The effects of exercise type and dose on depression in children and adolescents: A systematic review, network, and dose-response meta-analysis

Depression ranks as the second most common mental health disorder among children and adolescents. However, only a limited number of those affected pursue or receive appropriate treatment. While exercise has shown promise as a therapeutic strategy, its effectiveness in alleviating depressive symptoms within this population remains insufficiently explored and poorly understood. The purpose of this study was to determine the effects of different exercise interventions on depressive symptoms in children and adolescents and to explore dose-response relationships. A systematic search of five major scientific databases was conducted up to June 2024 for randomized controlled trials evaluating the use of exercise to treat depression in youth. Utilizing sophisticated meta-analytic methodologies, a comparative analysis was conducted on the efficacy of diverse exercise modalities, with the objective of elucidating the correlation between exercise dosage and the alleviation of symptoms. The quality and consistency of the evidence were subjected to rigorous evaluation. A total of 37 RCTs, comprising 4381 participants, were analyzed. Network meta-analysis revealed that aerobic exercise (SMD = -0.48, 95 % CI: -0.64, -0.31) and resistance exercise (SMD = -0.50, 95 % CI: -0.82, -0.17) were more effective interventions for alleviating depression, followed by mixed exercise (SMD = -0.26, 95 % CI: -0.44, -0.08). Mind-body exercises showed no significant effect. Additionally, a U-shaped dose-response relationship between exercise dose and depression was identified, with an estimated minimum effective dose of approximately 640 MET-min/week. These findings provide critical evidence for developing effective exercise interventions for depression in children and adolescents. However, due to the quality and heterogeneity of the studies, caution should be exercised in interpreting the results.