What Exercise is Best for Depression in Older Adults?
As a Physiotherapist, I frequently see how depression compounds the physical challenges older patients face. While we know exercise helps, an important question remains: which types deliver the most benefit, and how much is actually needed? An interesting systematic review published in Age and Ageing took a comprehensive look, analysing 80 randomised controlled trials with 5,536 participants to determine the optimal exercise prescription for depression in older adults.
Key Research Finding
Resistance training and mind-body exercises are significantly more effective at reducing depression in older adults than aerobic or mixed exercise programs. The study also revealed a U-shaped dose-response relationship, meaning both too little and too much exercise can diminish mental health benefits, with significant improvements observed at just 390 MET-min/week—below standard WHO recommendations.
Study Overview and Methodology
This comprehensive systematic review and network meta-analysis examined randomised controlled trials of exercise interventions for adults with a mean age of 65 years or older. The researchers employed sophisticated statistical methods to compare different exercise modalities both directly and indirectly, providing the most robust comparison of exercise types to date.
Exercise Types Compared
| Exercise Type | Examples | Number of Studies |
|---|---|---|
| Resistance Exercise (RE) | Weight training, resistance bands, strength exercises | 27 studies |
| Mind-Body Exercise (MBE) | Tai Chi, Qigong, yoga | 28 studies |
| Aerobic Exercise (AE) | Walking, cycling, swimming | 26 studies |
| Mixed Exercise (ME) | Combinations of different exercise types | 18 studies |
Methodological Strengths
This review employed several rigorous methodologies that enhance the reliability of its findings:
- Network Meta-Analysis: Allowed comparison of exercise types that haven't been directly tested against each other in clinical trials
- Dose-Response Analysis: Examined how different amounts of exercise impact depression levels
- Stratified Analysis: Separately analysed effects for those with and without baseline depression
- Comprehensive Search: Included 80 randomised controlled trials with 5,536 participants
Key Research Findings: Effectiveness by Exercise Type
The analysis revealed clear differences in effectiveness between exercise modalities, providing crucial guidance for clinical recommendations.
Resistance Exercise emerges as the Most Effective
Resistance training showed the largest effect size (SMD = -0.68), indicating it was the most effective single option for reducing depressive symptoms in older adults based on the options assessed. This significant effect was consistent across both depressed and non-depressed older adults at baseline, though the improvement was substantially greater in those with existing depression.
Mind-Body Exercises Close Second
Mind-body exercises like Tai Chi and yoga demonstrated strong antidepressant effects (SMD = -0.54), not significantly different from resistance exercise. The researchers noted these exercises uniquely engage both physical and mental components, potentially providing additional benefits for mood regulation beyond purely physical exercises.
Aerobic and Mixed Exercises Less Effective
While still beneficial compared to control conditions, aerobic exercise (SMD = -0.31) and mixed exercise programs (SMD = -0.23) showed significantly smaller effects than either resistance or mind-body exercises. This finding challenges conventional assumptions that aerobic exercise should be the primary exercise recommendation for depression.
The Dose-Response Relationship: How Much Exercise is Needed?
Perhaps the most clinically significant finding was the clear dose-response relationship between exercise volume and antidepressant effects.
U-Shaped Relationship Reveals Optimal Dosing
The researchers discovered a U-shaped relationship between total exercise dose and depression improvement, meaning:
- Minimum Effective Dose: Significant antidepressant effects begin at just 390 MET-min/week
- Optimal Range: Benefits increase up to a peak, then gradually diminish with higher doses
- Upper Limit: Doses exceeding 1000 MET-min/week showed reduced benefits
This U-shaped curve suggests that while some exercise is beneficial, excessive exercise may potentially counteract antidepressant effects through increased physical stress and fatigue.
Practical Exercise Translation
| Exercise Type | Equivalent to 390 MET-min/week | Optimal Weekly Dose |
|---|---|---|
| Resistance Training | ~70-100 minutes/week | 880 MET-min/week |
| Mind-Body Exercise | ~100-130 minutes/week | No clear peak (linear benefit) |
| Brisk Walking | ~110-130 minutes/week | 1000 MET-min/week |
Real-World Implications for People With Depression
These findings may have significant implications for how we prescribe exercise to older adults with depression in clinical practice.
Prioritise Resistance and Mind-Body Exercises
Given their superior effectiveness, resistance training and mind-body exercises may be first-line exercise recommendations for older adults with depression. This represents a paradigm shift from traditional emphasis on aerobic exercise alone.
Start Low, Progress Gradually
The minimum effective dose of 390 MET-min/week provides an achievable starting point for deconditioned or resistant patients. This translates to approximately:
- 30 minutes of resistance training 2-3 times per week
- 20-30 minutes of Tai Chi or yoga 3-4 times per week
- 30 minutes of brisk walking 3-4 times per week
Avoid Excessive Exercise Prescriptions
The U-shaped dose-response relationship suggests we should caution patients against extreme exercise regimens, as these may diminish mental health benefits. Moderate, consistent exercise appears more beneficial than intensive training for depression management in older adults.
Study Limitations and Generalisability
Short-Term Focus
The review primarily analysed outcomes immediately after interventions ended, with limited data on long-term maintenance of benefits. Future research should explore how to sustain exercise-induced mood improvements over time.
Blinding Challenges
Like most exercise studies, few trials successfully blinded participants or intervention providers, potentially introducing expectancy effects. However, the consistent findings across multiple studies strengthen confidence in the results.
Age-Specific Findings
The findings specifically apply to adults aged 65+, which is particularly valuable for geriatric practice but may not generalise to younger populations. Previous research suggests younger adults may respond differently to exercise interventions for depression.
Conclusion and Clinical Takeaways
This potentially important review provides compelling evidence that exercise type and dose significantly impact antidepressant effects in older adults. As physiotherapists, we now have robust evidence to specifically prescribe resistance training and mind-body exercises as first-line movement interventions for depression in our older patients.
The revelation that benefits begin at doses lower than standard recommendations is particularly valuable for building exercise adherence in depressed older adults who may struggle with motivation and energy. By prescribing targeted, achievable exercise doses, we can significantly enhance both mental and physical health outcomes in this population.
Most importantly, these findings reinforce that exercise is not a one-size-fits-all intervention for depression. Different exercise types engage distinct physiological and psychological mechanisms, and understanding these differences allows us to design more effective, personalised exercise prescriptions that address both the physical and mental health needs of our older patients.
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Reference
Tian, S., Liang, Z., Tian, M., Qiu, F., Yu, Y., Mou, H., & Gao, Y. (2024). Comparative efficacy of various exercise types and doses for depression in older adults: a systematic review of paired, network and dose-response meta-analyses. Age and Ageing, 53(10), afae211. https://doi.org/10.1093/ageing/afae211