Efficacy of different exercise interventions on cognitive function in adults with major depressive disorder and subthreshold depression: a systematic review with pairwise and network meta-analyses.

BACKGROUND: While exercise is widely recognized as an intervention to assist in the treatment of depression, its effects on cognitive function in adults with major depressive disorder or subthreshold depression remain inconsistent. METHODS: A comprehensive search was conducted across 11 databases from database inception to April 2025. Randomized controlled trials and quasi-experimental studies investigating exercise interventions for cognitive enhancement in adults with major depressive disorder or subthreshold depression were included. Pairwise and network meta-analyses were performed to compare the effects of aerobic exercise, resistance exercise, multicomponent exercise, and mind-body exercise. RESULTS: Twenty-six studies were included in the analysis. Traditional pairwise meta-analysis indicated that exercise interventions significantly improved global cognition (SMD = 0.71, 95% CI: 0.34 to 1.08), short-term memory (SMD = 0.29, 95% CI: 0.03 to 0.54), visuospatial memory (SMD = 0.25, 95% CI: 0.06 to 0.45), and attention (SMD = -1.09, 95% CI: -1.59 to -0.59). Network meta-analysis ranked mind-body exercise as the most effective modality for enhancing global cognition (SUCRA = 72.2%). Similarly, mind-body exercise also significantly improved attention (SMD = 0.67, 95%CI : 0.08 to 1.25), processing speed (SMD = 0.30, 95% CI: 0.02 to 0.58), and language function (SMD = 0.37, 95% CI: 0.08 to 0.67). Resistance exercise demonstrated significant benefits for processing speed (SMD = 0.46, 95% CI: 0.03 to 0.89). Multicomponent exercise yielded significant improvements in short-term memory (SMD = 0.96, 95% CI: 0.28 to 1.63). CONCLUSIONS: Despite methodological heterogeneity, this study provides preliminary evidence that exercise, particularly mind-body modalities, effectively enhances cognitive function in adults with major depressive disorder and subthreshold depression.