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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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“34 Furthermore, an increase from being inactive to achieving 150 min of moderate-intensity physical activity per week was assumed to lower the risk of type 2 diabetes incidence by 26%, after adjustment for body weight.”
Yang, G., & D’Arcy, C. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1078161 · Cited by 9
Quinlan, C., Rattray, B., Pryor, D. J., Northey, J. M., & Cherbuin, N. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1022868 · Cited by 9
“Future research in middle-aged cohorts will likely benefit from the increasing availability of validated computerised cognitive assessments (Salthouse, 2000; Finkel et al., 2007; Wild et al., 2008; Bauer et al., 2012; Cherbuin et al., 2015; Santos-Lozano et al., 2017; Schuch et al., 2018; Semkovska et al., 2019; Oyarc…”
BackgroundThe role of anticipated affect in the context of physical activity: a scoping review
Feil, K., Fritsch, J., Weyland, S., Warmbrunn, U., & Jekauc, D. (2023) · International Review of Sport and Exercise Psychology · doi:10.1080/1750984x.2023.2275249 · Cited by 11
“…various physical and mental diseases such as cardiovascular diseases (Lavie et al., 2019), metabolic syndrome (Amirfaiz & Shahril, 2019), cancer (Minihan et al., 2022), depression (Schuch et al., 2018), or dementia (Floud et al., 2020), and even increases all-cause mortality (Ekelund et al., 2016).”
Vlachopoulos, S. P., Lane, A. M., & Terry, P. C. (2023) · Sports · doi:10.3390/sports11120234 · Cited by 8
“A version of the POMS in Greek is mentioned in a paper by Roussi and Vas-silaki [111] but few details of the scale are provided, and an unpublished 30-item Greek version of the POMS was produced by Zervas and colleagues in 1993 [112].”
MethodUnlocking the power of physical activity in easing psychological distress
Liu, X., & Wang, X. (2024) · World Journal of Psychiatry · doi:10.5498/wjp.v14.i1.1 · Cited by 9
Hakimi, S., Martin, L. J., & Rosenberg, M. W. (2024) · Journal of Activity Sedentary and Sleep Behaviors · doi:10.1186/s44167-024-00047-7 · Cited by 12
“Our findings indicate that relative time spent in MVPA, LIPA, SB and sleep are possible risk factors for depression outcomes in older adults which align with recent findings from several smaller studies [5, 6, 8, 12, 14].”
BackgroundResultInfluentialZhu, J.-H., Shen, Z., Liu, B.-P., & Jia, C.-X. (2024) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-024-02708-z · Cited by 10
Gerber, M., Ehrbar, J., Brand, R., Antoniewicz, F., Brand, S., Colledge, F., Donath, L., Egger, S., Hatzinger, M., Holsboer‐Trachsler, E., et al. (2018) · Mental health and physical activity · doi:10.1016/j.mhpa.2018.08.001 · Cited by 10
Petzold, M. B., Ernst, F., Spitzer, U. S., Gabrysch, J., Schweinfurth, N., Satorius, N., Ströhle, A., & Betzler, F. (2020) · Psychotherapeut · doi:10.1007/s00278-020-00421-1 · Cited by 9
Wium‐Andersen, M. K., Villumsen, M. D., Wium‐Andersen, I. K., Jørgensen, M. B., Hjelmborg, J., Christensen, K., & Osler, M. (2020) · Molecular Psychiatry · doi:10.1038/s41380-020-00954-6 · Cited by 9
St‐Amour, S., Hains-Monfette, G., Dancause, K. N., Cailhol, L., & Bernard, P. (2021) · Mental health and physical activity · doi:10.1016/j.mhpa.2021.100394 · Cited by 9
Ekelöf, K., Andersson, O., Holmén, A., Thomas, K., & Almquist‐Tangen, G. (2021) · Sexual & Reproductive Healthcare · doi:10.1016/j.srhc.2021.100645 · Cited by 10
“In addition, a large meta -analysis of 49 prospective studies evaluating physical activity in the general population showed that physical activity was associated with a lower risk of developing depression in all age groups [2].”
Anouti, F. A., Thomas, J., Karras, S. Ν., & Asswad, N. E. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.829362 · Cited by 10
Christie, H. E., Roach, L. A., Kennedy, M., Beetham, K. S., Meyer, B. J., Schoenaker, D. A. J. M., & François, M. E. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-04913-7 · Cited by 9
Lee, Y. H., Kim, H., & Cho, H. (2022) · Healthcare · doi:10.3390/healthcare10101886 · Cited by 9
“These results suggest that physical activity can be an alternative tool to reduce the frequency of drug use due to depression, improve independence in daily activities, and contribute to a healthy lifestyle [16,36].”
Backgroundde Andrade, T. B., de Andrade, F. B., & Viana, M. C. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.04.051 · Cited by 9
Nagata, S., McCormick, B. P., & Austin, D. R. (2020) · Therapeutic Recreation Journal · doi:10.18666/trj-2020-v54-i1-9745 · Cited by 12
“Finally, Schuch et al. (2018), in a meta-analysis of 49 prospective cohort studies of physical activity and the development of depression, concluded that physical activity provided protective effects regardless of age or geographical world region.”
BackgroundHockey, M., Hoare, E., Mohebbi, M., Tolmunen, T., Hantunen, S., Tuomainen, T., Macpherson, H., Staudacher, H. M., Jacka, F. N., Virtanen, J. K., et al. (2022) · Journal of Nutrition · doi:10.1093/jn/nxac128 · Cited by 8
The impact of diet and lifestyle on wellbeing in adults during COVID-19 lockdown
Muth, A.-K., Vermeer, A. B. L., Terenzi, D., & Park, S. Q. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.993180 · Cited by 15
Wang, M., Wang, Z., Wang, Y., Zhou, Q., & Wang, J. (2024) · Frontiers in Neuroscience · doi:10.3389/fnins.2024.1436223 · Cited by 9
Shava, B. K., Vhudzijena, B., Kupenga-Maposa, T., Musingwini, T., Samudzi, T., Muchemwa, S., Chibanda, D., & Dambi, J. M. (2024) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2024.1205914 · Cited by 12
“…of prospective cohort studies revealed that people with high self-reported PA (vs. low PA) were at reduced odds of developing anxiety (adjusted odds ratio = 0.748 95%CI = 0.629, 0.889; p -value = 0.001) and depression (adjusted odds ratio = 0.83, 95%CI = 0.79, 0.88; p < 0.0001) (30, 32).”
InfluentialSantos, B., Monteiro, D., Silva, F. M., Flores, G., Bento, T., & Duarte‐Mendes, P. (2024) · Healthcare · doi:10.3390/healthcare12181866 · Cited by 13
“…better HRQoL, because physical activity is associated with many health-related outcomes like low mortality [50], low risk of depression and anxiety [51], improvements in cognition [52] and better sleep quality [53] and with a low risk of many diseases, like cancer, hypertension and type 2 diabetes…”
van Hooijdonk, K. J. M., Reed, Z. E., van den Broek, N., Singh, M., Sallis, H., Gillespie, N. A., Munafo, M. R., & Vink, J. M. (2025) · Psychological Medicine · doi:10.1017/s0033291724003349 · Cited by 8
“…et al., 2024; Pearce et al., 2022; Rebar et al., 2015; Roshanaei-Moghaddam, Katon, & Russo, 2009; Saghafian et al., 2018; Schuch et al., 2019; Schuch et al., 2018; Tuck, Farrow, & Thomas, 2019; Wanjau et al., 2023; Yan, Xu, Li, & Liu, 2023), while others have not (Appleton, Boxall,…”
Liu, X., Du, Z., Wang, L., Tian, J., Zhang, L., & Li, Y. (2025) · Mental health and physical activity · doi:10.1016/j.mhpa.2025.100677 · Cited by 8
Giurgiu, M., & Ebner‐Priemer, U. (2025) · Journal of Activity Sedentary and Sleep Behaviors · doi:10.1186/s44167-025-00077-9 · Cited by 9
Bürger, L., Reis, D., Spielmann, J., Mayer, J., & Steindorf, L. (2025) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2025.102868 · Cited by 8
Choi, K. W., Kim, H. H., Basu, A., Kwong, A. S. F., Hernández–Dı́az, S., Wyszynski, D. F., & Koenen, K. C. (2021) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2021.100288 · Cited by 8
“This is consistent with literature that has now identified physical activity as a likely protective factor for low mood and specifically depression (Schuch et al., 2018; Choi et al., 2019), Fig.”
Curtin, A. C., & Johnston, C. S. (2022) · Journal of Dietary Supplements · doi:10.1080/19390211.2022.2030843 · Cited by 8
“Behavioral interventions and exercise programs have been demonstrated to improve depression ratings (43, 44), but widening treatment strategies to include nutrition therapies is warranted.”
BackgroundAlpers, S. E., Furulund, E., Pallesen, S., Mamen, A., Dyrstad, S. M., & Fadnes, L. T. (2022) · Substance Abuse Research and Treatment · doi:10.1177/11782218221111840 · Cited by 10
Souza, G. A., Souza, G. F. D. A., Alves, A. C. D. S., Cordeiro, A. L. N., Carvalho, M. D. S. O., Costa, G., da Silva, J. R., & Souza, A. S. R. (2022) · Revista Brasileira de Educação Médica · doi:10.1590/1981-5271v46.3-20220042 · Cited by 14
Physical Activity and Depression and Anxiety Disorders in Australia: A Lifetable Analysis
Wanjau, M. N., Möller, H., Haigh, F., Milat, A., Hayek, R., Lucas, P., & Veerman, L. J. (2022) · AJPM Focus · doi:10.1016/j.focus.2022.100030 · Cited by 8
Tanaka, S., Saida, K., Murayama, A., Higuchi, D., & Shinohara, T. (2022) · Psychogeriatrics · doi:10.1111/psyg.12917 · Cited by 8
Hübner, M., Lechleitner, P., & Neumayr, G. (2022) · BMC Public Health · doi:10.1186/s12889-022-14838-7 · Cited by 8
“Our data appear to confirm the pre-existing notion that the regularity and duration of physical activity – and less so its intensity – improve well-being to a decisive extent [24, 25].”
BackgroundResultWerneck, A. O., Schuch, F. B., Félez-Nóbrega, M., Araújo, R. H. D. O., Szwarcwald, C. L., Stubbs, B., & da Silva, D. R. P. (2023) · Mental health and physical activity · doi:10.1016/j.mhpa.2023.100507 · Cited by 8
Self-citationPark, J. H., Lim, N.-K., & Park, H. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1176879 · Cited by 8
China Trends in Physical Inactivity from 2013 to 2019: An Analysis of 4.23 Million Participants
Tu, W., Sun, H., Yan, F., Fan, Y., Yi, Z., LI, J.-L., & Zeng, X. (2023) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003315 · Cited by 9
“Moreover, a meta-analysis of prospective cohort studies indicated that physical activity can help protect against depression regardless of age or geographic region (6).”
BackgroundTian, F., Yang, X., Xu, F., Dong, R., Song, Y., Fan, C., & Zhou, Z. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.10.065 · Cited by 8
Pereira-Payo, D., Mendoza-Muñoz, M., Denche-Zamorano, Á. M., la Osa, A. R.-D., Moreno-Quintanilla, M., & Pastor-Cisneros, R. (2024) · Healthcare · doi:10.3390/healthcare12050552 · Cited by 8
“Thus, research has suggested that greater volume, intensity and frequency can achieve greater improvements in psychological state [43,66].”
BackgroundResultPrevalence and Associated Factors of Depressive Symptoms among Older Adults in the Philippines
Pengpid, S., & Peltzer, K. (2024) · Actas Españolas de Psiquiatría · doi:10.62641/aep.v52i5.1686 · Cited by 8
“Physical inactivity [24], tobacco use, alcohol use (as self-medication) [25], and a history of falls [26] are risk behaviours linked to depressive symptoms.”
BackgroundDong, J., Huang, J., Parisi, J. M., Zhou, Z. E., Li, M., Calderon, R., & Li, J. (2025) · Sleep Health · doi:10.1016/j.sleh.2024.12.004 · Cited by 8
Werneck, A. O., Oyeyemi, A. L., Szwarcwald, C. L., Stubbs, B., & da Silva, D. R. P. (2019) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2019.07.005 · Cited by 8
“Beyond the well-established protective association between physical activity and depressive symptoms [4], sedentary behavior, defined as “any waking”
BackgroundSelf-citation
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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