| アブストラクト | BACKGROUND: Exercise is increasingly discussed as part of lifestyle-based and multimodal care for mood and anxiety disorders, but review-level evidence often mixes formally diagnosed clinical populations with symptom-defined or medically mixed samples. METHODS: We conducted an umbrella review of systematic reviews, meta-analyses, and network meta-analyses of structured exercise interventions for adults with depressive or anxiety disorders. Six databases were searched from inception to 1 March 2026. Primary outcomes were depressive and anxiety symptom severity, remission, and response; secondary outcomes were acceptability and tolerability. Review quality was appraised with AMSTAR 2, and primary-study overlap was quantified with corrected covered area (CCA), including overall and symptom-cluster analyses. The synthesis was designed to summarize review-level credibility and clinical interpretability rather than to generate a second-order pooled efficacy estimate. RESULTS: Nine reviews met eligibility criteria; four supplied directly extractable primary overall review-level estimates for core psychiatric symptom outcomes. AMSTAR 2 appraisal rated one review as high, three as low, and five as critically low. Recalculated overall overlap was slight (112 primary-study occurrences, 89 unique primary studies; CCA = 3.23%), although cluster-level analyses identified localized redundancy, particularly within anxiety-disorder-specific reviews. In major depressive disorder, one clinically focused review reported a large reduction in depressive symptoms for aerobic exercise versus non-exercise comparators (Hedges' g = -0.79, 95% CI -1.00 to -0.57; I(2) = 21%). Across diagnosed depressive and/or anxiety disorders, broader review-level estimates also favored exercise for depressive symptoms (SMD = -0.97, 95% CI -1.28 to -0.66) and anxiety symptoms (SMD = -0.66, 95% CI -1.09 to -0.23), but heterogeneity was high. Anxiety-disorder-specific evidence was less secure: the primary DSM-IV anxiety-disorder pooled estimate showed no clear benefit over selected controls (SMD = 0.02, 95% CI -0.20 to 0.24). Acceptability estimates were close to null, and adverse-event reporting was too sparse to support confident safety conclusions. CONCLUSION: Exercise is best supported as an adjunctive, patient-centered component of care for depressive disorders. Anxiety-disorder-specific efficacy remains uncertain when comparator rigor, diagnostic heterogeneity, and localized overlap are considered, and safety reporting needs substantial improvement. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261364264. |
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