JMIR Publications

ABSTRACT

Background:

Previous literature lacks summative information on the mental health benefits achieved from different forms of walking.

Objective:

The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety.

Methods:

This is a systematic review and meta-analysis with randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, AMED, CINAHL, and Web of Science were searched on 5th April 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMD) with 95% confidence intervals (CI) in forest plots. Risk of bias was assessed using the Cochrane risk of bias tool.

Results:

This review included 75 RCTs with 8636 participants: 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcome. One study reported the results in adolescents and was not included in the meta-analysis. The pooled results in adults indicated that walking could significantly reduce depressive symptoms (44 RCTs, SMD=-0.591, 95% CI: -0.778 to -0.403, I2=84.8%, tau2=0.3008) and anxiety symptoms (26 RCTs, SMD=-0.446, 95% CI: -0.628 to -0.265, I2=81.1%, tau2=0.1530) compared with the inactive control group. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different frequencies, time durations of each walk, indoor or outdoor, and group or individual-based. Both depressed (5 RCTs, SMD=-1.863, 95% CI: -2.764 to -0.962, I2=86.4%, tau2=0.8929) and non-depressed (39 RCTs, SMD=-0.442, 95% CI: -0.604 to -0.280, I2=77.5%, tau2=0.1742) adult participants could benefit from walking on their depressive symptoms, and depressed participants could benefit more (p=0.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (17 RCTs, SMD=-0.126, 95% CI: -0.343 to 0.092, I2=58.0%, tau2=0.1058) and anxiety symptoms (14 RCTs, SMD=-0.053, 95% CI: -0.311 to 0.206, I2=67.7%, tau2=0.1421).

Conclusions:

Walking can be effective in reducing symptoms of depression and anxiety, and its effects are comparable to active controls. Clinical Trial: PROSPERO CRD42021247983.