1月23日,，發(fā)表在《內科學文獻》（Archives of Internal Medicine）上的一項研究表明，運動可減輕慢性病患者的抑郁癥狀,，效果最好的患者為有輕—中度抑郁癥狀的患者,，以及運動可改善其功能相關轉歸的患者。
在慢性病病人中,，體力活動少和抑郁癥狀共存很常見,。沒有人就運動鍛煉對慢性病病人抑郁癥狀影響的隨機對照研究進行過系統(tǒng)回顧。近期,，美國學者就運動鍛煉對抑郁癥狀的影響進行了評估,，并確定這種影響是否因病人的特征、運動特征和臨床環(huán)境而改變,。
研究者們采用美國科學數(shù)據庫體力活動指南,、Google Scholar、MEDILINE,、PsycINFO,、PubMed和科學網，檢索2011年6月1日前發(fā)表的文章,。結果共找到90篇文章,，涉及10534例久坐少活動的慢性病病人。研究包括的文章要求：（1）病人隨機分入運動干預組和不運動對照組,；（2）在基線,、干預期過半和（或）干預期結束評估抑郁癥狀。計算Hedges d效應大小,，評估研究質量,，采用隨機效應模型估計抽樣誤差和觀察效應的總體方差。
結果顯示，運動鍛練顯著減少抑郁癥狀,，異質性平均效應的Δ值為0.30,。下列情況可獲得較大的抗抑郁效果：（1）基線抑郁癥狀較嚴重，（2）達到推薦的體力活動水平的病人,。在基線抑郁癥狀屬輕—中度的病人中,，臨床研究的主要轉歸——功能相關性轉歸顯著改善。（生物谷Bioon.com）
doi:10.1001/archinternmed.2011.696
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Effect of Exercise Training on Depressive Symptoms Among Patients With a Chronic Illness
A Systematic Review and Meta-analysis of Randomized Controlled Trials
Matthew P. Herring, PhD; Timothy W. Puetz, PhD; Patrick J. O’Connor, PhD; Rodney K. Dishman, PhD
Background Physical inactivity and comorbid depressive symptoms are prevalent among patients with a chronic illness. To our knowledge, randomized controlled trials of the effects of exercise training on depressive symptoms among patients with a chronic illness have not been systematically reviewed. We estimated the population effect of exercise training on depressive symptoms and determined whether the effect varied according to patient characteristics and modifiable features of exercise exposure and clinical settings.
Methods Articles published before June 1, 2011, were located using the Physical Activity Guidelines for Americans Scientific Database, Google Scholar, MEDLINE, PsycINFO, PubMed, and Web of Science. Ninety articles involving 10 534 sedentary patients with a chronic illness were selected. Included articles required (1) randomized allocation to an exercise intervention or nonexercise comparison condition and (2) a depression outcome assessed at baseline and at mid- and/or postintervention. Hedges d effect sizes were computed, study quality was evaluated, and random effects models were used to estimate sampling error and population variance of the observed effects.
Results Exercise training significantly reduced depressive symptoms by a heterogeneous mean effect size delta () of 0.30 (95% CI, 0.25-0.36). Larger antidepressant effects were obtained when (1) baseline depressive symptoms were higher, (2) patients met recommended physical activity levels, and (3) the trial primary outcome, predominantly function related, was significantly improved among patients having baseline depressive symptoms indicative of mild-to-moderate depression.
Conclusions Exercise reduces depressive symptoms among patients with a chronic illness. Patients with depressive symptoms indicative of mild-to-moderate depression and for whom exercise training improves function-related outcomes achieve the largest antidepressant effects.
