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Do workplace physical activity interventions improve mental health outcomes? |
Chu AH, Koh D, Moy FM, Muller-Riemenschneider F |
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CRD summary This review concluded that workplace physical activity programmes were associated with a significant reduction in depressive symptoms, and yoga reduced anxiety, but their impact on stress relief was less conclusive. Poor quality and inconsistent evidence mean that the authors' recommendations for better evidence were appropriate, but their conclusions on the effectiveness of these interventions may not be reliable. Authors' objectives To review the evidence for the effectiveness of workplace physical activity programmes on mental health outcomes. Searching EMBASE, PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant English-language publications from 1990 to August 2013. Search terms were reported and reference lists were screened to identify further relevant publications. Study selection Randomised controlled trials (RCTs) or quasi-experimental studies evaluating the effects of physical activity interventions, on mental health outcomes, were eligible for inclusion. Studies had to compare physical activity interventions against no treatment or other interventions, for working adults. The included studies were conducted in the Netherlands, Norway, Australia, Finland, the UK, the USA, Japan, Malaysia or Sweden. The intervention period ranged from two weeks to 12 months, with the frequency of sessions ranging from twice per week to once every four weeks. Sessions lasted from five to 60 minutes. Interventions were moderate-to-high intensity or low intensity aerobic exercise, yoga, light resistance training, body muscle stretching or relaxation, and multi-component interventions. Comparators were waiting-list controls, mindfulness training, cognitive-behavioural therapy, conventional aerobics, or anaerobic training. Outcomes were assessed using a wide variety of self-reported measures. It was not clear how many reviewers selected studies for inclusion. Assessment of study quality Modified Jadad criteria were used to allocate studies up to 4 points based on their statement of randomisation, randomisation method, blinding of outcome measurement, and description of withdrawals. Studies with a score of 3 or more were considered to be of good quality. It was not clear how many reviewers performed the assessment. Data extraction The authors did not state how data were extracted from the included studies. Methods of synthesis Study results were combined in a narrative synthesis, grouped into two main intervention areas: physical activity (aerobic dance or exercise, weight training, and strength or resistance training) or yoga. Studies were further grouped by outcome: stress, anxiety, depression, or mental well-being. Results of the review Thirteen RCTs and four non-randomised controlled trials were included in the review. Eight of the RCTs met three or more of the modified Jadad criteria. Physical activity: One of seven RCTs comparing physical activity with no treatment found a significant improvement in stress score, while none found a significant effect on anxiety. One of two RCTs reported a significant benefit for physical activity on depression; this intervention had a behaviour modification component. One comparative study found similar improvements in stress, anxiety, and depressive disorders, using preventative physical therapy and cognitive-behavioural therapy, after therapy and at six-month follow-up. Two non-randomised controlled trials reported significant positive effects of aerobic physical activity on stress. Yoga: Two RCTs of workplace yoga programmes reported significant improvements in stress. Two further RCTs showed significant reductions in anxiety with yoga practice, but in one trial, the effect was only significant for participants with higher adherence to the intervention. One comparative study found similar improvements in stress with yoga, compared with cognitive-behavioural therapy. Authors' conclusions Workplace physical activity programmes were associated with a significant reduction in depressive symptoms, and yoga reduced anxiety, but their impact on stress relief was less conclusive. CRD commentary This review addressed a very broad question, using appropriate inclusion criteria. There was an adequate search of the published literature. It was not clear whether attempts were made to minimise bias and error, and no attempts were made to identify unpublished and non-English-language studies. The authors separated trials into high and low quality, based on a modified form of the Jadad criteria, but the available details suggested that most trials had a substantial risk of bias. Wide variation between trials in the content, duration, and intensity of interventions, as well as differences in comparators and outcomes, precluded any meaningful synthesis of the results, and detailed conclusions on the effectiveness of any particular type of intervention. The included evidence appears to have been of poor quality and was mostly equivocal on the effectiveness of the interventions being evaluated. The authors' recommendations for better evidence seem appropriate, but their conclusion on the effects of the interventions may not be reliable. Implications of the review for practice and research Practice: The authors did not state any implications for practice. Research: The authors stated that there was a need for high-quality RCTs of people at risk of mental disorder. Trials should be methodologically rigorous, use objective and validated outcomes measures, and investigate the long-term sustainability of any effectiveness. Funding Funded by the Ministry of Higher Education (MoHE), Malaysia. Bibliographic details Chu AH, Koh D, Moy FM, Muller-Riemenschneider F. Do workplace physical activity interventions improve mental health outcomes? Occupational Medicine 2014; 64(4): 235-245 Indexing Status Subject indexing assigned by NLM MeSH Anxiety /prevention & Depression /prevention & Exercise; Humans; Mental Disorders /prevention & Mental Health; Stress, Psychological /prevention & Workplace; Yoga; control; control; control; control AccessionNumber 12014033942 Date bibliographic record published 01/07/2014 Date abstract record published 10/07/2014 Record Status This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn. |
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