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

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 ( 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.