Systematic review and meta-analysis of the effects of combined physical and cognitive training on depression symptoms in adults across clinical populations

Abstract

Objectives To compare the effect of combined physical training (PT) and cognitive training (CT) with single-modality interventions, on depression symptoms in adults across clinical populations. Methods PubMed, Scopus, Web of Science, SPORTDiscus, and APA PsycINFO were systematically searched for relevant English-language studies up to December 2025. Search terms focused on combined PT and CT compared with PT or CT alone in adults with depression symptoms. Included samples were predominantly heterogeneous clinical populations, particularly individuals with neurological conditions (e.g., stroke, Parkinson’s disease, multiple sclerosis, dementia, and mild cognitive impairment), as well as chronic somatic conditions (e.g., fibromyalgia), alongside a smaller number of non-clinical (healthy) populations. Data were extracted on training interventions, sample characteristics, and depression symptoms. Between-group standardized mean differences were calculated from post-intervention means and standard deviations using random-effects models to compare combined PT and CT with single-modality interventions. Results Sixteen studies were identified ( N = 813). Across the included studies, both combined and single-modality interventions (PT or CT) were associated with reductions in depression symptoms. However, pooled between-group analyses indicated that combined interventions were associated with greater reductions in depression symptoms than single-modality interventions (SMD = −0.40, 95% CI [−0.69, −0.11], I 2 = 69.7%), although moderate between-study heterogeneity was observed. Most comparisons were conducted against PT alone, with only limited evidence for CT-only comparators. Sensitivity analyses restricted to studies ( n = 13) using validated depression-specific scales showed a smaller effect in the same direction that was no longer statistically significant (SMD = −0.24, 95% CI [−0.51, 0.03], I 2 = 57.2%). Conclusion Combined PT and CT may provide greater reductions in depression symptoms than single-modality interventions, particularly PT alone. However, this effect was attenuated and no longer statistically significant when analyses were restricted to depression-specific measures. Given the heterogeneity, variability in outcome measures, limited evidence for CT-only comparisons, and very low certainty of evidence, findings need to be interpreted cautiously. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024583214 , Identifier CRD42024583214.