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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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“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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“The specific list includes allcause mortality [13], cardiovascular disease [14], type 2 diabetes [15], cancers [16,17], dementia [18–20], and depression [21].”
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“Furthermore, regular participation in physical activity can positively impact mental health [7,8].”
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Lee, J., Callaghan, T., Ory, M. G., Zhao, H., & Bolin, J. N. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.03.035 · Cited by 15
Integrating physical activity into the treatment of depression in adults: A qualitative enquiry
Machaczek, K. K., Allmark, P., Pollard, N., Goyder, E., Shea, M., Horspool, M. J., Lee, S., de la Haye, S., Copeland, R. J., & Weich, S. (2021) · Health & Social Care in the Community · doi:10.1111/hsc.13283 · Cited by 14
Denche-Zamorano, Á. M., My works are correct, B. M. I. A. A. I. S. R. L. M. T. I. D. A.-M., Gómez-Galán, R., Franco-García, J. M., Carlos‐Vivas, J., Mendoza-Muñoz, M., Rojo-Ramos, J., Vega-Muñoz, A., Contreras-Barraza, N., Gianikellis, K., et al. (2022) · Healthcare · doi:10.3390/healthcare10081442 · Cited by 18
“It also helps in mental and emotional aspects such as depression or anxiety [22], increased positive feelings associated with self-efficacy, and decreased negative thoughts [23,24].”
BackgroundWang, N., Zhu, S., Chen, S., Zou, J., Zeng, P., & Tan, S. (2025) · Reviews in the Neurosciences · doi:10.1515/revneuro-2024-0147 · Cited by 12
A complex systems view on physical activity with actionable insights for behaviour change
Schüler, J., Heino, M. T. J., Balagué, N., Chater, A., Grüber, M., Kanning, M. K., Keim, D. A., Mier, D. U., Moreno‐Villanueva, M., Nußbeck, F. W., et al. (2025) · Nature Human Behaviour · doi:10.1038/s41562-025-02279-2 · Cited by 13
“Physical inactivity is a major public health threat, ranking as the fourth leading cause of mortality 1 and a key risk factor for non-communicable diseases 2,3 and poor mental health 4 , while also contributing to substantial economic costs 5 .”
Diabetes, sleep disorders and risk of depression - A Danish register-based cohort study
Wium‐Andersen, I. K., Jørgensen, T. S. H., Jørgensen, M. B., Osler, M., & Wium‐Andersen, M. K. (2022) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2022.108266 · Cited by 15
Mordeno, I. G., Luzano, J. G. C., Gallemit, I. M. J. S., & Gonzaga, E. Z. J. (2023) · Psychology in the Schools · doi:10.1002/pits.22939 · Cited by 15
Hemodynamic Effects of the Osmopressor Response: A Systematic Review and Meta‐Analysis
Oyewunmi, O. A., Lei, L. Y., Laurin, J. K. H., Morillo, C. A., Sheldon, R. S., & Raj, S. R. (2023) · Journal of the American Heart Association · doi:10.1161/jaha.122.029645 · Cited by 12
“17 The quality of evidence for each outcome was graded using the Grading of Recommendations, Assessment, Development, and Evaluation framework.”
MethodRaatikainen, I., Mäntyselkä, P. T., Vanhala, M. J., Heinonen, A. O., Koponen, H., Kautiainen, H., & Korniloff, K. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.08.039 · Cited by 12
Rodríguez‐Roca, B., Subirón‐Valera, A. B., Gasch‐Gallén, À., Calatayud, E., Gómez‐Soria, I., & Marcén-Román, Y. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182010918 · Cited by 14
“Some studies have indicated a relation between mental problems and physical activity [32,33].”
BackgroundBewegung, körperliche Aktivität und Sport bei depressiven Erkrankungen
Bendau, A., Petzold, M. B., & Ströhle, A. (2022) · NeuroTransmitter · doi:10.1007/s15016-021-9343-y · Cited by 12
“In längsschnittlichen Kohortenstudien sagte körperliche Ak tivität zudem prospektiv ein im Schnitt deutlich reduziertes Ri siko für die Inzidenz einer depressiven Erkrankungen in den nachfolgenden Jahren vorher [2, 11, 12].”
BackgroundBrierley, M., Albertella, L., Christensen, E., Rotaru, K., Jacka, F. N., Segrave, R. A., Richardson, K. E., Lee, R. S., Kayayan, E., Hughes, S. D., et al. (2022) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674221085923 · Cited by 13
“For instance, the evidence base for exercise as both a preventive and treatment strategy for depression and anxiety is extensive (Schuch et al., 2018; Stubbs et al., 2017).”
BackgroundDahlstrand, J., Fridolfsson, J., Arvidsson, D., Börjesson, M., Friberg, P., & Chen, Y. (2023) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2023.03.006 · Cited by 14
Vancampfort, D., Basangwa, D., Kimbowa, S., Firth, J., Schuch, F. B., Damme, T. V., & Mugisha, J. (2019) · Physiotherapy Research International · doi:10.1002/pri.1821 · Cited by 14
Self-citationKolovos, S., Finch, A. P., van der Ploeg, H. P., van Nassau, F., Broulíková, H. M., Baka, A., Treweek, S. P., Gray, C. M., Jelsma, J. G. M., Bunn, C., et al. (2020) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-020-00934-7 · Cited by 13
“010 Fixed Meta-analysis; Health survey for England and Scotland [34, 35, 38]”
MethodInfluentialSpirituality, religion, and mood disorders
Mosqueiro, B. P., Pinto, A. D. R., & Moreira‐Almeida, A. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816766-3.00001-x · Cited by 12
Pearce, A., & Longhurst, G. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18030859 · Cited by 12
“all-cause mortality, and recommended that qualified professionals that could support these patients with exercise therapy, be included as part of the multidisciplinary team in mental health treatment [2].”
BackgroundOLIVE, L. S., Sciberras, E., Berkowitz, T. S., Hoare, E., Telford, R. M., Mikocka-Walus, A., Evans, S., Hutchinson, D., McGillivray, J., Teague, S. J., et al. (2020) · PsyArXiv (OSF Preprints) · doi:10.31234/osf.io/anqct · Cited by 12
Lin, Z., Zhu, S., Cheng, J., Lin, Q., Lawrence, W. R., Zhang, W., Huang, Y., Chen, Y., & Gao, Y. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.12.019 · Cited by 12
Patten, R. K., Bourke, M., McIlvenna, L. C., Moreno‐Asso, A., Woessner, M. N., Stepto, N. K., & Parker, A. G. (2022) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2022.102325 · Cited by 13
Stonerock, G. L., Gupta, R. P., & Blumenthal, J. A. (2023) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2023.05.006 · Cited by 11
Larisch, L.-M., Kallings, L., Jakobsson, B. T., & Blom, V. (2023) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2023.2258564 · Cited by 11
“Increasing physical activity and decreasing sedentary behaviour can improve mental health (Naczenski et al., 2017; Schuch et al., 2018; Stubbs et al., 2017; Teychenne et al., 2015; Zhai et al., 2015).”
BackgroundAssociation between commuting time and depressive symptoms in 5th Korean Working Conditions Survey
Lee, D., Yun, J., Lee, N., & Hong, Y. (2023) · Journal of Transport & Health · doi:10.1016/j.jth.2023.101731 · Cited by 13
Huang, Z., Chen, B., Dong, X., He, J., Liu, Y., Li, J., & Zhou, Y. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.10.039 · Cited by 13
Andrade-Lima, A., Werneck, A. O., Szwarcwald, C. L., Schuch, F. B., Stubbs, B., Bastos, A. D. A., & da Silva, D. R. P. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110122 · Cited by 11
Self-citationTikka, S. K., Garg, S., & Siddiqui, M. A. (2020) · Indian Journal of Psychological Medicine · doi:10.1177/0253717620972330 · Cited by 11
Santos, J. D., Ihle, A., Peralta, M., Domingos, C., Gouveia, É. R., Ferrari, G., Werneck, A. O., Rodrigues, F. F., & Marques, A. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2021.799870 · Cited by 11
Su, J., Wei, E., Clark, C. C. T., Liang, K., & Sun, X. (2022) · International Journal of Mental Health Promotion · doi:10.32604/ijmhp.2022.020152 · Cited by 11
Alvarado-Aravena, C., Castillo-Aguilar, M., Villegas, V., Goic, C. A. E., Harris, K., Barría, P., Moraes, M. M., Mendes, T. T., Arantes, R. M. E., Valdés-Badilla, P. A., et al. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20031719 · Cited by 17
Schwefel, M., Kaufmann, C., Gutmann, G., Henze, R., Fydrich, T., Rapp, M. A., Ströhle, A., Heißel, A., & Heinzel, S. (2023) · NeuroImage Clinical · doi:10.1016/j.nicl.2023.103401 · Cited by 11
Nakua, E. K., Amissah, J., Tawiah, P., Barnie, B. A., Donkor, P., & Mock, C. (2023) · BMC Public Health · doi:10.1186/s12889-023-15361-z · Cited by 13
Pengpid, S., Peltzer, K., & Anantanasuwong, D. (2023) · BJPsych Open · doi:10.1192/bjo.2023.72 · Cited by 11
Dang, K., Ritvo, P., Katz, J. D., Gratzer, D., Knyahnytska, Y., Ortiz, A., Walters, C., Attia, M., Gonzalez‐Torres, C., Lustig, A., et al. (2023) · Interactive Journal of Medical Research · doi:10.2196/46419 · Cited by 12
“…evidence supports increased physical activity (PA) and its exercise subsets [6,7] as an adjunctive treatment for major depressive disorder (MDD) or as a single-modality treatment [8-12] with small to moderate antidepressant effects [13,14] and protective benefits against future depression [15].”
BackgroundDeterminants of depression in patients with comorbid depression following cardiac rehabilitation
Sever, S., Harrison, A. S., Golder, S., & Doherty, P. (2019) · Open Heart · doi:10.1136/openhrt-2018-000973 · Cited by 11
“88).(36) However, our study adds, given prior depression on 13 A ril 2019 by gest.”
BackgroundPeng, W., Shi, H., Li, M., Li, X., Liu, T. C., & Wang, Y. (2021) · Environmental Science and Pollution Research · doi:10.1007/s11356-021-16585-5 · Cited by 11
Mullin, E. M., Hutchinson, J., Mellano, K. T., Bird, J. M., & Karageorghis, C. I. (2021) · Journal of Gay & Lesbian Mental Health · doi:10.1080/19359705.2021.1995097 · Cited by 11
“PA has been shown to protect both physical and mental health (Rebar et al., 2015) and shows inverse associations with anxiety and depressive symptoms (McDowell et al., 2019; Schuch et al., 2018).”
BackgroundTaniguchi, H., Okuda, N., Arima, H., Satoh, A., Abe, M., Nishi, N., Higashiyama, A., Suzuki, H., Ohkubo, T., Kadota, A., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-063213 · Cited by 11
Qiu, S., & Xing, Z. (2025) · Translational Psychiatry · doi:10.1038/s41398-025-03543-9 · Cited by 12
“One area of growing interest is the role of physical activity (PA) as a potentially modi fi able factor that may help lower the risk and severity of depression [3].”
Werneck, A. O., Liang, C., Smith, L., Aldisi, D. A., Al‐Daghri, N. M., Baca, A., Zou, L., Yu, Q., Kuang, J., Zhang, Z., et al. (2025) · Child and Adolescent Mental Health · doi:10.1111/camh.70048 · Cited by 10
Self-citationDevice-measured physical activity and incident affective disorders
Ho, F. K. W., Petermann-Rocha, F. E., Parra-Soto, S. L., Boonpor, J., Gill, J. M. R., Gray, S. R., Pell, J. P., & Celis-Morales, C. A. (2022) · BMC Medicine · doi:10.1186/s12916-022-02484-0 · Cited by 10
“multiple limitations of existing studies: most notably, the reliance on self-reported measurement and the failure to adjust for key confounders, such as ethnicity and chronic conditions [6, 7].”
BackgroundResultDaily Physical Activity: Associations With Memory and Affect
Kompf, J. M., & Lachman, M. E. (2022) · American Journal of Health Promotion · doi:10.1177/08901171221139836 · Cited by 11
Roempler, J., Petzold, M. B., Bendau, A., Plag, J., & Ströhle, A. (2023) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-023-01565-2 · Cited by 10
Petersen, C. B., Krüger, C., Guldager, J. D., Algren, M. H., Jervelund, S. S., & Berg‐Beckhoff, G. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1126240 · Cited by 11
“The association between physical activity and mental health is well established (9).”
BackgroundZhu, N., Guo, H., Ma, D., Wang, Q., Ma, J., & Kim, H. (2023) · Children · doi:10.3390/children10071146 · Cited by 11
“These studies suggest that PA acts as a protective factor against internalised behavioural problems, including symptoms of depression and anxiety, regardless of age and geographical location [42,43].”
Background
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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