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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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BackgroundSelf-citationHoller, P., Jaunig, J., Moser, O., Tuttner, S., Simi, H., Wallner, D., Amort, F. M., & van Poppel, M. N. M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168593 · Cited by 23
“There is a compelling body of literature highlighting the physiological [1,2] and psychological benefits [3,4] of being sufficiently physically active.”
BackgroundPuterman, E. M., Hives, B. A., Mazara, N., Grishin, N. K., Webster, J., Hutton, S., Koehle, M. S., Liu, Y., & Beauchamp, M. R. (2021) · British Journal of Sports Medicine · doi:10.1136/bjsports-2021-104379 · Cited by 25
“These recommendations are supported by an extant literature providing compelling evidence for impactful prevention of 11 and reductions in 12 depressive symptoms in clinical and non-clinical populations following the adoption of physical activity programming.”
Denche-Zamorano, Á. M., Mendoza-Muñoz, M., Carlos‐Vivas, J., Bermejo, L. M., Rojo-Ramos, J., Pastor-Cisneros, R., Giakoni-Ramírez, F., Godoy-Cumillaf, A. E. R., & My works are correct, B. M. I. A. A. I. S. R. L. M. T. I. D. A.-M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095656 · Cited by 24
“In addition, there is evidence of an association with improved symptoms related to mental illness [13,14], reduced pain [15], and better health-related quality of life [16].”
BackgroundTeixeira, A. L., Martins, L. B., Berk, M., & Bauer, M. E. (2022) · Clinical Science · doi:10.1042/cs20211106 · Cited by 22
Gu, Q., Zhao, X., Lin, L., Teo, W., Liu, L., & Yuan, S. (2024) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2024.100512 · Cited by 24
The effect of exercise on depression and gut microbiota: Possible mechanisms
Yao, M., Qu, Y., Zheng, Y., & Guo, H. (2024) · Brain Research Bulletin · doi:10.1016/j.brainresbull.2024.111130 · Cited by 26
“(Created with BioRender.com). depression by 30 % and impede its development (Choi et al., 2020; Schuch et al., 2018; Schuch et al., 2016).”
Zhang, W., Huang, W., Hu, C., Yuan, Y., & Chen, X. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1683468 · Cited by 29
Physical inactivity caused economic burden depends on regional cultural differences
Mattli, R., Wieser, S., Probst-Hensch, N. M., Schmidt‐Trucksäss, A., & Schwenkglenks, M. M. (2018) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.13311 · Cited by 23
Moving more, ageing happy: findings from six low- and middle-income countries
Félez-Nóbrega, M., Haro, J. M., Stubbs, B., Smith, L., & Koyanagi, A. (2020) · Age and Ageing · doi:10.1093/ageing/afaa137 · Cited by 25
Self-citationRole of childhood maltreatment on weight and weight-related behaviors in adulthood.
Ruiz, A. L., & Font, S. A. (2020) · Health Psychology · doi:10.1037/hea0001027 · Cited by 20
“Since low levels of physical activity is linked to increased risk for obesity and poor diet (F. B. Schuch et al., 2018).”
BackgroundDuncan, M. J., Rayward, A. T., Holliday, E. G., Brown, W. J., Vandelanotte, C., Murawski, B., & Plotnikoff, R. C. (2021) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-021-01112-z · Cited by 20
“In light of this, and the different biological mechanisms that link physical activity and sleep to physical health and mental health outcomes [3, 58, 59, 69], there is a need for more research examining the effect of the overall pattern of physical activity and sleep on physical and mental health outcomes.”
BackgroundResistance training reduces depressive and anxiety symptoms in older women: a pilot study
Cunha, P. M., Werneck, A. O., Nunes, J. P., Stubbs, B., Schuch, F. B., Kunevaliki, G., Zou, L., & Cyrino, E. S. (2021) · Aging & Mental Health · doi:10.1080/13607863.2021.1922603 · Cited by 21
“as already shown in a recent meta-analysis (Schuch et al., 2018), physical exercise can reduce risks and symptoms of depression and anxiety regardless of age.”
ResultSelf-citationMorales, J. S., Castillo‐García, A., Valenzuela, P. L., Saco‐Ledo, G., Mañas, A., Santos‐Lozano, A., & Lucía, A. (2021) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.14038 · Cited by 21
Duncan, M. J., Holliday, E. G., Burton, N. W., Glozier, N., & Oftedal, S. (2022) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2022.02.002 · Cited by 20
de Lima, K. S., Schuch, F. B., Righi, N. C., Chagas, P., Lamberti, M. H., Puntel, G. O., da Silva, A. M. V., & Signori, L. U. (2022) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2022.2048290 · Cited by 21
Self-citationLuo, Y., Yang, P., Wan, Z., Kang, Y., Dong, X., Li, Y., Wang, Y., Xie, J., & Duan, Y. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.10.038 · Cited by 22
de Santana, E. E. S., Neves, L. M., de Souza, K. C., Mendes, T. B., Rossi, F. E., da Silva, A. A., de Oliveira, R., Perilhão, M. S., Roschel, H., & Gil, S. D. S. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20054494 · Cited by 21
“Physical inactivity inarguably consists of a risk for distinct health-related outcomes such as mental [7,22,23] and cardiometabolic [24–26] disorders and, mostly important, morbimortality [27].”
BackgroundPhysical Inactivity, Sedentarism, and Low Fitness: A Worldwide Pandemic for Public Health
Bueno‐Antequera, J., & Munguía‐Izquierdo, D. (2023) · Integrated science · doi:10.1007/978-3-031-17778-1_19 · Cited by 28
Rena, M., Fancourt, D. E., Bu, F., Paul, E., Sonke, J. K., & Bone, J. K. (2023) · Social Science & Medicine · doi:10.1016/j.socscimed.2023.116198 · Cited by 23
“…measured always involved participants leaving their homes, thereby providing gentle physical activity, which is associated with benefits across all four of the domains of healthy aging included in this study (Durstine et al., 2013; Potter et al., 2011; Sanders et al., 2019; Schuch et al., 2018).”
BackgroundComparative analysis of the economic burdens of physical inactivity in Hungary between 2005 and 2017
Ács, P., Kovács, A., Paár, D., Hoffbauer, M., Szabó, P., Szabó, T., & Stocker, M. (2020) · BMC Public Health · doi:10.1186/s12889-020-08478-y · Cited by 21
Leisure‐time exercise is associated with lower depressive symptoms in community dwelling adults
Aguilar, B. A. S., Tebar, W. R., Silva, S. C. B., Gomes, L. Q., Damato, T. M. D. M., Mota, J. A. P. S., Werneck, A. O., & Christófaro, D. G. D. (2021) · European Journal of Sport Science · doi:10.1080/17461391.2021.1895892 · Cited by 24
“physical activity for depressive symptoms (Firth et al., 2019; Marques et al., 2020a; Norouzi et al., 2020; Schuch et al., 2018).”
BackgroundResultInfluentialCovid-19 in Turkey: Leisure Boredom, Psychological Resilience, Physical Activity and Emotional State
Dursun, M., Yarayan, Y. E., Çağrı, A. R. I., Ulun, C., & Adaş, S. K. (2021) · IJERI International Journal of Educational Research and Innovation · doi:10.46661/ijeri.5588 · Cited by 23
Opdal, I. M., Morseth, B., Handegård, B.-H., Lillevoll, K. R., Nilsen, W., Nielsen, C., Furberg, A.-S., Rosenbaum, S., & Rognmo, K. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-035549 · Cited by 20
Self-citationHou, J., Deng, Q., Sha, L., Zhu, J., Xiang, R., Zhao, X., Xiao, C., Qin, C., Qu, Y., Han, T., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.11.065 · Cited by 26
The Kids Are Alright—Right? Physical Activity and Mental Health in College Students
Petruzzello, S. J., & Box, A. G. (2020) · Kinesiology Review · doi:10.1123/kr.2020-0039 · Cited by 28
“…of physical activity and both anxiety (Ensari, Greenlee, Motl, & Petruzzello, 2015; Petruzzello, Landers, Hatfield, Kubitz, & Salazar, 1991; Schuch et al., 2019; Stubbs et al., 2017) and depression (Choi et al., 2020; Currier et al., 2020; Schuch et al., 2018), albeit not only in college students.”
BackgroundPhysical activity as an intervention in severe mental illness
Kandola, A. A., & Osborn, D. (2021) · BJPsych Advances · doi:10.1192/bja.2021.33 · Cited by 22
“For example, population-level research shows that higher levels of physical activity are associated with lower incidence of cardiovascular disease, diabetes, cancer and common mental health disorders (Wilmot 2012; Kyu 2016; Bennett 2017; Schuch 2018, 2019).”
BackgroundKleppang, A. L., Ridder, K. D., Haugland, S. H., & Stea, T. H. (2021) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-021-01215-7 · Cited by 21
“The results from a longitudinal study and meta-analysis of prospective studies indicated that physical activity may have a preventive effect on the development of depression [10, 11].”
ResultPhysical exercise, depression, and anxiety in 2190 affective disorder subjects
D'Angelantonio, M., Collins, J. L., Manchia, M., Baldessarini, R. J., & Tondo, L. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.04.079 · Cited by 20
Tashiro, T., Maeda, N., Tsutsumi, S., Komiya, M., Arima, S., Mizuta, R., Fukui, K., Nishikawa, Y., & Urabe, Y. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03997-x · Cited by 20
“Sedentary behavior is related to depressive symptoms [6], while physical activity is related to a lower incidence and prevalence of depression [7].”
BackgroundWerneck, A. O., Schuch, F. B., Vancampfort, D., Stubbs, B., Lotufo, P. A., Benseñor, I. M., Teychenne, M. J., & Brunoni, A. R. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.02.080 · Cited by 20
Self-citationKhoury, R. E., & Nagy, C. (2023) · Frontiers in Molecular Biosciences · doi:10.3389/fmolb.2023.1154872 · Cited by 20
Alpers, S. E., Pallesen, S., Vold, J. H., Haug, E., Lunde, L.-H., Skogen, J. C., Mamen, A., Mæland, S., & Fadnes, L. T. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1181046 · Cited by 21
“Regular PA has been associated with lower levels of stress, anxiety, and depression (26).”
BackgroundFerguson, J. P., Alvarez, A., Mulligan, M., Judge, C. S., & O'Donnell, M. J. (2024) · European Journal of Epidemiology · doi:10.1007/s10654-023-01063-8 · Cited by 22
Singh, S., Rivier, C. A., Papier, K., Chemali, Z. N., Gutiérrez-Martínez, L., Parodi, L., Mayerhofer, E., Senff, J. R., Clocchiatti‐Tuozzo, S., Nunley, C., et al. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1373797 · Cited by 22
“…risk factors for late-life depression, dementia and stroke have been consistently reported in previous meta-analyses: and include smoking tobacco, nutrition, physical activity and social-emotional determinants of health, all of which are included in the McCance Brain Care Score [BCS] (2, 6 – 9).”
BackgroundFukai, K., Kuwahara, K., Chen, S., Eguchi, M., Kochi, T., Kabe, I., & Mizoue, T. (2020) · Journal of Occupational Health · doi:10.1002/1348-9585.12120 · Cited by 20
Möller, H., Haigh, F., Hayek, R., & Veerman, L. J. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17176186 · Cited by 20
“Concerning depression, a recently published meta-analysis of prospective cohort studies reported protective effect of physical activity on depression in youths, adults and elderly persons [36].”
BackgroundZhang, P., Li, Z., Yang, Q., Zhou, J., & Ma, X. (2021) · Sports Medicine and Health Science · doi:10.1016/j.smhs.2021.12.004 · Cited by 23
Mattli, R., Farcher, R., Syleouni, M., Wieser, S., Probst-Hensch, N. M., Schmidt‐Trucksäss, A., & Schwenkglenks, M. M. (2019) · Sports Medicine · doi:10.1007/s40279-019-01233-3 · Cited by 21
Li, L., Lahaye, S. L. D., Ding, S., & Schnell, F. (2025) · Sports Medicine · doi:10.1007/s40279-024-02163-5 · Cited by 19
“Studies that scored 0–3, 4–6, and 7–9 were determined as low, medium, and high quality, respectively [35].”
Local patterns of genetic sharing between neuropsychiatric and insulin resistance-related conditions
Fanelli, G., Franke, B., Fabbri, C., Werme, J., Erdogan, I., Witte, W. D., Poelmans, G., Ruisch, I. H., Reus, L. M., van Gils, V., et al. (2025) · Translational Psychiatry · doi:10.1038/s41398-025-03349-9 · Cited by 24
“Beyond shared environmental risk factors – including poor diet, sedentary lifestyle, and disturbed sleep [13 – 15], which could also be direct manifestations of psychopathology – shared genetic components have been identi fi ed [8].”
McKeon, G., Steel, Z., Wells, R., Newby, J. M., Hadži-Pavlović, D., Vancampfort, D., & Rosenbaum, S. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-030668 · Cited by 18
“Recent data from the Health Study of Nord-Trøndelag County study showed that as little as 60 min per week of additional PA could prevent 12% of all incident cases of depression.(23) 26 Despite the known mental health and cardioprotective benefits of increased PA, there has not been extensive research exploring ways to…”
MethodSelf-citationZhang, D., Gabriel, K. P., Sidney, S., Sternfeld, B., Jacobs, D. R., & Whitaker, K. M. (2021) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2021.101489 · Cited by 21
“Physical activity has received much attention in the past decade as one potentially modifiable risk factor for depression, with cohort studies and clinical trials reporting higher levels of physical activity are associated with lower risk of depression and depressive symptoms (Gordon et al., 2018; Hallgren et al., 201…”
BackgroundRamsey, C. M., Lynch, K. G., Gehrman, P., Vairavan, S., Narayan, V. A., Li, Q. S., & Oslin, D. W. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.12.116 · Cited by 19
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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