The combined effect of exercise and behavioral therapy for depression and anxiety: systematic review and meta-analysis
Open accessAbstract
Behavioral therapy (BT) and exercise are efficacious treatments for depression and anxiety when employed separately. The combination of BT and exercise (BT+Ex) may augment improvements but the combined effect of these therapies is not fully elucidated. The purpose of this meta-analysis was to determine if BT+Ex yielded a significant reduction in depression and anxiety symptoms compared to BT alone (BT). Randomized controlled studies published prior to September 2019 were searched among several databases (PUBMED, MEDLINE, PsychArticle, and Cochrane Central Register of Clinical Trials). Studies that measured depression and anxiety symptoms following BT+Ex vs. BT were extracted and analyzed. The effect of these therapies on depression and anxiety were analyzed. Subgroup analyses were performed to evaluate the effect of exercise intensity (moderate and high), exercise type (aerobic and combined exercise), and baseline levels of depression. The moderating effects of gender, age, and treatment duration were performed. Data were extracted from 18 studies (1686 participants, mean age = 47 years, 65% female). There was a significant effect of BT+Ex on symptoms of depression. The effect of BT+Ex was significant for moderate intensity exercise and elevated baseline levels of depression. Age moderated the effect for depression. There was a significant effect of BT+Ex on depressive symptoms in humans. Exercise intensity and elevated depressive symptoms may play a role in the effect of exercise.
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Bourbeau et al (2020) systematic review and meta-analysis on eight studies reported that moderate-intensity exercise combined with behavioural therapy had a significant effect size to reduce depressive symptoms, while increasing age moderated the association.
“Bourbeau et al (2020) conducted a systematic review and meta-analysis on eight studies evaluating the effect of combined physical exercise and behavioural therapy on patients with depression and anxiety and reported that moderate-intensity exercise combined with behavioural therapy had significant effect size to reduce depressive symptoms, while increasing age moderated the above association.31”
From Study protocol on the efficacy of exergames-acceptance and commitment therapy program for the treatment of major depressive disorder: Comparison with acceptance and commitment therapy alone and treatment-as-usual in a multicentre randomised controlled trial (2024) · cites this paper as [31]
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Experimental — accuracy not yet measuredThe combination of physical exercise and psychotherapy for the treatment of major depressive disorder increases the rate of full remission among patients.
“However, the combination of physical exercise and psychotherapy for the treatment of MDD increase the rate of full remission among patients.”
From Study protocol on the efficacy of exergames-acceptance and commitment therapy program for the treatment of major depressive disorder: Comparison with acceptance and commitment therapy alone and treatment-as-usual in a multicentre randomised controlled trial (2024) · cites this paper as [31]
The Results (§3.4; page not available) report that adding exercise to behavioral therapy significantly improved depressive symptoms. The Methods (§2.3) identify symptom change—not full remission—as the primary outcome, and the included participants had varied conditions (§3.2); the paper does not establish an increased full-remission rate specifically among patients with MDD. (LLM, conf=0.90)
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“31 Depression has not been effectively treated with antide-pressants and psychotherapy as studies documented that patients with depression exhibited substantial reduction in severity of symptoms while on antidepressant, only if additional psychosocial interventions are prescribed.”
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- Authors
- Bourbeau, K., Moriarty, T., Ayanniyi, A., & Zuhl, M.
- Affiliations
- University of Northern Iowa (US)
- University of New Mexico (US)
- Central Michigan University (US)
- Corresponding author
- Bourbeau, Kelsey
- Zuhl, Micah
- Venue
- Behavioral Sciences
- Publisher
- MDPI AG
- Published
- 2020-07-14
- Volume
- 10
- Issue
- 7
- Pages
- 116
- ISSN
- 2076-328X (ISSN-L)
- PMC
- PMC7407099
- OpenAlex
- W3042711409
- Cited by
- 56
- References
- 54
- Citations by year
- 2026: 11 · 2025: 5 · 2024: 7 · 2023: 16 · 2022: 9 · 2021: 7 · 2020: 1
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- Behavioral Sciences (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UNI ScholarWorks (University of Northern Iowa) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- physical activity, behavior therapy, depression, anxiety, combination therapy, exercise intensity, aerobic exercise, baseline depression severity, age moderation, gender differences, treatment duration
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