Exercise for patients with major depression: a protocol for a systematic review with meta-analysis and trial sequential analysis

BACKGROUND: The lifetime prevalence of major depression is estimated to affect 17% of the population and is considered the second largest health-care problem globally in terms of the number of years lived with disability. The effects of most antidepressant treatments are poor; therefore, exercise has been assessed in a number of randomized clinical trials. A number of reviews have previously analyzed these trials; however, none of these reviews have addresses the effect of exercise for adults diagnosed with major depression. METHODS/DESIGN: The objective of this systematic review is to investigate the beneficial and harmful effects of exercise, in terms of severity of depression, lack of remission, suicide, and so on, compared with treatment as usual with or without co-interventions in randomized clinical trials involving adults with a clinical diagnosis of major depression. A meta-analysis of the effect estimates of the individual trials, taking bias risk into consideration, will be carried out. Any heterogeneity will be explored using meta-regression and subgroup analyses. Trial sequential analysis will be carried out on the trials to control for risks of random errors. The results from the study will aid health authorities and clinicians to understand whether exercise should be offered to patients with major depression.