Frontiers in psychology · 2026
Effects of traditional Chinese mind-body exercises on depressive symptoms in middle-aged and older adults: a multilevel meta-analysis with exploratory dose-response and machine learning analyses.
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Yang Xuesong, Guo Jianwei, Luo Bingquan
Аннотация
OBJECTIVE: This study evaluated the effects of traditional Chinese mind-body exercises on depressive symptoms in middle-aged and older adults and examined potential dose-related and study-level moderators.
METHODS: PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, and Wanfang were searched through May 3, 2026, for randomized controlled trials. A three-level random-effects model was used to account for dependent effect sizes. Subgroup analyses, meta-regression, exploratory dose-response analyses, and an XGBoost-based machine-learning extension were conducted. The risk of bias and the certainty of evidence were assessed using RoB 2 and GRADE.
RESULTS: Thirty randomized controlled trials were included. Traditional Chinese mind-body exercises were associated with a statistically significant reduction in depressive symptoms among middle-aged and older adults (SMD = -0.88; 95% CI, -1.18 to -0.58; p < 0.001). Sensitivity and supplementary analyses generally supported the robustness of the main findings; however, substantial heterogeneity and risk of bias contributed to low certainty of the evidence. Subgroup analyses indicated that most estimates favored traditional Chinese mind-body exercises, with statistically significant subgroup differences observed only by country. Meta-regression showed that older age was associated with a smaller intervention effect (β = 0.03, p = 0.025). Exploratory dose-response analyses did not identify a statistically supported optimal dose, although descriptive patterns were observed. XGBoost and SHAP analyses suggested that age, scale type, total dose, and session duration may be important study-level features, though these findings were exploratory.
CONCLUSION: Traditional Chinese mind-body exercises may reduce depressive symptoms in middle-aged and older adults; however, the certainty of the evidence is low because of substantial heterogeneity and risk of bias. Dose-response and machine-learning findings should be considered exploratory. Further high-quality randomized controlled trials are warranted to confirm these findings and refine intervention parameters.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261388878, identifier PROSPERO (CRD420261388878).
METHODS: PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, and Wanfang were searched through May 3, 2026, for randomized controlled trials. A three-level random-effects model was used to account for dependent effect sizes. Subgroup analyses, meta-regression, exploratory dose-response analyses, and an XGBoost-based machine-learning extension were conducted. The risk of bias and the certainty of evidence were assessed using RoB 2 and GRADE.
RESULTS: Thirty randomized controlled trials were included. Traditional Chinese mind-body exercises were associated with a statistically significant reduction in depressive symptoms among middle-aged and older adults (SMD = -0.88; 95% CI, -1.18 to -0.58; p < 0.001). Sensitivity and supplementary analyses generally supported the robustness of the main findings; however, substantial heterogeneity and risk of bias contributed to low certainty of the evidence. Subgroup analyses indicated that most estimates favored traditional Chinese mind-body exercises, with statistically significant subgroup differences observed only by country. Meta-regression showed that older age was associated with a smaller intervention effect (β = 0.03, p = 0.025). Exploratory dose-response analyses did not identify a statistically supported optimal dose, although descriptive patterns were observed. XGBoost and SHAP analyses suggested that age, scale type, total dose, and session duration may be important study-level features, though these findings were exploratory.
CONCLUSION: Traditional Chinese mind-body exercises may reduce depressive symptoms in middle-aged and older adults; however, the certainty of the evidence is low because of substantial heterogeneity and risk of bias. Dose-response and machine-learning findings should be considered exploratory. Further high-quality randomized controlled trials are warranted to confirm these findings and refine intervention parameters.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261388878, identifier PROSPERO (CRD420261388878).