OBJECTIVE: To evaluate the antidepressant effects of exercise in older adults, using randomized controlled trial (RCT) data. METHODS: We conducted a meta-analysis of exercise in older adults, addressing limitations of previous works. RCTs of exercise interventions in older people with depression (>= 60 years) comparing exercise versus control were eligible. A random-effects meta-analysis calculating the standardized mean difference (SMD) (95% confidence interval (95%CI)), meta-regressions, and trim, fill, and fail-safe number analyses were conducted. RESULTS: Eight RCTs were included, representing 138 participants in exercise arms and 129 controls. Exercise had a large and significant effect on depression (SMD -0.90 (95%CI -0.29 to -1.51)), with a fail-safe number of 71 studies. Significant effects were found for (1) mixed aerobic and anaerobic interventions, (2) at moderate intensity, (3) that were group-based, (4) that utilized mixed supervised and unsupervised formats, and (5) in people without other clinical comorbidities. CONCLUSION: Adjusting for publication bias increased the beneficial effects of exercise in three subgroup analysis, suggesting that previous meta-analyses have underestimated the benefits of exercise due to publication bias. We advocate that exercise be considered as a routine component of the management of depression in older adults.

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