Effects of exercise on obsessive-compulsive disorder symptoms: a systematic review and meta-analysis

Abstract

Objective

This systematic review and meta-analysis assessed the efficacy of exercise in reducing OCD symptoms.

Methods

We searched PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, Scopus and grey literature until March 2022. The study was preregistered at Prospero (CRD42021283931). We included randomised controlled and pre-post trials assessing physical activity as an intervention for OCD. Risk of bias was assessed using the Cochrane ROBINS-I tool and the RoB2 tool.

Results

The analysis included 6 trials (N = 92); 2 were RCTS and 4 were pre-post design studies. A random-effects meta-analysis of pre-post data identified a large reduction of OCD symptoms following exercise (g = 1.33 [95%CI 1.06–1.61]; k = 6). Exercise was also associated with significant pre-post reductions in anxiety (g = 0.71 [95%CI 0.37–1.05; k = 4) and depression (g = 0.57 [95%CI 0.26–0.89]; k = 2). Risk of bias was moderate-high in uncontrolled trials on the ROBINS-I and RCTs showed ‘some concerns’ on the RoB2.

Conclusion

Exercise was associated with a large pre-post reduction of OCD symptoms; however, few trials were of robust quality and all were at risk of bias. Further well-powered and better quality RCTs are required to assess the role of exercise as an intervention for OCD.

KEY POINTS

• Studies exploring exercise as an adjunct therapy for OCD have small participant numbers, therefore a systematic review and meta-analysis is needed to estimate potential efficacy.

• Pre-post analysis shows that exercise was associated with a large reduction of OCD symptoms

• The current systematic review and meta-analysis points to the potential for exercise to be beneficial for the treatment for OCD symptoms. However, more well-powered and better controlled RCTs are required to fully assess the benefit of exercise for the treatment of OCD symptoms.

Keywords:

• OCD
• obsessive-compulsive disorder
• exercise
• exercise therapy
• physical activity
• meta-analysis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

RC’s involvement in his research was funded in whole, or in part, by Wellcome [Grant number 110049/Z/15/Z and 110049/Z/15/A]. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. SRC receives honoraria from Elsevier for editorial work. NF receives honoraria from Elsevier for editorial work, from the Global Mental Health Academy for giving lectures and from the Medicines and Healthcare Products Regulatory Agency for consultation. She has received payment to her institution for research by the NIHR, COST Action and Orchard-Advancing Research in OCD, personal royalties from Oxford University Press and payment to attend scientific meetings from the British Association for Psychopharmacology, European College for Neuropsychopharmacology (ECNP), Royal College of Psychiatrists, International College for Neuropsychopharmacology, COST Action, World Psychiatric Association, International Forum for Mood and Anxiety Disorders, American College for Neuropsychopharmacology.