1. The Effect of Exercise on Mental Health in Medicine and Allied Health Students: A Meta-Analysis
Rachel Morell1, Simon Rosenbaum1,2 and Belinda J Parmenter1
1 Department of Exercise Physiology, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
2 The Black Dog Institute, University of New South Wales, Prince of Wales Hospital, Randwick, NSW, Australia
Background
Data Extraction, Synthesis and Analysis
Results
The prevalence of mental illness world-wide continues to rise and has been identified as an area requiring urgent attention by the World Health Organisation1.
While prevalence rates in the general population are increasing, University students have been identified as suffering depression, stress and anxiety at significantly higher rates than the general population2. More specifically students studying medicine have been identified as a group experiencing particularly higher rates of psychological distress2. This deterioration in mental health has been linked to lifestyle and wellbeing with a major component being due to lack of physical activity2.
Physical activity is widely accepted as having protective and treatment effects on stress, depression and anxiety, yet it has been relatively understudied with regards to the mental health of students studying medicine.
An electronic database search of PubMed, EMBASE, Cochrane and CINAHL was conducted up until November Search terms included (exercise or physical activity) and (mental health or depression or stress or anxiety) and (students or college or university) and (random*). Primary outcomes of change in stress, depression and anxiety from baseline to post exercise intervention were extracted in duplicate for both the control and intervention groups. The change in mean and standard deviation from pre-post for both groups, and corresponding p-values were then used to calculate the standardised mean difference using RevMan Assessment of heterogeneity and publication bias was performed using Revman 5.2. Level of significance was set at p<0.05.
Figure 2: Forest plot of the effect of exercise on depression in university students.
Results
Figure 3: Forest plot of the effect of exercise on anxiety in university students.
Aims
The aim of this paper is to:
Conduct a systematic review and meta-analysis of the literature to determine the impact, if any, of various exercise interventions on the mental health of university students enrolled in health related courses.
To identify if any specific exercise interventions are more effective at improving students mental health.
Figure 4: Forest plot of the effect of exercise on stress in university students.
Discussion and Conclusions
This review was limited by:
the small number of trials meeting inclusion criteria; and
the different types of interventions used (i.e. only one aerobic exercise intervention, with the other 3 being “Energy Arts”).
Exercise was favourable for depression in 2 of the 3 trials measuring it. Though, due to the difference in response to jogging between men and women, heterogeneity between studies was high. With only three studies measuring this outcome, it was difficult to do any further sub-analysis. Exercise did not appear to improve anxiety or stress in this population, though it is noted the number of studies were low.
Inclusion/Exclusion Criteria
Trials were included if they:
were randomised controlled trials;
enrolled university students in a health or medical degree;
implemented structured exercise interventions for anxiety, stress and/or depression that were a minimum of 4 weeks in length;
Studies completed on animals, or that were not written in English were excluded.
Figure 1: PRISMA flow chart of search strategy.
Only 4 studies met the criteria for inclusion. In total 835 participants were studied, mean age of 19.9±1.1 years and 51.5% were female. The students were enrolled in Medicine, Chinese Traditional Medicine or Health Science. Jogging was used in only one study, otherwise studies used a form of Tai Chi as the intervention.
References
World Health Organisation (2001). The World Health Report 2001: Mental Health: New Understanding, New Hope.
Beyond Blue, (2013) National Mental Health Survey of Doctors and Medical Students.
Berger, BG. et al. (1988) J Sp & Ex Psych 10(4)
Kanojia, S. et al (2013).J Clin Diag Res 7(10)
Li, M. et al. (2015) PLoS ONE 10(7) e
Zheng, G. et al. (2015) PLoS ONE 10(7) e
With strong evidence available to show the treatment effect of exercise and physical activity on mental health in other populations, more studies are warranted to see if interventions incorporating aerobic and/or resistance exercise at various intensities are effective at improving mental health in students studying medicine.
This meta-analysis was registered with PROSPERO on the 23rd August 2015 Registration #CRD