Structured exercise modalities significantly reduce depressive symptoms and anxiety in adults with large effect sizesStructured exercise helps adults manage symptoms of depression and anxiety

ObjectiveTo systematically compare the intervention effects of eight common structured exercise modalities on depressive and anxiety symptoms in adults using a network meta-analysis approach, providing evidence-based insights for developing precision exercise prescriptions in mental health.MethodsA computer search was conducted across PubMed, Web of Science, Embase, and the Cochrane Library databases, covering the period from the database establishment to March 31,2026. Randomized controlled trials comparing different exercise modalities for treating adult depressive or anxiety symptoms were included. Literature quality was assessed using the Cochrane Collaboration’s Bias Risk Assessment Tool (Revised Version), with statistical analyses performed using Stata 19.0 and RevMan 5.4. The standardized mean difference (SMD) was used as the effect measure, consistency was evaluated by the node splitting method, and the cumulative rank-sum area under the curve (SUCRA) was calculated to rank intervention efficacy. Publication bias was assessed and corrected using the trimming method and meta-regression.ResultsA total of 22 studies involving 23 randomized controlled trials with 1,830 participants were included, encompassing eight exercise modalities: yoga, Tai Chi, Pilates, resistance training, aerobic exercise, combined exercise, high-intensity interval training, and moderate-intensity continuous training. Traditional meta-analysis demonstrated that exercise intervention groups showed significantly better improvements in both depressive symptoms (SMD = -0.67,95% CI: -0.97 to-0.37) and anxiety symptoms (SMD = -0.77,95% CI: -1.12 to-0.41) compared to the control groups (both P 0.05), although the effect sizes were larger in the elderly group (≥60 years) compared to other age groups. Consistency testing indicated a reliable evidence network (P>0.05). Egger’s test suggested potential publication bias (depression P = 0.017, anxiety P = 0.010), but the meta-analysis did not incorporate missing studies, and meta-regression did not detect small-sample effects; the direction and significance of the effects remained unchanged, rendering the conclusions robust.ConclusionDifferent exercise modalities exhibit beneficial effects on both depression and anxiety symptoms. Yoga, MICT, and HIIT all demonstrated significant potential in alleviating both symptoms; however, the differences in efficacy among the three interventions were not statistically significant, making them all viable prioritized exercise modalities in clinical practice. Clinical selection should be based on a comprehensive evaluation of the patient’s dominant symptom cluster, tolerance, preferences, and safety profile to develop individualized exercise regimens. Since only one study included Pilates, its independent effect remains to be validated.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier.