Dropout from exercise randomized controlled trials among people with depression: A meta-analysis and meta regression

Brendon Stubbs, Davy Vancampfort, Simon Rosenbaum, Justin Richards, Philip Ward, Andrew Soundy

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Exercise has established efficacy in improving depressive symptoms. Dropouts from randomized controlled trials (RCT’s) pose a threat to the validity of this evidence base, with dropout rates varying across studies. We conducted a systematic review and meta-analysis to investigate the prevalence and predictors of dropout rates among adults with depression participating in exercise RCT’s.


Three authors identified RCT’s from a recent Cochrane review and conducted updated searches of major electronic databases from 01/2013 to 08/2015. We included RCT’s of exercise interventions in people with depression (including major depressive disorder (MDD) and depressive symptoms) that reported dropout rates. A random effects meta-analysis and meta regression were conducted.


Overall, 40 RCT’s were included reporting dropout rates across 52 exercise interventions including 1,720 people with depression (49.1 years (range=19-76 years), 72% female (range=0-100)). The trim and fill adjusted prevalence of dropout across all studies was 18.1% (95%CI=15.0 to 21.8%) and 17.2% (95%=CI 13.5=to 21.7, N=31) in MDD only. In MDD participants, higher baseline depressive symptoms (β 0.0409, 95%CI=0.0809 to 0.0009, P=0.04) predicted greater dropout, whilst supervised interventions delivered by physiotherapists (β-1.2029, 95%CI=-2.0967 to-0.3091, p=0.008) and exercise physiologists (β-1.3396, 95%CI=-2.4478 to-0.2313, p=0.01) predicted lower dropout. A comparative meta-analysis (N=29) established dropout was lower in exercise than control conditions (OR=0.642, 95%CI=0.43 to 0.95, p=0.02).


Exercise is well tolerated by people with depression and drop out in RCT’s is lower than control conditions. Thus, exercise is a feasible treatment, in particular when delivered by healthcare professionals with specific training in exercise prescription
Original languageEnglish
Pages (from-to)457-466
JournalJournal of Affective Disorders
Early online date29 Oct 2015
Publication statusPublished - 15 Jan 2016


  • Depression
  • Exercise
  • Physical activity
  • Dropout


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