Article Text

Customary physical activity and odds of depression: a systematic review and meta-analysis of 111 prospective cohort studies
  1. Rodney K Dishman1,
  2. Cillian P McDowell2,
  3. Matthew Payton Herring3
  1. 1 Biomedical & Health Sciences Institute and Department of Kinesiology, University of Georgia, Athens, Georgia, USA
  2. 2 The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
  3. 3 Health Research Institute and Department of Physical Education and Sports Sciences, University of Limerick, Limerick, Ireland
  1. Correspondence to Professor Rodney K Dishman, University of Georgia, Athens, GA 30602, USA; rdishman{at}


Objective To explore whether physical activity is inversely associated with the onset of depression, we quantified the cumulative association of customary physical activity with incident depression and with an increase in subclinical depressive symptoms over time as reported from prospective observational studies.

Design Systematic review and meta-analysis.

Data sources MEDLINE, PsycINFO, PsycARTICLES and CINAHL Complete databases, supplemented by Google Scholar.

Eligibility criteria Prospective cohort studies in adults, published prior to January 2020, reporting associations between physical activity and depression.

Study appraisal and synthesis Multilevel random-effects meta-analysis was performed adjusting for study and cohort or region. Mixed-model meta-regression of putative modifiers.

Results Searches yielded 111 reports including over 3 million adults sampled from 11 nations in five continents. Odds of incident cases of depression or an increase in subclinical depressive symptoms were reduced after exposure to physical activity (OR, 95% CI) in crude (0.69, 0.63 to 0.75; I2=93.7) and adjusted (0.79, 0.75 to 0.82; I2=87.6) analyses. Results were materially the same for incident depression and subclinical symptoms. Odds were lower after moderate or vigorous physical activity that met public health guidelines than after light physical activity. These odds were also lower when exposure to physical activity increased over time during a study period compared with the odds when physical activity was captured as a single baseline measure of exposure.

Conclusion Customary and increasing levels of moderate-to-vigorous physical activity in observational studies are inversely associated with incident depression and the onset of subclinical depressive symptoms among adults regardless of global region, gender, age or follow-up period.

  • depression
  • exercise
  • meta-analysis
  • evidence based review
  • physical activity

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  • Correction notice This article has been corrected since it published Online First. The first affiliation and tables 1 and 2 have been updated.

  • Contributors All authors had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. All authors contributed to study concept and design; acquisition, analysis or interpretation of data; critical revision of the manuscript and administrative, technical or material support. RKD drafted the manuscript and contributed to statistical analysis. RKD and MPH supervised the study.

  • Funding CPMcD is funded by the Irish Research Council under the Government of Ireland Postdoctoral Programme.

  • Disclaimer No funding was used in the design, collection, management, analysis, interpretation of the data, preparation, review, approval of the manuscript, and decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.