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144
Summer 2021, Volume 27, Number 2
Iranian Journal of
PSYCHIATRY AND CLINICAL PSYCHOLOGY
Research Paper
Eect of Exercise and Meditaon on Depression and Anxiety Reducon: A System-
ac Review and Meta-analysis
1. Department of Clinical Psychology, School of Medicine, Shahid Behesh University of Medical Sciences, Tehran, Iran.
2. Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Instute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.
Saeed Mohammadi1 , Komeil Zahedi Tajrishi2 , *Mojtaba Tashkeh2
Objecves Despite the studies that examined the eect of exercise and meditaon on depression and
anxiety, no meta-analysis has proved this eect so far. Also, the eect of these factors is unknown in
terms of gender and aerobic exercise. This meta-analysis addressed these gaps.
Methods Major electronic databases, including PubMed, Web of Science, and Embase, were searched
unl July 2019. Studies addressing the eect of exercise and meditaon on depression and anxiety were
found. Q-test and I2 stasc invesgated the heterogeneity across the studies. The probability of publica-
on bias was explored using Begg's and Egger's tests. The results were expressed as the Standardized
Mean Dierence (SMD) with a 95% condence interval using a random-eects model.
Results We idened a total of 10015 references and 51 studies involving 3594 parcipants. Compared
with the control group, the SMD esmate of anxiety was -0.7 (-1.20, -0.19) for meditaon, -0.9 (-1.24,
-0.57) for aerobic, and -1.07 (-1.67, -0.46) for other exercises. Also, the SMD esmate of depression was-
0.84 (-1.26, -0.42) for meditaon, -0.44 (-0.72, -0.17) for aerobic, and -1.10 (-1.55, -0.65) for other exercises.
Conclusion Exercise and meditaon had a signicant eect on depression and anxiety. Furthermore,
there was an eect of the exercise and meditaon on depression and anxiety regarding the female gen-
der and aerobic exercise.
A B S T R A C T
Key words:
Anxiety, Depression,
Exercise, Meditaon,
Meta-analysis
A
Extended Abract
1. Introduction
nxiety is one of the mo common manifes-
tations of psychiatric disorders, and daily
ress causes a signicant loss in the perfor-
mance of individuals [1]. Also, depression is a global dis-
ease that has infected 350 million people in the world [2].
Several udies worldwide have shown that exercise can
reduce the severity of anxiety, and after quitting, the anxiety
reappears. According to the results of Izard, regular exer-
cise reduces anxiety, and symptoms of anxiety recur with
quitting the exercise [3].
These meta-analyses had several limitations and poten-
tial biases, including unclear search rategies, enrolling a
limited number of udies, and the absence of analysis by
gender. But their main limitation was their sole udy on the
eect of exercise on depression, and they did not inveigate
the eect of meditation. Besides, aerobic exercise was not
inveigated separately.
* Corresponding Author:
Mojtaba Tashkeh, PhD Student.
Address: Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (
Tehran Instute of Psychiatry
), Iran University of Medical
Sciences, Tehran, Iran.
Tel: +98 (990) 1913252
E-mail: mojtabatashkeh@gmail.com
Citation
Mohammadi S, Zahedi Tajrishi K, Tashkeh M. Eect of Exercise and Meditation on Depression and Anxiety Reduc-
tion: A Syematic Review and Meta-analysis. Iranian Journal of Psychiatry and Clinical Psychology. 2021; 27(2):144-161. http://
dx.doi.org/10.32598/ijpcp.27.2.3406.1
:
http://dx.doi.org/10.32598/ijpcp.27.2.3406.1
Use your device to scan
and read the arcle online
Received: 01 May 2020
Accepted: 19 Aug 2020
Available Online: 01 Jul 2021
145
Summer 2021, Volume 27, Number 2
Iranian Journal of
PSYCHIATRY AND CLINICAL PSYCHOLOGY
Mohammadi S, et al. Eect of Exercise on Depression and Anxiety. Iranian Journal of Psychiatry and Clinical Psychology. 2021; 27(2):144-161.
Despite the udies that examined the eect of exercise and
meditation on depression and anxiety, there was a serious
lack of information about the eect of dierent exercises and
meditation on depression and anxiety. Besides, the eect of
these methods on depression and anxiety has not been speci-
ed by gender. This meta-analysis addressed these gaps.
Major electronic databases, including PubMed, Web of
Science, and Embase, were searched until July 2019. Stud-
ies addressing the eect of exercise and meditation on de-
pression and anxiety were found. The heterogeneity across
udies was inveigated by Q-te and I2 atiic. The prob-
ability of publication bias was explored using Begg's and
Egger's tes. The results were expressed as the Standard-
ized Mean Dierence (SMD) with 95% Condence Inter-
vals (CI) using a random-eects model.
2. Materials and Methods
Information sources and search
Major electronic databases, including PubMed, Web of
Science, and Scopus, were searched until October 2018.
The reference lis of the included udies were searched,
and the udy authors were contacted to identify additional
udies.
Study selection
We merged search results obtained from dierent databas-
es using EndNote software and removed duplicate records.
Then, two authors (MT, SM) screened titles and abracts
independently to remove irrelevant reports.
Methodological quality
The same two authors (MT, SM) independently assessed
the udy quality and risk of bias using the Jadad scale
method [4] that was used to assess the quality of each udy.
Furthermore, the criteria of high and low quality of included
udies were dened as Jadad score ≤3 and >3, respectively.
Disagreements were resolved in pairs of authors by con-
sensus. The ve quality criteria were random allocation,
method of randomization, blinding, method of blinding, and
incomplete outcome data.
Heterogeneity and Reporting Biases
Heterogeneity was explored using Q-te [5], and its quan-
tity was measured using the I2 atiic [6]. The possibility of
publication bias was explored using Begg's [7] and Egger's
[8] tes.
Summary Measures
We reported the eect of exercise, aerobic and meditation
on depression and anxiety with SMD. Data were analyzed,
and the results were reported using a random-eects model
[9]. All atiical analyses were performed at a signicance
level of 0.05 using Stata software, version 11 (Stata Corp,
College Station, TX, USA).
Subgroup analysis
Subgroup analyses were performed based on the following
items: (a) type of intervention (aerobic, other exercises, and
meditation); and (b) gender (female and both).
3. Results
Synthesis of results
We identied a total of 10015 references in 51 udies in-
volving 3594 participants. Based on the udy results and
compared to the control group, the SMD eimate of anxiety
was -0.7(95%CI: -1.2, -0.19, I2=86.2%, 12 udies) for med-
itation, -0.9(95%CI: -1.24, -0.57, I2=66.3%, 8 udies) for
aerobic, and -1.07 (95%CI: -1.67, -0.46, I2=0.0%, 9 udies)
for other exercises
(Figure 1)
. Also, the SMD eimate of de-
pression was -0.84 (95%CI: -1.26, -0.42, I2=73.4%, 9 ud-
ies) for meditation, -0.44 (95%CI: -0.72, -0.17, I2=73.3%,
10 udies) for aerobic, and -1.10 (95%CI: -1.55, -0.65,
I2=90.2%, 14 udies) for other exercises
(Figure 2)
.
Publication bias
The possibility of publication bias was explored using the
Begg's and Egger's tes and visualized by the funnel plot.
Based on Begg's te, there was no evidence of publica-
tion bias among udies addressing the eect of meditation
on anxiety (P=0.322), aerobic on anxiety (P=0.805), other
exercises on anxiety (P=0.677), meditation on depression
(P=0.477), aerobic on depression (P=0.714), and other ex-
ercises on depression (P=0.803). Besides, according to Eg-
ger's te results, there was no evidence of publication bias
among udies addressing the eect of meditation on anxiety
(P=0.726), aerobic on anxiety (P=0.415), other exercises
on anxiety (P=0.219), meditation on depression (P=0.271),
aerobic on depression (P=0.773), and other exercises on de-
pression (P=0.428).
Subgroup analysis
The eect of exercise, meditation, and aerobic on depres-
sion and anxiety was inveigated by gender. Regarding
female gender compared to the control group, the SMD es-
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timate of anxiety was -2.61 (95%CI: -2.93, -2.29) for med-
itation and the SMD eimate of depression was -1.42 (95%
CI: -2.09, -0.75) for meditation, -2.21 (95%CI: -3.73,-0.69)
for aerobic and was -1.04 (95%CI: -1.98,-0.10).
4. Discussion and Conclusion
We summarized the available evidence for RCT, experi-
mental, and quasi-experimental udies addressing the ef-
fect of exercise and meditation on depression and anxiety.
Our results suggeed that exercise and meditation were
signicantly associated with depression and anxiety and
positively aected them. Also, there was a positive eect
of aerobic exercise on depression and anxiety. These eects
are seen in women, too.
The anxiolytic eect of exercise has been mentioned in
other udies [3, 10, 11]. Various mechanisms can explain
exercise anti-anxiety eects. These mechanisms include
physical, physiological, and psychological mechanisms
of exercise. From the biological point of view, exercise
can have anti-anxiety eects by providing the person with
physical tness [12, 13], aecting the level of nervous trans-
ducers [14] and ress hormones involved in anxiety, and
reducing the muscle tension [15]. From the psychological
point of view, exercise can reduce anxiety with increased
activity levels followed by increased positive reinforcement
Figure 1. The eect of aerobic exercise, other exercises and meditation on anxiety
Mohammadi S, et al. Eect of Exercise on Depression and Anxiety. Iranian Journal of Psychiatry and Clinical Psychology. 2021; 27(2):144-161.
147
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conditioned by a response [16], providing a situation that
diorts one's attention from threatening and anxious situa-
tions and provides a basis for increasing tru, self-eeem,
and self-ecacy [17]. In some udies, the eects of exer-
cise have been udied by aerobic or anaerobic types, which
some of these udies have shown that anaerobic exercise is
more benecial [18].
To explain ndings on the eect of meditation on reduc-
ing anxiety and depression, we can argue that meditation
reinforces important brain parts that relate to emotions.
Based on this view, like music, yoga, exercise, and udy,
meditation also brings happiness and relaxation and thus re-
duces depression [19]. Some udies believe that meditation
reduces rumination and malicious behaviors and reduces
anxiety [20]. Scientic udies have shown that meditation
aects metabolism, the endocrine syem, central nervous
syem, and autoimmune syem. The respiration and heart
rates and blood pressure decreased, and alpha brain waves
increased that these mechanisms reduce anxiety and pain.
To prove this mechanism, we can udy brain function dur-
ing meditation with brain holographic imaging and electro-
encephalography [21].
Figure 2. The eect of aerobic exercise, other exercises and meditation on depression
Mohammadi S, et al. Eect of Exercise on Depression and Anxiety. Iranian Journal of Psychiatry and Clinical Psychology. 2021; 27(2):144-161.
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In explaining the eect of exercise on depression, re-
search into serotonin secretion and depression indicate
that exercise and physical activities increase this hormone
and reduce depression. Research has proved a signicant
relationship between the increase in serotonin and depres-
sion reduction [22]. Exercise also increases monoamines,
including serotonin and dopamine. The increase in these
chemical carrier subances leads to a better transfer of neu-
ral messages and mood improvement [23].
The Q-te and I2 atiic te indicated heterogeneity
among the included udies. The majority of the observed
heterogeneity may be attributable to the quality of the ud-
ies, variation in population size, sociodemographic charac-
teriics, and potential confounding factors that were not con-
trolled in the udies. However, these atiical tes should
be interpreted with caution. The Q-te is likely to have low
atiical power when the sample size or the number of ud-
ies included in the analysis is small. On the other hand, when
the sample size or the number of the udies included is large,
the te is more powerful in detecting a small amount of het-
erogeneity that may be clinically unimportant [24].
In this udy, the eect of exercise on decreasing depres-
sion and anxiety was more than the eect of meditation. Af-
ter analyzing the eect of these methods on reducing anxiety
and depression by gender, the eect for females was more
than both genders. Because few udies have inveigated
the eect of these methods on men, we could not analyze the
eect of exercise and meditation on depression and anxiety
for males, so we did not compare males and females.
Our udy had a few limitations: (i) we performed sub-
group analysis to assess the eect of meditation, aerobic,
and other exercises on depression and anxiety by gender.
However, the number of udies in subgroups was limited;
this may aect the reliability of the results of subgroup anal-
ysis. Besides, because of this limitation, we could not make
a comparison between men and women. (ii) We attempted
to use an SMD eimate. Nonetheless, ve udies did not
report mean and andard deviation for the control and in-
tervention groups. (iii) Mo udies were low-quality, rais-
ing the possibility of bias in the included udies.
Despite its limitations, this meta-analysis provided good
evidence of the eect of meditation and exercise on de-
pression and anxiety. This udy calculated the relationship
between these two methods for both diseases; however,
previous udies only examined the eects of exercise on
depression. Also, the gender eect was udied in this udy.
This meta-analysis addressed the eect of meditation, aer-
obic, and other exercises on anxiety and depression. This
udy indicates that all three methods have signicantly af-
fected depression and anxiety. This nding can help reduce
anxiety and depression.
Ethical Considerations
Compliance with ethical guidelines
This article is a meta-analysis with no human or animal
sample.
Funding
This research did not receive any grant from funding agen-
cies in the public, commercial, or non-prot sectors.
Authors contributions
Searching for resources and computational framework and
data analysis: Saeed Mohammadi; Model design and manu-
script writing and interpretation: Mojtaba Tashkeh; Super-
vising the design and participation in the nal version of the
manuscript: Kamil Zahedi Tajrishi.
Conicts of intere
The authors declared no conict of intere.
Mohammadi S, et al. Eect of Exercise on Depression and Anxiety. Iranian Journal of Psychiatry and Clinical Psychology. 2021; 27(2):144-161.
mojtabatashkeh@gmail.com
Embase
PubMed
Web
of
Knowledge
I2
stata
11
PubMed Web of
EmbaseKnowledge
Depressionor Dysthymia or Anxiety or Disambigu-
aon or MDD or Depressive Disorder or Mood Dis-
orders) and (Exercise or Meditaon or Aerobics or
Physical acvity or Running or Walk or Cycling
Synonym
EndNote
Jadad
Jadad
I
2
I
2
stata
1. Higgins
2. Standardized Mean Dierence
stata11
I2
I2
I2
I2
I2
Jadad
Bahrke and Morgan 1978
[22]
Bartholomew et al. 2005
[23]
Blumenthal et al. 1999 [16]
Broman-Fulks et al. 2004
[17]
Canan and Ataoğlu 2010
[18]
Carraro and Gobbi 2012
[19]
Chu et al. 2009 [20]
Dadashali and Rahma
2015 [24]
Davis et al. 2015 [25]
Dimeo et al. 2001 [27]
El-Rae et al. 2016 [28]
Hassanzadeh et al. 2013
[29]
Hatami et al. 2013 [30]
Hekmapour et al. 2013
[31]
Helgador et al. 2016 [32]
Hemaar et al. 2012 [33]
Herring et al. 2011 [34]
Hoge et al. 2013 [35]
Karimi et al. 2012 [36]
Khesali et al. 2015 [37]
Moss 2012 [38]
Mota-Pereira et al. 2011
[39]
Nazer et al. 2012 [40]
Olsen et al. 2017 [41]
Patel et al. 2016 [42]
Pourranjbar et al. 2004 [43]
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Rashidi et al. 2017 [45]
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