Comparison of closed-skill and open-skill exercises on depression symptoms in adults : A systematic review and meta-analysis
7 affiliations
- 1Physical Education School of Shaanxi Normal University, Xi’an, Shaanxi, China
- 2Xi’an Jiaotong University, Xi’an, Shaanxi, China
- 3School of Continuing Education, China University of Geosciences, Beijing, China
- 4School of Physical Education, Ningxia University, Yinchuan, Ningxia, China
- 5School of Physical Education, Yancheng Teachers University, Yancheng, Jiangsu, China
- 6School of Physical Education, Shaanxi University of Technology, Hanzhong, Shaanxi, China
- 7Shaanxi Vocational and Technical College, Xi’an, Shaanxi, China.
Abstract
Background:: Depression is a leading cause of disability worldwide, and exercise has been recognized as an important non-pharmacological intervention for improving depressive symptoms. This systematic review and meta-analysis aimed to compare the effects of closed-skill and open-skill exercises on depressive symptoms in adults with depressive disorders or clinically relevant depressive symptoms, and to investigate whether exercise characteristics, including skill type, duration, and frequency, influence intervention effects.
Methods:: PubMed, Web of Science, Embase, Scopus, Cochrane Library, and China National Knowledge Infrastructure were searched for randomized controlled trials comparing exercise interventions with non-exercise controls. Exercise interventions were classified as closed-skill or open-skill exercises according to motor skill characteristics. Random-effects meta-analysis was conducted using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Subgroup analyses, meta-regression, funnel plots, Egger’s test, trim-and-fill analysis, leave-one-out sensitivity analyses, and Grading of Recommendations Assessment, Development and Evaluation assessment were performed.
Results:: Twenty-one randomized controlled trials were included. Exercise interventions significantly reduced depressive symptoms compared with non-exercise controls (SMD = −0.38, 95% CI = −0.67 to − 0.08), with substantial heterogeneity (I2 = 72.4%). Closed-skill exercise showed a significant improvement in depressive symptoms (SMD = −0.27, 95% CI = −0.54 to − 0.00), whereas open-skill exercise showed a larger but nonsignificant effect (SMD = −0.83, 95% CI = −2.12 to 0.46). No significant differences were found between closed-skill and open-skill exercises. Meta-regression showed no significant moderating effects of exercise duration or frequency. Publication bias was detected by Egger’s test (P = .0038), and trim-and-fill analysis reduced the estimated effect, indicating that the overall findings should be interpreted cautiously. Sensitivity analysis confirmed the stability of results. The certainty of evidence was rated as low according to Grading of Recommendations Assessment, Development and Evaluation.
Conclusion:: Exercise interventions can improve depressive symptoms in adults with depressive disorders; however, current evidence does not demonstrate a clear advantage of either closed-skill or open-skill exercise. Closed-skill exercise is supported by a larger evidence base, whereas the potential benefits of open-skill exercise remain uncertain due to limited studies and low-certainty evidence. Further high-quality randomized controlled trials directly comparing different exercise skill characteristics are required.
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BibTeX
@article{yuan2026comparison,
title = {{Comparison of closed-skill and open-skill exercises on depression symptoms in adults : A systematic review and meta-analysis}},
author = {Yuan Yuan and Lei Shi and Meihua Yuan and Mingrui Shao and Ting Peng and Xiaofa Yuan and Xiupeng Li and Tengxiu Chen and Feng Wang and Aiping Chi and Jing Fan},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051339},
url = {https://europepmc.org/article/PMC/PMC13727200},
note = {CC BY},
}
RIS
TY - JOUR
TI - Comparison of closed-skill and open-skill exercises on depression symptoms in adults : A systematic review and meta-analysis
AU - Yuan Yuan
AU - Lei Shi
AU - Meihua Yuan
AU - Mingrui Shao
AU - Ting Peng
AU - Xiaofa Yuan
AU - Xiupeng Li
AU - Tengxiu Chen
AU - Feng Wang
AU - Aiping Chi
AU - Jing Fan
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051339
UR - https://europepmc.org/article/PMC/PMC13727200
AB - Background:: Depression is a leading cause of disability worldwide, and exercise has been recognized as an important non-pharmacological intervention for improving depressive symptoms. This systematic review and meta-analysis aimed to compare the effects of closed-skill and open-skill exercises on depressive symptoms in adults with depressive disorders or clinically relevant depressive symptoms, and to investigate whether exercise characteristics, including skill type, duration, and frequency, influence intervention effects. Methods:: PubMed, Web of Science, Embase, Scopus, Cochrane Library, and China National Knowledge Infrastructure were searched for randomized controlled trials comparing exercise interventions with non-exercise controls. Exercise interventions were classified as closed-skill or open-skill exercises according to motor skill characteristics. Random-effects meta-analysis was conducted using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Subgroup analyses, meta-regression, funnel plots, Egger’s test, trim-and-fill analysis, leave-one-out sensitivity analyses, and Grading of Recommendations Assessment, Development and Evaluation assessment were performed. Results:: Twenty-one randomized controlled trials were included. Exercise interventions significantly reduced depressive symptoms compared with non-exercise controls (SMD = −0.38, 95% CI = −0.67 to − 0.08), with substantial heterogeneity (I2 = 72.4%). Closed-skill exercise showed a significant improvement in depressive symptoms (SMD = −0.27, 95% CI = −0.54 to − 0.00), whereas open-skill exercise showed a larger but nonsignificant effect (SMD = −0.83, 95% CI = −2.12 to 0.46). No significant differences were found between closed-skill and open-skill exercises. Meta-regression showed no significant moderating effects of exercise duration or frequency. Publication bias was detected by Egger’s test (P = .0038), and trim-and-fill analysis reduced the estimated effect, indicating that the overall findings should be interpreted cautiously. Sensitivity analysis confirmed the stability of results. The certainty of evidence was rated as low according to Grading of Recommendations Assessment, Development and Evaluation. Conclusion:: Exercise interventions can improve depressive symptoms in adults with depressive disorders; however, current evidence does not demonstrate a clear advantage of either closed-skill or open-skill exercise. Closed-skill exercise is supported by a larger evidence base, whereas the potential benefits of open-skill exercise remain uncertain due to limited studies and low-certainty evidence. Further high-quality randomized controlled trials directly comparing different exercise skill characteristics are required.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -