S., Hoare, E., Telford, R. M., O'Neil, A. E., Mikocka‐Walus, A. A., Evans, S., Hutchinson, D. M., McGillivray, J., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.774858 · Cited by 31
Hallgren, M. Å., Nguyen, T.-T.-D., Lundin, A., Vancampfort, D., Stubbs, B., Schuch, F. B., Bellocco, R., & Lagerros, Y. T. (2018) · Preventive Medicine · doi:10.1016/j.ypmed.2018.10.009 · Cited by 27
Self-citationThe effect of PFAS exposure on glucolipid metabolism in children and adolescents: a meta-analysis
Zheng, Q., Yan, W., Gao, S., & Li, X. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1261008 · Cited by 26
Fernández‐Buhigas, I., Martín-Arias, A., Vargas‐Terrones, M., Brik, M., Rollé, V., Barakat, R., Muñoz-Gonzalez, M. D., Refoyo, I., Gil, M. M., & Santacruz, B. (2023) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2023.2183759 · Cited by 26
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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