Abstract
Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years. Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12 th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups. Results: The systematic review included 82 RCTs, with 69 meeting eligibility for the network meta-analysis ( n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges' g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges' g = -0.06, PrI = -0.91, 0.79), mind-body versus aerobic (Hedges' g = -0.12, PrI = -0.95, 0.72), mind-body versus resistance (Hedges' g = -0.06, PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment. Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults. Registration: PROSPERO CRD42018115866 (23/11/2018).
Highlights
I suggest a presentation of the concepts of physical activity and exercise, as well as a discussion about divergences in the classification of Yoga and other mind-body practices as physical exercise
Studies were excluded when (i) the intervention condition used a multicomponent treatment including non-exercise components with the exercise condition, or (ii) the participants were diagnosed with clinical depression, defined by DSM or ICD criteria, or a clinical threshold on a questionnaire validated against a structured diagnostic interview prior to study enrollment
Despite a lack of impact here, we offer this as a cautionary note should evidence of differential antidepressant response to exercise become available for these subgroups, and encourage researchers to report all ongoing pharmacological regimens and co-morbidities in randomised controlled trials (RCTs) recruiting older participants
Summary
I suggest a presentation of the concepts of physical activity and exercise, as well as a discussion about divergences in the classification of Yoga and other mind-body practices as physical exercise. We are genuinely grateful to this Reviewer for generating some important points relating to exercise gerontology which remain unresolved Until such time as epidemiological controversy such as nuanced and unresolved characteristics amongst ageing cohorts is evidenced, it is our belief that we must accept perceived imperfections within the literature, which is a notable limitation of meta-analytical investigation. Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
