Exercise in prevention and treatment of anxiety and depression among children
and young people

L Larun, LV Nordheim, E Ekeland, KB Hagen, F Heian

Cochrane Database of Systematic Reviews 2006 Issue 3 (Status: New)
Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.
DOI: 10.1002/14651858.CD004691.pub2 This version first published online: 19
July 2006 in Issue 3, 2006
Date of Most Recent Substantive Amendment: 23 May 2006

Full article via:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004691/frame.\
html

Abstract

Background
Depression and anxiety are common psychological disorders for children and
adolescents. Psychological (e.g. psychotherapy), psychosocial (e.g. cognitive
behavioral therapy) and biological (e.g. SSRIs or tricyclic drugs) treatments
are the most common treatments being offered. The large variety of therapeutic
interventions give rise to questions of clinical effectiveness and side effects.
Physical exercise is inexpensive with few, if any, side effects.

Objectives
To assess the effects of exercise interventions in reducing or preventing
anxiety or depression in children and young people up to 20 years of age.

Search strategy
We searched the Cochrane Controlled Trials Register (latest issue available),
MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC and Sportdiscus up to August 2005.

Selection criteria
Randomised trials of vigorous exercise interventions for children and young
people up to the age of 20, with outcome measures for depression and anxiety.

Data collection and analysis
Two authors independently selected trials for inclusion, assessed methodological
quality and extracted data. The trials were combined using meta-analysis
methods. A narrative synthesis was performed when the reported data did not
allow statistical pooling.

Main results
Sixteen studies with a total of 1191 participants between 11 and 19 years of age
were included.

Eleven trials compared vigourous exercise versus no intervention in a general
population of children. Six studies reporting anxiety scores showed a
non-significant trend in favour of the exercise group (standard mean difference
(SMD) (random effects model) -0.48, 95% confidence interval (CI) -0.97 to 0.01).
Five studies reporting depression scores showed a statistically significant
difference in favour of the exercise group (SMD (random effects model) -0.66,
95% CI -1.25 to -0.08). However, all trials were generally of low methodological
quality and they were highly heterogeneous with regard to the population,
intervention and measurement instruments used. One small trial investigated
children in treatment showed no statistically significant difference in
depression scores in favour of the control group (SMD (fixed effects model)
0.78, 95% CI -0.47 to 2.04). No studies reported anxiety scores for children in
treatment.

Five trials comparing vigorous exercise to low intensity exercise show no
statistically significant difference in depression and anxiety scores in the
general population of children. Three trials reported anxiety scores (SMD (fixed
effects model) -0.14, 95% CI -0.41 to 0.13). Two trials reported depression
scores (SMD (fixed effects model) -0.15, 95% CI -0.44 to 0.14). Two small trials
found no difference in depression scores for children in treatment (SMD (fixed
effects model) -0.31, 95% CI -0.78 to 0.16). No studies reported anxiety scores
for children in treatment.

Four trials comparing exercise with psychosocial interventions showed no
statistically significant difference in depression and anxiety scores in the
general population of children. Two trials reported anxiety scores (SMD (fixed
effects model) -0.13, 95% CI -0.43 to 0.17). Two trials reported depression
scores (SMD (fixed effects model) 0.10, 95% CI
-0.21 to 0.41). One trial found no difference in depression scores for children
in treatment (SMD (fixed effects model) -0.31, 95% CI -0.97 to 0.35). No studies
reported anxiety scores for children in treatment.

Authors' conclusions
Whilst there appears to be a small effect in favour of exercise in reducing
depression and anxiety scores in the general population of children and
adolescents, the small number of studies included and the clinical diversity of
participants, interventions and methods of measurement limit the ability to draw
conclusions. It makes little difference whether the exercise is of high or low
intensity. The effect of exercise for children in treatment for anxiety and
depression is unknown as the evidence base is scarce.


Plain language summary
Exercise is promoted as an active strategy to prevent and treat depression and
anxiety. We found that the research data are sparse and mostly done on college
students. Six small trials indicate that exercise decreases reported anxiety
scores in healthy children when compared to no intervention. Five small trials
indicate that exercise decreases reported depression scores when compared to no
intervention. The research base for children in treatment is scarce; only three
small trials investigated the effect of exercise in depression.