Effects of exercise therapy on anxiety and depression in patients with COVID-19: a systematic review and meta-analysis

Objective: With increasing rates of anxiety and depression during COVID-19, exercise treatment has drawn attention for its effects on COVID-19 patients with anxiety and depression. This study set out to assess the impact of exercise therapy on COVID-19 patients’ anxiety and depression. Methods: PubMed, EMBASE, Web of Science and Cochrane Library were searched from inception to April 30, 2023, for randomized clinical trials (RCTs) of exercise therapy for anxiety and depression in COVID-19 patients. Risk of bias was assessed with the Cochrane Collaboration tool. Data were pooled using a random-effects model. RevMan 5.4 was used for analyses. PROSPERO registration: CRD42023406439. Selection criteria: RCTs including COVID-19 patients with anxiety and/or depression, assessing the impact of physical exercise on anxiety and depression. Results: Six studies with 461 COVID-19 patients were included. Compared with control, exercise significantly improved anxiety (SMD = −0.76; 95% CI: −0.96 to −0.55; p < 0.00001), depression (SMD = −0.39; 95% CI: −0.70 to −0.09; p = 0.01), PHQ-9 score (MD = −1.82; 95% CI: −2.93 to −0.71; p = 0.001), and sleep quality (SMD = −0.73; 95% CI: −1.32 to −0.14; p = 0.01). Conclusion: Exercise therapy helps COVID-19 patients experience less anxiety and depression and have better-quality sleep. Systematic review registration: CRD42023406439.