Effects of aerobic exercise on core executive function in adults with major depressive disorder: A Systematic review and three-level meta‑analysis

This study aimed to investigate the effects of aerobic exercise (AE) on overall core executive function (EF) and its subdomains in adults with major depressive disorder (MDD). We systematically searched Embase, Ovid MEDLINE, Web of Science, Scopus, and PubMed up to October 12, 2024. We included randomized controlled trials (RCTs) that investigated the effects of AE on core EF in adults with MDD. We conducted a three-level meta-analysis with a random-effects model in R and used the Physiotherapy Evidence Database scale to assess study quality. Ten RCTs involving 780 depressed adults were included. AE statistically significantly improved overall core EF (g = 0.14; 95% confidence intervals [CI] = 0.05, 0.22; p = 0.004) and its subdomains of inhibitory control (g = 0.19; 95% CI = 0.07, 0.32; p = 0.004) and cognitive flexibility (g = 0.17; 95% CI = 0.01, 0.33; p = 0.043), but not working memory (g = 0.08; 95% CI = -0.01, 0.17; p = 0.070) in adults with MDD. Aerobic exercise, conducted three times weekly at moderate and vigorous intensities (45 min per session, 90–149 min weekly) and over 3–10 weeks or longer, can improve the overall core EF in adults with MDD. This study found that AE is a promising nonpharmacological therapy to improve the overall core EF and its subdomains of inhibitory control and cognitive flexibility in adults with MDD. AE plus antidepressants and the percentage of females were significant moderators.