1
CA20104 – Ne wo k on e idence-based
physical ac i i y in old age (PhysAgeNe )
Deli e able D1.2
Sys ema ic e iews using he da abase D1.1 submi ed o
publica ion ela ed o PA in e en ions and EBM
Con ibu o s
Wo king G oup 1: Implemen a ion and de elopmen o
s anda ds om e idence-based medicine (EBM)
1.3.1. Ch onic exe cise and dep essi e symp oms
Leade s o he subg oup: Melanie Mack (CHE) and Michel Audi en (FRA)
Membe s o he subg oup: Claudia Voelcke -Rehage (DEU), Pinelopi S a inou (CYP), Julia
Pa lo a (UKR), Yaël Ne z (ISR), Bu cu Kömü cü (TUR), An onia Kal sa ou (GRC), Sand a Haide
(AUT), Ch is o o os Giannaki (CYP), A zu E den (TUR), And eea Badache (SWE).
Desc ip ion o he ac i i ies o he subg oup:
The subg oup “Ch onic exe cise and dep essi e symp oms” has me 10 imes since he
summe o 2022. The slides p esen ed du ing he mee ings we e pos ed on he Riga S adins
Uni e si y Teams space. The subg oup al eady comple ed he ollowing ope a ions: (1)
sea ch o andomized con olled ials examining he e ec o ch onic exe cise on dep essi e
symp oms in olde adul s in se e al da abases (30,765 a icles ound), (2) uploading he
e e ences o hese 30,765 a icles in Rayyan, (3) emo al o duplica es (10,347 duplica es
emo ed), (4) selec ion o s udies based on abs ac s by pai s o e iewe s (19,845 a icles
excluded), (5) selec ion o s udies based on ull- ex by pai s o e iewe s (411 a icles
excluded), (6) p epa a ion o he ques ionnai e o ex ac he da a on REDCap, (7) ex ac ion
o a sample o selec ed da a and s o age o hese da a in REDCap by pai s o e iewe s, (8)
conduc ing he me a-analysis on Comp ehensi e me a-analysis 4. The i s esul s a e
p esen ed in sec ion 3. The e iew p o ocol has been egis e ed on PROSPERO
[CRD42022361418] and accep ed o publica ion in PLOS One. The nex s ages o inish he
sys ema ic e iew and me a-analysis a e desc ibed in he wo Gan cha s he ea e . The
submission o he inal a icle is planned in Janua y 2025.
Timeline o he ac i i ies o 2024 and 2025:
2
….
2. Resul s o he me a-analysis on he ch onic e ec s o exe cise on o e all dep ession
le el in olde adul s
As men ioned in sec ion 1.3.1, he p o ocol o he p esen me a-analysis has been egis e ed
on PROSPERO [CRD42022361418] and accep ed o publica ion in PLOS One (doi:
10.1371/jou nal.pone.0297348). We p esen he ea e he main esul s o he me a-analysis
ha will be published in a indexed in e na ional jou nal.
2.1. Gene al esul s
The analysis is based on 162 e ec sizes (129 s udies). A able wi h he e e ences o he 129
s udies is p o ided in appendix 1. The e ec size index is he s anda dized di e ence in
means (Cohen’s d). Compu a ions we e ca ied ou using Comp ehensi e Me a-Analysis
Ve sion 4 (Bo ens ein e . al., 2022).
2.1.1. S a is ical model
The andom-e ec s model was employed o he analysis. The s udies in he analysis a e
assumed o be a andom sample om a uni e se o po en ial s udies, and his analysis will
be used o make an in e ence o ha uni e se (Bo ens ein, 2019; Bo ens ein e al., 2010;
Bo ens ein e al., 2021; Hedges & Ve ea, 1998; Higgins & Thomas, 2019).
2.1.2. Wha is he mean e ec size?
The mean e ec size o he e ec o ch onic exe cise on o e all dep ession le el is -0,675
wi h a 95% con idence in e al o -0,779 o -0,572 (see Figu e 1). The mean e ec size in he
uni e se o compa able s udies could all anywhe e in his in e al. This mode a e e ec size
indica es ha ch onic exe cise educes he o e all dep ession le el by 0.675 s anda d
de ia ion.
3
Figu e 1: Ca e pilla plo o he 162 e ec sizes included in he me a-analysis
The Z- alue es s he null hypo hesis ha he mean e ec size is ze o. The Z- alue is -12,776
wi h p < 0,001. Using a c i e ion alpha o 0,050, we ejec he null hypo hesis and conclude
ha in he uni e se o popula ions compa able o hose in he analysis, he mean e ec size
is no p ecisely ze o.
2.1.3. The Q- es o he e ogenei y
The Q-s a is ic p o ides a es o he null hypo hesis ha all s udies in he analysis sha e a
common e ec size. I all s udies sha ed he same ue e ec size, he expec ed alue o Q
would be equal o he deg ees o eedom ( he numbe o s udies minus 1). The Q- alue is
1143,668 wi h 161 deg ees o eedom and p < 0,001. Using a c i e ion alpha o 0,100, we
can ejec he null hypo hesis ha he ue e ec size is he same in all hese s udies.
2.1.4. The I-squa ed s a is ic
The I-squa ed s a is ic is 86%, which ells us ha some 86% o he a iance in obse ed
e ec s e lec s a iance in ue e ec s a he han sampling e o .
2.1.5. Tau-squa ed and au
Tau-squa ed, he a iance o ue e ec sizes, is 0,348 in d uni s. Tau, he s anda d de ia ion
o ue e ec sizes, is 0,590 in d uni s.
2.1.6. The p edic ion in e al
I we assume ha he ue e ec s a e no mally dis ibu ed (in d uni s), we can es ima e ha
he p edic ion in e al is -1,845 o 0,495 (see Figu e 2). The ue e ec size in 95% o all
compa able popula ions alls in his in e al (Bo ens ein, 2019, 2020; Bo ens ein e al., 2021;
Bo ens ein e al., 2017; De Simonian & Lai d, 1986, 2015; Higgins, 2008; Higgins &
Thompson, 2002; Higgins e al., 2003; Higgins & Thomas, 2019; In Hou e al., 2016).
4
Figu e 2: P edic ion in e al o ue e ec s and con idence in e al o he mean e ec size.
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5
2.2. Mode a o analyses
2.2.1. Exe cise cha ac e is ics
2.2.1.1. Mode a o : Type o exe cise
Ra ionale: Nume ous ecen me a-analyses ha e been conduc ed o in es iga e he
di e en ial e ec s o a ious ypes o exe cise on o e all dep ession le els in heal hy olde
adul s (Mille e al., 2020), and in olde adul s wi h Mild Cogni i e Impai men (MCI) (Liu e
al., 2023). Fo olde adul s, bo h wi h and wi hou MCI, i was ound ha mind-body
exe cises we e mos bene icial in educing dep ession le els (Liu e al., 2023; Mille e al.,
2020). Howe e , esis ance, ae obic, and mul icomponen exe cises also p o ed e ec i e,
albei sligh ly less so, s ill demons a ing mode a e e ec sizes. The e o e, we hypo hesize
ha all he ypes o exe cise included in ou s udy a e e ec i e in educing dep essi e
symp oms, hough h ough di e en mechanisms. Mind-body exe cises, which combine low-
in ensi y muscula ac i i ies (such as lexibili y o balance aining) wi h an in e nally guided
ocus os e ing a sel -con empla i e s a e o mind, a e hypo hesized o be pa icula ly
e ec i e.
Resul s: A subg oup analysis, including 162 e ec sizes, e ealed ha he ype o exe cise
signi ican ly explained he he e ogenei y o he e ec sizes, Q (6) = 19.830, p = .003. The
e icacy o di e en ypes o exe cise in educing o e all dep ession le els can be anked in
he ollowing o de : (1) exe games (n = 6; SMD = -1.705; 95 % CI = [-2.789, -0.622]), (2)
esis ance exe cises (n = 27; SMD = -0.973; 95 % CI = [-1.244, -0.702]), (3) mind-body
exe cises (n = 33; SMD = -0.733; 95 % CI = [-0.979, -0.568]), (4) ae obic exe cises (n = 30;
SMD = -0.625; 95 % CI = [-0.947, -0.304]), (6) Coo dina i e exe cises (n = 3; SMD = -0.529;
95 % CI = [-0.965, -0.093]), (7) Mul i-componen exe cises (n = 55; SMD = -0.460; 95 % CI = [-
0.602, -0.318]), (8) Dance exe cises (n = 8; SMD = -0.378; 95 % CI = [-0.087, -0.069]).
Discussion: Con a y o ou hypo hesis and he esul s o he me a-analyses by Mille e al.
(2020) and Liu e al. (2023), we did no ind mind-body exe cise o be he mos e ec i e ype
o exe cise. Howe e , simila o hose s udies, he e ec sizes be ween mind-body exe cises,
ae obic exe cise, and s eng h exe cises we e compa able ( anging om -0.97 o -0.63).
In e es ingly, o exe games, a ype no included in he me a-analyses by Mille e al. (2020)
and Liu e al. (2023), we ound hem o be he mos e ec i e, wi h an e ec size o -1.71.
This bene icial e ec aligns wi h he indings o Yen & Chui (2021), who epo ed la ge
e ec s o exe games on dep essi e ou comes in olde adul s. I migh be sugges ed ha
exe games bene i he men al heal h o olde adul s by no only including cogni i e and
physical exe cises bu also p omo ing social in e ac ions wi h o he ac o s such as playe s,
he apis s, a a a s, and animals. Howe e , he wi hin-s udy he e ogenei y was qui e high.
The e o e, u he esea ch is needed o mo e speci ically iden i y which aspec s o
exe games mode a e he bene icial e ec on dep ession in olde adul s.
2.2.1.2. Mode a o : In ensi y o exe cise
Ra ionale: The le el o exe cise in ensi y can signi ican ly a ec he ype and ex en o
psychological and physiological adap a ion o exe cise aining and can impac he human
body's in e nal me abolic and ca dio ascula s ess (Mann, Lambe s, & Lambe , 2013; Xie
e al., 2021). Rega ding he an i-dep essan p ope ies o exe cise, ecen esea ch has
6
shown ha he in ensi y o exe cise plays a signi ican ole in he an i-dep essan e ec o
a ious ypes o exe cise, such as s eng h aining, esis ance aining, yoga, and ai chi
(Nebike e al., 2018; Noe el e al., 2024). Fo ins ance, inc easing he in ensi y o exe cise by
10% has been ound o ha e a no able posi i e e ec on dep ession le els (Nebike e al.,
2018). The e o e, we hypo hesized ha he highe he exe cise in ensi y, he la ge he
e ec o exe cise aining in e en ion on o e all dep ession le els.
Resul s: The e was a signi ican e ec o he in ensi y o exe cise on he e ec size: Q (2) =
7.180; p = .028. The exe cises wi h a igo ous in ensi y o highe (n = 25; SMD = -1.138; 95 %
CI = [-1.535, -0.740]) led o a la ge e ec size han mode a e (n = 80; SMD = -0.570; 95 % CI
= [-0.707, -0.432]) and ligh in ensi y exe cises (n = 57; SMD = -0.676; 95 % CI = [-0.842, -
0.509])). The di e ence be ween he mean e ec size o ligh and mode a e in ensi y
exe cises: Q (1) = 0.922; p = .337.
Discussion: The esul s o he cu en analysis e ealed ha exe cise aining p esc ip o s,
such as exe cise in ensi y, can signi ican ly impac he le el o amelio a ion o o e all
dep ession symp oms in olde people. The esul s o his s udy suppo ecen me a-analyses
on he ela ionship be ween exe cise aining and dep ession in younge popula ions ha
epo ed ha high-in ensi y exe cise in e en ions a e mo e e ec i e in educing dep ession
compa ed o mode a e o ligh -in ensi y ones (Nebike e al., 2018; Noe el e al., 2024). In
conclusion, exe cise in ensi y has a mode a ing e ec on o e all dep ession le els in olde
people, wi h high in ensi ies being mo e e ec i e han mode a e and ligh in ensi ies.
2.2.1.3. Mode a o : Du a ion o exe cise sessions
Ra ionale: Based on a p e ious me a-analysis examining he e ec s o ch onic exe cise on
cogni i e aging (Colcombe & K ame , 2003), we can hypo hesize ha RCTs ha use
mode a e du a ion sessions lead o la ge e ec sizes because i could be conside ed ha
he op imal du a ion o main ain a high le el o engagemen o olde pa icipan s is be ween
30 and 60 minu es. RCTs using sho e o longe in e en ion sessions could be conside ed
as less op imal and leading o smalle e ec sizes. Sho session RCTs would no be
su icien ly long o induce la ge and endu ing changes, whe eas long session RCTs would
in oduce acu e a igue e ec s. To pe o m his analysis, we dis inguished ou ca ego ies o
s udies: (1) sho du a ion sessions (< 30 min), (2) mode a e du a ion sessions (30 < du a ion
< 60 min), (3) long du a ion session (> 60 min), (4) session du a ion no speci ied.
Resul s: A subg oup analysis, including 162 e ec sizes, e ealed ha he du a ion o
exe cise sessions did no signi ican ly explain he he e ogenei y o he e ec sizes, Q (3) =
2.562, p = .464. The e was no signi ican di e ence be ween he ou ca ego ies o RCTs:
RCTs using sho du a ion sessions (n = 16; mean du a ion = 18.79 min; SMD = -0.434; 95 %
CI = [-0.767, -0.101]), RCTs using mode a e du a ion sessions (n = 90; mean du a ion = 48.95
min; SMD = -0.660; 95 % CI = [-0.794, -0.525]), RCTs using long du a ion sessions (n = 13;
mean du a ion = 95.36 min; SMD = -0.687; 95 % CI = [-0.985, -0.389]), RCTs ha did no
speci y he du a ion o sessions (n = 18; SMD = -0.482; 95 % CI = [-0.778, -0.186]).
Discussion: Con a y o ou hypo hesis, he du a ion o he exe cise sessions did no
in luence he size o he e ec o ch onic exe cise on o e all dep ession le el. Howe e , i
can be no iced ha mode a e du a ions a e he mos used by esea che s (75%).
7
2.2.1.4. Mode a o : F equency o exe cise sessions
Ra ionale: The me a-analysis o Sande s e al. (2019) sugges ed ha he mo e equen he
exe cise sessions we e, he g ea e he bene i in cogni i e unc ion in olde adul s. Using
he same logic, we can hypo hesize ha he mo e equen he exe cise sessions, he la ge
he educ ion in o e all dep ession le el.
Resul s: The me a- eg ession, including 145 e ec sizes, indica ed ha he equency o
exe cise sessions did no explain he he e ogenei y o he e ec sizes o ch onic exe cises on
o e all dep ession le el (β = -0.008, R² = .00, p = .795).
Discussion: Con a y o ou expec a ions, we did no ind a ela ionship be ween he
equency o exe cise sessions and he e ec size o he in e en ions. This mode a o
should no be conside ed alone, bu ce ainly in combina ion wi h session du a ion and
du a ion o he in e en ion.
2.2.1.5. Mode a o : To al du a ion o he in e en ion (in weeks)
Ra ionale: Recen sys ema ic e iews and me a-analyses a e inconclusi e ega ding he
e ec o in e en ion du a ion on pa icipan s' dep essi e episodes (Kandola e al., 2019;
Singh e al., 2023). I is no ed ha he e ec i eness o physical ac i i y in e en ions may
dec ease wi h inc easing du a ion o in e en ions. Longe du a ion in e en ions had
smalle e ec s i compa e wi h mid- and sho du a ion, bu he longes du a ion
in e en ions s ill had posi i e e ec s (Singh e al., 2023). Wi hin clinical popula ions
in e en ions las ing 10–16 weeks lead o g ea e e ec s han in e en ions las ing 4–9
weeks (Lee e al., 2022; Re ho s e al., 2009; Singh e al., 2023). Howe e , in he gene al
popula ion, in e en ions las ing 4–9 weeks esul ed in signi ican ly la ge e ec s han
in e en ions las ing 17–26 weeks, and in e en ions las ing 10–16 weeks also p oduced
signi ican ly la ge e ec s han in e en ions las ing 16–26 weeks and mo e han 26 weeks
(Re ho s e al., 2009). Conside ing he esul s o esea ch, we hypo hesized ha he
du a ion o he in e en ion is posi i ely co ela ed wi h he bene icial e ec s o exe cise
un il a ce ain du a ion.
Resul s: The me a- eg ession, including 155 e ec sizes, indica ed a ma ginal ela ionship
be ween he du a ion and he e ec size o ch onic exe cises on o e all dep ession le el (β =
-0.0001, R² = .00, p = .05456). This indica ed ha he longe he du a ion o he in e en ion
in he s udies, he la ge he bene icial e ec s o ch onic exe cise on he o e all dep ession
le el (see Figu e 3). This esul ma ches wi h ha ound by Yen e al. (2021) who obse ed
ha he o al in e en ion du a ion had a signi ican e ec on dep essi e ou comes, he
longes du a ion leading o a g ea e e iciency agains dep essi e ou comes (β = -0.255; p =
0.11).
8
Figu e 3: eg ession line be ween s anda dized di e ence in means o le el o dep ession as a
unc ion o du a ion o in e en ion in he RCT.
Discussion: Ou me a- eg ession did no ind a signi ican ela ionship be ween he du a ion
o in e en ion and he e ec o ch onic exe cise on o e all dep ession le el. This esul is
inconsis en wi h ea lie s udies (C a & Lande s, 1998; No h e al., 1990) acco ding o
which longe in e en ion esul ed in la ge dec eases in dep ession sco es, while also being
consis en wi h mo e ecen wo k on he lack o a linea ela ionship (Lee e al., 2022;
Re ho s e al., 2009; Singh e al., 2023). One o he possible mechanisms explaining his
e ec may be he insu icien du a ion o he in e en ions, as well as he numbe o such
in e en ions. Mos exe cise in e en ions o dep ession a e a ound 16 weeks, and his
pe iod may only be su icien o induce unc ional connec i i y changes (Re ho s e al.,
2009). Exe cise mus las o a leas six mon hs o induce s uc u al changes ( o example, in
hippocampal olume), longe exe cise in e en ions may induce s uc u al changes ha ha e
a mo e p onounced impac on dep essi e symp oms. Also exe cise p oduces se e al
unc ional, bu ansien changes in neu oplas ici y, such as ele a ions in BDNF ci cula ion,
imp o emen s in ca dio espi a o y i ness a e necessa y o mo e las ing s uc u al changes
and cogni i e bene i s (Kandola e al., 2019).
2.2.1.6. Mode a o : Volume o he in e en ion
Volume = Session equency (NO sessions pe week) * Session du a ion (in min) * P og am
du a ion (in weeks)
Ra ionale: Among he numbe o s udies ha in es iga e he p o ec i e ole o physical
ac i i y on dep ession, esul s a e la gely he e ogeneous (Noe el e al., 2024; Singh e al.,
2023; Wang e al., 2019). Among he indings is he asce ainmen o he ac o a posi i e
e ec o physical ac i i y on educing he se e i y and symp oms o dep ession (Singh e al.,
2023). O he s udies ha e examined physical ac i i y ac oss di e en pa ame e s, including
equency, du a ion, and olume, and ha e p oduced mo e complex esul s. Some indings
9
indica ed ha indi iduals who pa icipa ed in physical ac i i y wi h g ea e equency we e
less likely o be dep essed; some esea ches ha lowe equency o PA wi h a lowe olume
is a p o ec i e ac o (Wang e al., 2019). We hypo hesize ha ch onic exe cise in e en ions
di e in hei e icacy in educing o e all dep ession se e i y in olde adul s ac oss
in e en ions wi h di e en exe cise cha ac e is ics (i.e., equency o exe cise sessions,
du a ion o exe cise session, and du a ion o in e en ion).
Resul s: The me a- eg ession, including 141 e ec sizes, indica ed a linea ela ionship
be ween he olume o in e en ion and he e ec size o ch onic exe cise on o e all
dep ession le el (β = -0.0001, R² = .00, p = .04). This indica ed ha he la ge he olume o
he in e en ion in he s udies, he la ge he e ec s o ch onic exe cise on he o e all
dep ession le el (see Figu e 4).
Discussion: Ou me a- eg ession indica ed a signi ican ela ionship be ween in e en ion
olume and he e ec o ch onic exe cise on o e all dep ession le el. This esul is consis en
wi h some p e ious s udies (Wang e al., 2019). A he same ime he lack o consensus on
his issue indica es ha he ela ionship be ween physical ac i i y and dep ession may be
dependen on cul u al and socio-demog aphic indica o s (Olan ewaju e al., 2016), and also
con i ms he mul idimensional na u e o exe cise aining ha consis s o in ensi y,
equency, and du a ion o in e en ion (Falck e al., 2016).
Figu e 4: eg ession line be ween s anda dized di e ence in means o le el o dep ession as
a unc ion o olume o in e en ion in he RCT.
2.2.1.7. Mode a o : Cogni i e demand o exe cises
Ra ionale: Two ca ego ies o exe cise ha e been dis inguished based on he cogni i e load o
he exe cises included in he exe cise p og ams. On he one hand, high cogni i e demanding
exe cises include balance exe cises, coo dina i e exe cises, mind-body exe cises, exe games
and cogni i e asks. On he o he hand, low cogni i e demanding exe cises include ae obic
exe cises and esis ance exe cises. Based on p e ious wo ks, we know ha dep essed
16
comple e-case analysis, he numbe o pa icipan s is he same a he beginning and a he
end o he in e en ion o all he g oups o he au ho s only analyzed da a om pa icipan s
who comple ed he s udy and had no missing da a. Finally, in RCTs using a pe -p o ocol
analysis, only he pa icipan s who adhe e o he ea men a e included in he analysis o
es he e icacy o he ea men . Mos clinical esea che s and s a is icians ag ee ha he
p ima y analysis o da a in a andomised con olled ial should compa e pa ien s acco ding
o he g oup o which hey we e andomly alloca ed, ega dless o pa ien s' compliance,
c osso e o o he ea men s, o wi hd awal om he s udy. Such an analysis is e e ed o
as an in en ion o ea analysis. P oponen s a gue ha he in en ion o ea app oach helps
p ese e p ognos ic balance in he s udy a ms, limi s in e ences based on a bi a y o ad hoc
sub-g oups o pa ien s in he ial, emphasizes g ea e accoun abili y o all pa ien s en e ed
in o he s udy and consequen ly minimizes he in luence o wi hd awals, non-complie s, and
pa ien s los o ollow up, is he mos cau ious app oach and so minimizes ype 1 e o , and
inally allows o he g ea es gene alizabili y (Fe gusson e al., 2002). C i ics say, howe e ,
ha an in en ion o ea app oach is oo cau ious and mo e suscep ible o ype II e o
(Somme & Zege , 1991; Rubin, 1998). Consequen ly, we can hypo hesize ha in en ion- o-
ea analyses ha e he endency o unde es ima e he e ec size ( ype II e o ) and pe -
p o ocol analysis o o e es ima e he e ec size ( ype I e o ).
Resul s: A subg oup analysis, including 162 e ec sizes, e ealed ha he ype o s a is ical
analysis signi ican ly explains he he e ogenei y o he e ec sizes, Q (2) = 8.724, p = .013.
Pai wise compa isons e ealed ha RCTs using a comple e-case analysis (n = 119; SMD = -
0.744; 95 % CI = [-0.873, -0.615]) led o a la ge e ec size han RCTs using an in en ion- o-
ea analysis (n = 32; SMD = -0.421; 95 % CI = [-0.603, -0.238]): Q (1) = 8.009, p = .005. RCTs
using a pe -p o ocol analysis (n = 11; SMD = -0.851; 95 % CI = [-1.339, -0.364]) ob ained he
la ges mean e ec size as expec ed, bu i was no signi ican ly di e en om he mean
e ec size ob ained wi h he wo o he ypes o analysis.
Discussion: Con a y o ou hypo hesis, we did no obse e a signi ican di e ence be ween
he e ec sizes ob ained in RCTs using an in en ion- o- ea analysis and hose using a pe -
p o ocol analysis. In con as , he RCTs using comple e-case analysis, which we e he mos
equen ca ego y (73%), showed a la ge e ec size han RCTs using in en ion- o- ea
analysis. Consequen ly, o ha e a clea idea o he e icacy o an exe cise p og am i would
be in e es ing o conduc he h ee analyses: one eplacing missing alues o people who
d opped ou (in en ion- o- ea analysis), one analyzing only pa icipan s wi h no missing
alue (comple e-case analysis) and one analyzing only pa icipan s who adhe e o he
di e en in e en ions (pe -p o ocol analysis).
2.2.3.3. Mode a o : S udy design
Ra ionale: Two s udy designs, o mo e p ecisely wo di e en me hods o andomiza ion,
ha e been dis inguished. In he pa allel-g oup design, each pa icipan is andomly assigned
o a g oup, and all pa icipan s ecei e (o do no ecei e) an in e en ion. In he clus e
design, p e-exis ing g oups o pa icipan s (e.g., illages, nu sing homes) a e andomly
selec ed o ecei e (o no ecei e) an in e en ion. This analysis is explo a o y and we ha e
no a p io i hypo hesis conce ning his mode a o .
17
Resul s: A subg oup analysis, including 162 e ec sizes, e ealed ha he s udy design did
no signi ican ly explain he he e ogenei y o he e ec sizes, Q (1) = 0.082, p = .775. In o he
wo ds, he s udy design does no signi ican ly in luence he e ec size. RCTs using a pa allel-
g oup design (n = 148; SMD = -0.674; 95 % CI = [-0.786, -0.562]) did no led o a signi ican ly
di e en e ec size han RCTs using a clus e -design (n = 14; SMD = -0.720; 95 % CI = [-1.018,
-0.422]).
Discussion: The ype o s udy design (pa allel-g oup s. clus e ) does no seem o be an
impo an de e minan o he e ec size o ch onic exe cise in e en ions on o e all
dep ession le el. The pa allel-g oup design emains he mos used design in he esea ch
communi y (91%).
2.3. Conclusion
The i s esul s o he p esen me a-analysis clea ly showed ha exe cise-based
in e en ions a e e ec i e o educe o e all dep ession le el leading o a mode a e e ec
size (d = -0,675). Acco ding o mode a o analyses, he mos e ec i e exe cise p og am
should include exe cises wi h he ollowing cha ac e is ics: high cogni i e demand (e.g.,
exe games o mind-body exe cise), igo ous o high in ensi y, supe ised g oup-based. In
addi ion, in e en ions wi h a la ge olume o aining a e mo e e ec i e han in e en ions
wi h a lowe olume. Conce ning, he popula ion mo e esponsi e o exe cise in e en ions
wi h he aim o educe o e all dep ession le el, he mode a o analyses sugges ha he
highe he age and dep essi e symp oms a baseline, he smalle he e ec size; i.e., wi h
aging, i is mo e and mo e di icul o educe dep ession h ough exe cise in e en ion.
Based on his esuls, e idence-based ecommenda ions will be o mula ed.
The p esen esul s will be sho ly comple ed by se e al analyses: analysis o he in e ac ions
be ween pai s o mode a o s, analysis o he e ec o he isk o bias on he e ec size,
analysis o he e ec o publica ion bias on he e ec size, analysis o he e ec o ch onic
exe cise on di e en symp oms o dep ession (e.g., apa hy, a igue, sleep).
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24
Appendix 1
#
Au ho s
Dep ession scale
1
Ahmed (2019)
GDS-30
2
Aiba -Almazan e al. (2019)
HADS
3
Albine e al. (2016)
GDS-30
4
An e al. (2020)
GDS-30
5
Ansai & Rebela o (2015)
GDS-15
6
An unes e al. (2005)
GDS-30
7
Belza e al. (2002)
CESD-11
8
Be na d e al. (2015)
BDI
9
Be na delli e al. (2019)
GDS-30
10
Bonu a (2008), Bonu a e al. (2014)
GDS-30
11
Bouaziz e al. (2019)
GADS-18
12
B ăilescu e al. (2017)
HAMD-17
13
B enes e al. (2007)
HAMD-17 & GDS-15
14
Buman e al. (2011)
CESD-10
15
Casas-He e o e al. (2022)
GDS-15
16
Chang e al. (2020)
BDI & HAMD-17
17
Chang e al. (2021)
GDS-15
18
Chen e al. (2008)
CESD-20
19
Chen e al. (2021)
GDS-15
20
Cheng e al. (2012)
GDS-15
21
Chin e al. (2022)
HADS & PHQ-9
22
Choi & Sohng (2018)
GDS-15
23
Chou e al. (2004)
CESD-20
24
Clegg e al. (2014)
GDS-15
25
Co des e al. (2021)
CESD
26
Cugusi e al. (2015)
BDI-II
27
Deus e al. (2021)
BDI
28
Dong e al. (2013)
GDS-15
29
Egge mon e al. (2009)
GDS-30
30
Fakha i (2017)
BDI-II
31
Fa zane & Koushkie Jah omi (2022)
HADS
32
Fe ei a e al. (2015)
GDS
33
Flegal e al. (2007) / Oken e al. (2006)
CESD-10
34
F ih e al. (2017)
HADS
35
Fu ado e al. (2021)
CESD-20
36
Ga y e al. (2004), Ga y (2006)
GDS-15
37
Ga y e al. (2010)
HAMD-17
38
Ge e al. (2022)
GDS-30
39
Gleeson e al. (2017)
GDS-5
40
Haboush e al. (2006)
HAMD-17 & GDS-30
41
Hashimo o e al. (2015)
SDS
42
Hemb ee (2000)
BDI
43
Henskens e al. (2018)
CSDD
25
44
Hsu e al. (2016)
GDS-15
45
I win e al. (2014)
IDS-30
46
Jeong e al. (2019)
GDS-15
47
Jeong e al. (2021)
GDS-30
48
Jin e al. (2019)
GDS-15
49
Jolly e al. (2009)
HADS
50
Ke se e al. (2010)
GDS-15
51
Kim e al. (2019)
GDS-15
52
K aiwong e al. (2021)
PHQ-9
53
K awcyk e al. (2019)
MDI
54
K ishnamu hy & Telles (2007)
GDS-15
55
Lai e al. (2006)
GDS-15
56
Langoni e al. (2019)
GDS-15
57
La edo-Aguile a e al. (2018)
GDS-15
58
Lee e al. (2013)
GDS-15
59
Lee e al. (2018)
BDI
60
Liao e al. (2018)
GDS-30
61
Lima e al. (2019)
HAMD-17
62
Lin e al. (2007)
GDS-15
63
Lin e al. (2020)
HADS
64
Lincoln e al. (2011)
GDS-30
65
Lippke e al. (2022)
CESD-20
66
Liu e al. (2018)
GDS-30
67
Ma e al. (2018)
CESD-10
68
Maci e al. (2012)
CSDD
69
Makizako e al. (2020)
GDS-15
70
Ma ínez e al. (2015)
GDS-5
71
Ma ínez-Velilla e al. (2021)
GDS-15
72
McNeil e al. (1991)
BDI
73
Mo is e al. (2017)
CSDD
74
Mo amedi e al. 2021)
GDS-15
75
Ne z e al. (1994)
GDS-30
76
Niemi e al. (2016)
PHQ-9
77
Nol e e al. (2015)
PHQ-9
78
Pakkala e al. (2008)
CESD-20
79
Pa in e al. (2020)
GDS-15
80
Phansuea e al. (2020)
GDS-30
81
Picelli e al. (2016)
BDI
82
Pi aux e al. (2021)
CESD-20
83
P akhinki e al. (2014)
GDS-30
84
Ra a i e al (2021)
BDI-II
85
Redwine e al. (2020)
BDI-IA
86
Requena He nández e al. (2008)
GDS-30
87
Rica e al. (2020)
BDI
88
Rolland e al. (2007)
MADRS
89
Roswiyani e al. (2020)
BDI-II
