Physical Activity interventions on health-related quality of life (HR-QoL) in major depressive disorder (MDD): a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

Major Depressive Disorder (MDD) causes global disability and economic burden. Standard treatments often yield incomplete recovery with impaired health-related quality of life (HR-QoL). This meta-analysis evaluates exercise interventions' effects on HR-QoL in adults with clinically diagnosed MDD.

METHODS

Following PRISMA 2020 guidelines, randomized controlled trials (RCTs) of adults (≥18 years) with MDD were included if they evaluated physical activity/exercise interventions (e.g., aerobic, resistance, yoga, Tai Chi) versus active or non-active controls with HR-QoL outcomes. Comprehensively the main four databases and grey literature searches were conducted. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane RoB-2 tool. Statistical analysis performed by STAT-17.

RESULTS

Finally, 11 RCTs were included (mean age about 48.9 years; majority female participants (68%)). The meta-analysis showed that exercise interventions significantly improved overall HR-QoL immediately after treatment (SMD = 0.31 [0.16, 0.46], I² = 0.00%). At follow-up, exercise was also associated with a significant improvement in HR-QoL (SMD = 0.41 [0.13, 0.70], I² = 34.42%). Domain-level analyses indicated significant improvements favoring exercise in overall (SMD = 0.25 [0.05, 0.45], I² = 0%), physical (SMD = 0.50 [0.10, 0.91], I² = 48.18%), psychological (SMD = 0.58 [0.24, 0.92], I² = 0%), and emotional (SMD = 0.51 [0.11, 0.91], I² = 21.03%) domains, while the social domain showed no significant difference (SMD = 0.11 [-0.34, 0.57], I² = 0%).

CONCLUSION

Exercise interventions, primarily structured and supervised, may improve short-term HR-QoL in adults with major depressive disorder, particularly in the physical and psychological domains. However, long-term effects remain uncertain, and current evidence does not support the superiority of any specific exercise modality. Given the limited number of studies, heterogeneity in control conditions, and variability in HR-QoL measures, further high-quality randomized controlled trials with longer follow-up are needed.