1. In a systematic review and meta-analysis, physical activity interventions were shown to alleviate depressive symptoms in patients <19 years old, although the effects did not persist at follow-up

2. Secondary analyses suggest that certain factors were associated with greater reductions in depressive symptoms: age ≥13 years, mental illness, depression diagnosis, and treatment duration ≥12 weeks.

 Evidence Rating Level: 2 (Good)

Study Rundown: Depressive symptoms are common in children and adolescents and have broad implications for social functioning, suicide, and the risk for developing mood disorders in adulthood. In adults, practice guidelines suggest physical activity interventions are an appropriate alternative and/or adjunct treatment strategy to pharmacologic and cognitive behavioral therapy interventions, although the evidence in children and adolescents is limited. To address these limitations, researchers conducted a systematic review and meta-analysis to evaluate the association between physical activity interventions and depressive symptoms in children and adolescents. 21 studies were included with 2441 participants. The study found that physical activity interventions alleviate depression symptoms, but these differences were not present at follow-up (although only 4 studies measured follow-up). Secondary analyses suggest that there were greater reductions in depressive symptoms for participants ≥13 years, those with a mental illness and/or depression diagnosis, and treatment duration ≥12 weeks. The main limitation of this review is its inability to assess long-term treatment effects, given the lack of significant follow-up periods in the included studies. Overall, this study suggests that physical activity may be beneficial in alleviating depressive symptoms in children and adolescents and should be discussed with patients alongside existing pharmacological and psychotherapy-based treatments.

Click here to read the article in JAMA Pediatrics

Relevant Reading: Can physical education improve the mental health of children? the LOOK study cluster-randomized controlled trial

In-Depth [systematic review and meta-analysis]: This systematic review and meta-analysis included randomized clinical trials (RCTs) and nonrandomized clinical trials (NRCTs) from inception to February 2022. The exposure was aerobic physical activity for at least 4 weeks in children and adolescents (age <19 years). The primary outcome was depressive symptoms using any validated depression rating scale. 21 studies were included (2441 participants) in a meta-analysis. Of these, 12 studies included participants with somatic or psychiatric disorders. Physical activity sessions were commonly prescribed as monotherapy (17 studies) with a mean duration of 50 minutes and ranging from 2 to 5 days per week (most commonly 3 days per week). Most studies involved supervised (16 studies) physical activity. Meta-analysis revealed that physical activity interventions were associated with a reduction in depressive symptoms (Hedges g = −0.29; 95%CI, −0.47 to −0.10; p=0.004) post-intervention, although in 4 studies with follow-up measures, no differences were noted at that time point. Primary moderator factors such as participant health status, total physical activity volume, allocation/assessment concealment, or study design did not show significant moderation effects to the treatment effect. Secondary analyses revealed moderators to the treatment effect such as intervention duration (p=0.08), age (≥13 years, p=0.003), mental illness (p<0.001), depression diagnoses (p=0.004) may influence treatment effect.

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