OBJECTIVE: To review and quantify the effect of exercise on depression in adults with neurological disorders. We searched CINAHL, the Cochrane Register of Controlled Clinical Trials, Embase, ERIC, Medline, PsycINFO, PubMed, and SPORTDiscus with the last search performed in May 2014. STUDY SELECTION: We included randomized controlled trials conducted in adults diagnosed with a neurological disorder. We included studies which compared an exercise intervention group with a control group and used depression as an outcome measure. DATA EXTRACTION: Depression data were extracted independently by 2 authors. Methodological quality was assessed independently by 2 authors. DATA SYNTHESIS: Forty-three full-length articles were reviewed and 26 trials met our inclusion criteria. These trials represented 1,324 participants with 7 different neurological disorders; Alzheimer's disease (n = 4), migraine (n = 1), multiple sclerosis (n = 13), Parkinson's disease (n = 2), spinal cord injury (n = 1), stroke (n = 2) and traumatic brain injury (n = 3). Depression measure data were extracted and effect sizes were computed for 23 trials. Results from a meta-analysis yielded an overall effect size of 0.28 (SE 0.07, CI 0.15 to 0.41, p = 0.00) favoring a reduction in depression outcomes following an exercise intervention compared with control. Of note, interventions which met physical activity guidelines yielded an overall effect of 0.38 compared with 0.19 for studies which did not meet physical activity guidelines. CONCLUSIONS: This review provides evidence that exercise, particularly when meeting physical activity guidelines, can improve depressive symptoms in adults with neurological disorders.

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