Effects of different exercise modalities on depressive symptom score changes in patients with type 2 diabetes: a systematic review and network meta-analysis

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Abstract

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a major global public health challenge, and depressive symptoms are common among patients with T2DM. These symptoms may impair quality of life, self-management behaviors, glycemic control, and long-term prognosis. Exercise is a promising non-pharmacological strategy, but the comparative effects of different exercise modalities on depressive symptom scores remain unclear. OBJECTIVE: This study aimed to evaluate and compare the effects of different exercise modalities on depressive symptom score changes in patients with T2DM. METHODS: PubMed, Embase, Cochrane Library, Web of Science, SPORTDiscus, and MEDLINE were searched from inception to April 2026. Randomized controlled trials involving adults with T2DM were included if they compared structured exercise interventions with usual care or non-exercise controls and reported depressive symptom outcomes. Standardized mean differences (SMDs) were used because different depression scales were applied across studies. Exercise modes were classified as aerobic exercise or walking training (AE), combined aerobic/resistance or walking/resistance training (COMB), mind-body exercise (MBE), aquatic aerobic training (AT), and control (CON). Pairwise random-effects meta-analysis and frequentist network meta-analysis were performed. SUCRA values were used to describe ranking probabilities, and CINeMA was used to assess the certainty of evidence. RESULTS: The network meta-analysis showed that, compared with the control group, MBE showed a relatively clear reduction in depressive symptom scores (SMD = -1.09, 95% CI: -2.03 to -0.14). AE, COMB, and AT also showed potential improvement trends, although some confidence intervals were wide or crossed the null line. SUCRA rankings were highest for MBE (72.4), followed by AT (69.5), COMB (69.4), AE (33.4), and CON (5.6). However, the similar SUCRA values for MBE, AT, and COMB, together with limited direct evidence and uncertainty in some comparisons, suggest that these rankings should not be interpreted as definitive clinical superiority. The overall certainty of evidence was moderate to low. CONCLUSION: Structured exercise interventions may improve depressive symptoms in patients with T2DM, with MBE appearing to be the most promising mode. However, these findings should be interpreted cautiously because of heterogeneity, wide confidence intervals, and limited direct evidence. More high-quality randomized controlled trials with larger samples and long-term follow-up are needed. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261374583.

Abstract as published, via PubMed.