{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T12:17:24Z","timestamp":1780489044570,"version":"3.54.1"},"reference-count":68,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Johannes Gutenberg-Universit\u00e4t Mainz"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    This systematic review with network meta-analysis aimed to identify the most effective intervention incorporating a substantial physical activity component in individuals with comorbid depressive symptoms and nonspecific chronic low back pain (LBP). A search of six databases (PubMed\/Medline, PsycINFO, Web of Science Core Collection, EMBASE, CINAHL, CENTRAL) was conducted up to July 30, 2025. Randomised controlled trials on participants\u2009&gt;\u200915 years with comorbid clinically relevant depressive symptoms (e.g., Beck Depression Inventory (BDI)-II\u2009&gt;\u200913) and chronic (&gt;\u200912 weeks) LBP were included. Interventions involved\u2009\u2265\u200933% active movement and lasted\u2009\u2265\u20092 weeks. Outcome-wise risk of bias (RoB) for the self-reported outcomes was assessed using the Cochrane RoB 2 tool. Primary outcomes were (i) changes in depressive symptoms (mandatory) and (ii) pain intensity, disability and quality of life, with each study required to include at least one of three additional outcomes. We calculated frequentist-based network meta-analysis. Of 2138 studies, five studies (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u2009834, 50.1% female, mean age: 52.8 years) with eight treatments were included. Overall RoB ranged from low to some concerns. Yoga with education was most effective at mid-term follow-up (intervention duration closest to 12 weeks, k\u2009=\u20099), showing improvements in pain (SMD=\u22121.05 [95%CI=\u22121.38 to \u22120.72]) and clinically relevant improvements in depressive symptoms (SMD=\u22121.48 [95%CI=\u22121.81 to \u22121.14]), all vs. usual care. Antidepressant therapy with pain self-management (e.g., physical activity, relaxation, breathing) moderately affected depressive symptoms (SMD=\u22120.56 [95%CI=\u22120.60 to \u22120.53]) and pain (SMD=\u22120.53 [95%CI=\u22120.56 to \u22120.49]). At long-term follow-up, antidepressant therapy with pain self-management, and online- and mobile-based therapy showed superiority over usual care. The overall certainty of evidence across outcomes was low to very low. With very low certainty evidence, yoga combined with education yielded the most favourable effects across outcomes. However, these findings should be interpreted with caution and require adequately powered future trials. While other approaches showed small to moderate effects, their clinical relevance remains uncertain.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>PROSPERO 2024 ID<\/jats:bold>\n                    : CRD42024523604.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-54397-0","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:36:10Z","timestamp":1780486570000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative effectiveness of interventions incorporating physical activity in individuals with comorbid low back pain and depressive symptoms: a systematic review with network meta-analysis"],"prefix":"10.1038","volume":"16","author":[{"given":"Nils","family":"Haller","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"K\u00f6bel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larissa","family":"Sch\u00e4ffer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Overath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Niederer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"issue":"6","key":"54397_CR1","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1001\/archpsyc.62.6.593","volume":"62","author":"RC Kessler","year":"2005","unstructured":"Kessler, R. C. et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch. Gen. Psychiatry. 62 (6), 593\u2013602. https:\/\/doi.org\/10.1001\/archpsyc.62.6.593 (2005).","journal-title":"Arch. Gen. Psychiatry"},{"issue":"18","key":"54397_CR2","doi-asserted-by":"publisher","first-page":"2005","DOI":"10.1097\/BRS.0b013e318133fad8","volume":"32","author":"CO Schmidt","year":"2007","unstructured":"Schmidt, C. O. et al. Back pain in the German adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey. Spine 32 (18), 2005\u20132011 (2007).","journal-title":"Spine"},{"key":"54397_CR3","doi-asserted-by":"publisher","first-page":"111909","DOI":"10.1016\/j.exger.2022.111909","volume":"167","author":"Y Selvamani","year":"2022","unstructured":"Selvamani, Y., Sangani, P. & Muhammad, T. Association of back pain with major depressive disorder among older adults in six low- and middle-income countries: A cross-sectional study. Exp. Gerontol. 167, 111909. https:\/\/doi.org\/10.1016\/j.exger.2022.111909 (2022).","journal-title":"Exp. Gerontol."},{"key":"54397_CR4","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.genhosppsych.2016.09.008","volume":"43","author":"B Stubbs","year":"2016","unstructured":"Stubbs, B. et al. The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries. Gen. Hosp. Psychiatry. 43, 63\u201370. https:\/\/doi.org\/10.1016\/j.genhosppsych.2016.09.008 (2016).","journal-title":"Gen. Hosp. Psychiatry"},{"issue":"9","key":"54397_CR5","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1016\/j.jpain.2011.03.003","volume":"12","author":"K Kroenke","year":"2011","unstructured":"Kroenke, K. et al. Reciprocal Relationship Between Pain and Depression: A 12-Month Longitudinal Analysis in Primary Care. J. Pain. 12 (9), 964\u2013973. https:\/\/doi.org\/10.1016\/j.jpain.2011.03.003 (2011).","journal-title":"J. Pain"},{"key":"54397_CR6","unstructured":"Bundes\u00e4rztekammer (B\u00c4K) KBK, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Nicht-spezifischer Kreuzschmerz \u2013 Langfassung, 2. Auflage. Version 1. www.kreuzschmerz.versorgungsleitlinien.de (2017)."},{"key":"54397_CR7","doi-asserted-by":"crossref","unstructured":"Hayden, J., Van Tulder, M. W., Malmivaara, A. & Koes, B. W. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst. Rev. (3). (2005).","DOI":"10.1002\/14651858.CD000335.pub2"},{"key":"54397_CR8","doi-asserted-by":"publisher","first-page":"1613","DOI":"10.1007\/s00586-010-1412-z","volume":"19","author":"P Hendrick","year":"2010","unstructured":"Hendrick, P. et al. The effectiveness of walking as an intervention for low back pain: a systematic review. Eur. Spine J. 19, 1613\u20131620 (2010).","journal-title":"Eur. Spine J."},{"issue":"12","key":"54397_CR9","doi-asserted-by":"publisher","first-page":"e52082","DOI":"10.1371\/journal.pone.0052082","volume":"7","author":"XQ Wang","year":"2012","unstructured":"Wang, X. Q. et al. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One. 7 (12), e52082. https:\/\/doi.org\/10.1371\/journal.pone.0052082 (2012).","journal-title":"PLoS One"},{"issue":"4","key":"54397_CR10","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/j.jphys.2021.09.004","volume":"67","author":"JA Hayden","year":"2021","unstructured":"Hayden, J. A. et al. Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. J. physiotherapy. 67 (4), 252\u2013262. https:\/\/doi.org\/10.1016\/j.jphys.2021.09.004 (2021).","journal-title":"J. physiotherapy"},{"issue":"21","key":"54397_CR11","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1136\/bjsports-2019-100886","volume":"54","author":"PJ Owen","year":"2020","unstructured":"Owen, P. J. et al. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br. J. Sports Med. 54 (21), 1279\u20131287. https:\/\/doi.org\/10.1136\/bjsports-2019-100886 (2020).","journal-title":"Br. J. Sports Med."},{"issue":"1","key":"54397_CR12","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1186\/s12891-022-05722-x","volume":"23","author":"WJA Grooten","year":"2022","unstructured":"Grooten, W. J. A. et al. Summarizing the effects of different exercise types in chronic low back pain\u2013a systematic review of systematic reviews. BMC Musculoskelet. Disord. 23 (1), 801 (2022).","journal-title":"BMC Musculoskelet. Disord."},{"key":"54397_CR13","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.jpsychires.2016.02.023","volume":"77","author":"FB Schuch","year":"2016","unstructured":"Schuch, F. B. et al. Exercise as a treatment for depression: A meta-analysis adjusting for publication bias. J. Psychiatr. Res. 77, 42\u201351. https:\/\/doi.org\/10.1016\/j.jpsychires.2016.02.023 (2016).","journal-title":"J. Psychiatr. Res."},{"issue":"16","key":"54397_CR14","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1136\/bjsports-2022-106282","volume":"57","author":"A Heissel","year":"2023","unstructured":"Heissel, A. et al. Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression. Br. J. Sports Med. 57 (16), 1049\u20131057 (2023).","journal-title":"Br. J. Sports Med."},{"key":"54397_CR15","unstructured":"Bundes\u00e4rztekammer, B. \u00c4. K. KBK, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Unipolare Depression \u2013 Langfassung. https:\/\/register.awmf.org\/de\/leitlinien\/detail\/nvl-005 (2022)."},{"key":"54397_CR16","doi-asserted-by":"crossref","unstructured":"Fuhr, K., Fahse, B., Hautzinger, M. & Gulewitsch, M. D. Implementation of an Internet-based self-help for patients waiting for outpatient psychotherapy-first results. Psychother. Psychosomatik Med. Psychol. 68 (6), 234\u2009\u2013\u200941. (2018).","DOI":"10.1055\/s-0043-122241"},{"key":"54397_CR17","doi-asserted-by":"publisher","first-page":"100999","DOI":"10.1016\/j.arr.2019.100999","volume":"58","author":"KJ Miller","year":"2020","unstructured":"Miller, K. J. et al. Comparative effectiveness of three exercise types to treat clinical depression in older adults: A systematic review and network meta-analysis of randomised controlled trials. Ageing Res. Rev. 58, 100999. https:\/\/doi.org\/10.1016\/j.arr.2019.100999 (2020).","journal-title":"Ageing Res. Rev."},{"key":"54397_CR18","doi-asserted-by":"publisher","first-page":"705559","DOI":"10.3389\/fpsyt.2021.705559","volume":"12","author":"Y Xie","year":"2021","unstructured":"Xie, Y. et al. The Effects and Mechanisms of Exercise on the Treatment of Depression. Front. Psychiatry. 12, 705559. https:\/\/doi.org\/10.3389\/fpsyt.2021.705559 (2021).","journal-title":"Front. Psychiatry"},{"issue":"4","key":"54397_CR19","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1093\/pm\/pny128","volume":"20","author":"DS Oliveira","year":"2019","unstructured":"Oliveira, D. S., V\u00e9lia Ferreira Mendon\u00e7a, L., Sofia Monteiro Sampaio, R., Manuel Pereira Dias de Castro-Lopes, J. & Ribeiro de Azevedo, L. F. The Impact of Anxiety and Depression on the Outcomes of Chronic Low Back Pain Multidisciplinary Pain Management-A Multicenter Prospective Cohort Study in Pain Clinics with One-Year Follow-up. Pain Med. (Malden Mass). 20 (4), 736\u2013746. https:\/\/doi.org\/10.1093\/pm\/pny128 (2019).","journal-title":"Pain Med. (Malden Mass)"},{"issue":"1","key":"54397_CR20","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.spinee.2015.10.037","volume":"16","author":"MB Pinheiro","year":"2016","unstructured":"Pinheiro, M. B. et al. Symptoms of depression as a prognostic factor for low back pain: a systematic review. spine journal: official J. North. Am. Spine Soc. 16 (1), 105\u2013116. https:\/\/doi.org\/10.1016\/j.spinee.2015.10.037 (2016).","journal-title":"spine journal: official J. North. Am. Spine Soc."},{"issue":"4","key":"54397_CR21","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1136\/bjsports-2021-103987","volume":"56","author":"CL Ardern","year":"2022","unstructured":"Ardern, C. L. et al. Implementing the 27 PRISMA 2020 Statement items for systematic reviews in the sport and exercise medicine, musculoskeletal rehabilitation and sports science fields: the PERSiST (implementing Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science) guidance. Br. J. Sports Med. 56 (4), 175\u2013195 (2022).","journal-title":"Br. J. Sports Med."},{"key":"54397_CR22","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/1472-6947-7-16","volume":"7","author":"C Schardt","year":"2007","unstructured":"Schardt, C., Adams, M. B., Owens, T., Keitz, S. & Fontelo, P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med. Inf. Decis. Mak. 7, 16. https:\/\/doi.org\/10.1186\/1472-6947-7-16 (2007).","journal-title":"BMC Med. Inf. Decis. Mak."},{"issue":"1","key":"54397_CR23","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.berh.2006.08.004","volume":"21","author":"M Krismer","year":"2007","unstructured":"Krismer, M., van Tulder, M. & Low Back Pain Group of the B. Joint Health Strategies for Europe P. Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific). Best Pract. Res. Clin. Rheumatol. 21 (1), 77\u201391. https:\/\/doi.org\/10.1016\/j.berh.2006.08.004 (2007).","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"issue":"2","key":"54397_CR24","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1093\/occmed\/kqv087","volume":"66","author":"G Jackson-Koku","year":"2016","unstructured":"Jackson-Koku, G. Beck Depression Inventory. Occup. Med. (Lond). 66 (2), 174\u2013175. https:\/\/doi.org\/10.1093\/occmed\/kqv087 (2016).","journal-title":"Occup. Med. (Lond)"},{"issue":"7","key":"54397_CR25","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1080\/03007995.2017.1298521","volume":"33","author":"G Muller-Schwefe","year":"2017","unstructured":"Muller-Schwefe, G. et al. Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms. Curr. Med. Res. Opin. 33 (7), 1199\u20131210. https:\/\/doi.org\/10.1080\/03007995.2017.1298521 (2017).","journal-title":"Curr. Med. Res. Opin."},{"issue":"1","key":"54397_CR26","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1002\/ejp.721","volume":"20","author":"S Deckert","year":"2016","unstructured":"Deckert, S. et al. A systematic review of the outcomes reported in multimodal pain therapy for chronic pain. Eur. J. Pain. 20 (1), 51\u201363. https:\/\/doi.org\/10.1002\/ejp.721 (2016).","journal-title":"Eur. J. Pain"},{"key":"54397_CR27","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.jclinepi.2016.01.021","volume":"75","author":"J McGowan","year":"2016","unstructured":"McGowan, J. et al. PRESS peer review of electronic search strategies: 2015 guideline statement. J. Clin. Epidemiol. 75, 40\u201346 (2016).","journal-title":"J. Clin. Epidemiol."},{"key":"54397_CR28","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","volume":"366","author":"JAC Sterne","year":"2019","unstructured":"Sterne, J. A. C. et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366, l4898. https:\/\/doi.org\/10.1136\/bmj.l4898 (2019).","journal-title":"BMJ"},{"key":"54397_CR29","doi-asserted-by":"crossref","unstructured":"Deeks, J. J., Higgins, J. P., Altman, D. G. & Group, C. S. M. Analysing data and undertaking meta-analyses. Cochrane handbook for systematic reviews of interventions. :241\u2009\u2013\u200984. (2019).","DOI":"10.1002\/9781119536604.ch10"},{"issue":"2","key":"54397_CR30","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1136\/bmjebm-2020-111600","volume":"27","author":"MP Hengartner","year":"2022","unstructured":"Hengartner, M. P. & Ploderl, M. Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression. BMJ Evid. Based Med. 27 (2), 69\u201373. https:\/\/doi.org\/10.1136\/bmjebm-2020-111600 (2022).","journal-title":"BMJ Evid. Based Med."},{"key":"54397_CR31","doi-asserted-by":"crossref","unstructured":"Noetel, M. et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. bmj 384. (2024).","DOI":"10.1136\/bmj-2023-075847"},{"issue":"12","key":"54397_CR32","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.1016\/j.jclinepi.2013.02.018","volume":"66","author":"ML Ferreira","year":"2013","unstructured":"Ferreira, M. L. et al. The smallest worthwhile effect of nonsteroidal anti-inflammatory drugs and physiotherapy for chronic low back pain: a benefit harm trade-off study. J. Clin. Epidemiol. 66 (12), 1397\u20131404. https:\/\/doi.org\/10.1016\/j.jclinepi.2013.02.018 (2013).","journal-title":"J. Clin. Epidemiol."},{"issue":"2","key":"54397_CR33","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1002\/jrsm.1037","volume":"3","author":"G Salanti","year":"2012","unstructured":"Salanti, G. Indirect and mixed-treatment comparison, network, or multiple\u2010treatments meta\u2010analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool. Res. synthesis methods. 3 (2), 80\u201397 (2012).","journal-title":"Res. synthesis methods"},{"key":"54397_CR34","doi-asserted-by":"crossref","unstructured":"Belav\u00fd, D. L., Kaczorowski, S., Saueressig, T., Owen, P. J. & Nikolakopoulou, A. How to conduct and report checking transitivity and inconsistency in network-meta-analysis: a narrative review including practical worked examples, code and source data for sports and exercise medicine researchers. BMJ Open Sport Exerc. Med. 10 (4). (2024).","DOI":"10.1136\/bmjsem-2024-002262"},{"key":"54397_CR35","doi-asserted-by":"publisher","unstructured":"R\u00fccker, G. & Schwarzer, G. Ranking treatments in frequentist network meta-analysis works without resampling methods. BMC Med. Res. Methodol. 15 https:\/\/doi.org\/10.1186\/s12874-015-0060-8 (2015).","DOI":"10.1186\/s12874-015-0060-8"},{"issue":"7\u20138","key":"54397_CR36","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1002\/sim.3767","volume":"29","author":"S Dias","year":"2010","unstructured":"Dias, S., Welton, N. J., Caldwell, D. M. & Ades, A. E. Checking consistency in mixed treatment comparison meta-analysis. Stat. Med. 29 (7\u20138), 932\u2013944. https:\/\/doi.org\/10.1002\/sim.3767 (2010).","journal-title":"Stat. Med."},{"issue":"7109","key":"54397_CR37","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","volume":"315","author":"M Egger","year":"1997","unstructured":"Egger, M., Davey Smith, G., Schneider, M. & Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ 315 (7109), 629\u2013634. https:\/\/doi.org\/10.1136\/bmj.315.7109.629 (1997).","journal-title":"BMJ"},{"issue":"9","key":"54397_CR38","doi-asserted-by":"publisher","first-page":"1274","DOI":"10.6061\/clinics\/2013(09)15","volume":"68","author":"Y-P Wang","year":"2013","unstructured":"Wang, Y-P. & Gorenstein, C. Assessment of depression in medical patients: a systematic review of the utility of the Beck Depression Inventory-II. Clinics 68 (9), 1274\u20131287 (2013).","journal-title":"Clinics"},{"key":"54397_CR39","doi-asserted-by":"publisher","first-page":"1466","DOI":"10.3389\/fpsyg.2016.01466","volume":"7","author":"AM Boonstra","year":"2016","unstructured":"Boonstra, A. M. et al. Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing. Front. Psychol. 7, 1466 (2016).","journal-title":"Front. Psychol."},{"issue":"7","key":"54397_CR40","doi-asserted-by":"publisher","first-page":"e99682","DOI":"10.1371\/journal.pone.0099682","volume":"9","author":"G Salanti","year":"2014","unstructured":"Salanti, G., Del Giovane, C., Chaimani, A., Caldwell, D. M. & Higgins, J. P. Evaluating the quality of evidence from a network meta-analysis. PLoS One. 9 (7), e99682. https:\/\/doi.org\/10.1371\/journal.pone.0099682 (2014).","journal-title":"PLoS One"},{"issue":"20","key":"54397_CR41","doi-asserted-by":"publisher","first-page":"2099","DOI":"10.1001\/jama.2009.723","volume":"301","author":"K Kroenke","year":"2009","unstructured":"Kroenke, K. et al. Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: A randomized controlled trial. JAMA: J. Am. Med. Association. 301 (20), 2099\u20132110. https:\/\/doi.org\/10.1001\/jama.2009.723 (2009).","journal-title":"JAMA: J. Am. Med. Association"},{"issue":"4","key":"54397_CR42","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1080\/10503307.2015.1040485","volume":"26","author":"SJ Waters","year":"2016","unstructured":"Waters, S. J. et al. Self-system therapy for distress associated with persistent low back pain: A randomized clinical trial. Psychother. Res. 26 (4), 472\u2013483. https:\/\/doi.org\/10.1080\/10503307.2015.1040485 (2016).","journal-title":"Psychother. Res."},{"issue":"8","key":"54397_CR43","doi-asserted-by":"publisher","first-page":"1522","DOI":"10.1016\/j.jpain.2023.04.008","volume":"24","author":"JP Sanabria-Mazo","year":"2023","unstructured":"Sanabria-Mazo JP et al. Efficacy of Videoconference Group Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) for Chronic Low Back Pain (CLBP) Plus Comorbid Depressive Symptoms: A Randomized Controlled Trial (IMPACT Study). J. Pain. 24 (8), 1522\u20131540. https:\/\/doi.org\/10.1016\/j.jpain.2023.04.008 (2023).","journal-title":"J. Pain"},{"issue":"4","key":"54397_CR44","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1159\/000511881","volume":"90","author":"H Baumeister","year":"2021","unstructured":"Baumeister, H. et al. Effectiveness of a guided internet- and mobile-based intervention for patients with chronic back pain and depression (WARD-BP): A multicenter, pragmatic randomized controlled trial. Psychother. Psychosom. 90 (4), 255\u2013268. https:\/\/doi.org\/10.1159\/000511881 (2021).","journal-title":"Psychother. Psychosom."},{"key":"54397_CR45","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1016\/j.ctcp.2018.03.008","volume":"31","author":"G Kuva\u010di\u0107","year":"2018","unstructured":"Kuva\u010di\u0107, G., Fratini, P., Padulo, J., Antonio, D. I. & De Giorgio, A. Effectiveness of yoga and educational intervention on disability, anxiety, depression, and pain in people with CLBP: A randomized controlled trial. Complement. Ther. Clin. Pract. 31, 262\u2013267 (2018).","journal-title":"Complement. Ther. Clin. Pract."},{"issue":"6","key":"54397_CR46","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1016\/j.genhosppsych.2007.08.005","volume":"29","author":"K Kroenke","year":"2007","unstructured":"Kroenke, K. et al. Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study: Design and practical implications of an intervention for comorbid pain and depression. Gen. Hosp. Psychiatry. 29 (6), 506\u2013517. https:\/\/doi.org\/10.1016\/j.genhosppsych.2007.08.005 (2007).","journal-title":"Gen. Hosp. Psychiatry"},{"key":"54397_CR47","doi-asserted-by":"publisher","unstructured":"Sander, L. et al. Effectiveness and cost-effectiveness of a guided Internet- and mobile-based intervention for the indicated prevention of major depression in patients with chronic back pain\u2014study protocol of the PROD-BP multicenter pragmatic RCT. BMC Psychiatry 17. https:\/\/doi.org\/10.1186\/s12888-017-1193-6 (2017).","DOI":"10.1186\/s12888-017-1193-6"},{"issue":"12","key":"54397_CR48","doi-asserted-by":"publisher","first-page":"e015226","DOI":"10.1136\/bmjopen-2016-015226","volume":"7","author":"J Lin","year":"2017","unstructured":"Lin, J. et al. Effectiveness and cost-effectiveness of a guided internet- and mobile-based depression intervention for individuals with chronic back pain: protocol of a multi-centre randomised controlled trial. BMJ Open. 7 (12), e015226. https:\/\/doi.org\/10.1136\/bmjopen-2016-015226 (2017).","journal-title":"BMJ Open."},{"issue":"1","key":"54397_CR49","first-page":"1","volume":"3","author":"DG Chang","year":"2016","unstructured":"Chang, D. G., Holt, J. A., Sklar, M. & Groessl, E. J. Yoga as a treatment for chronic low back pain: A systematic review of the literature. J. Orthop. Rheumatol. 3 (1), 1 (2016).","journal-title":"J. Orthop. Rheumatol."},{"issue":"10128","key":"54397_CR50","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1016\/S0140-6736(17)32802-7","volume":"391","author":"A Cipriani","year":"2018","unstructured":"Cipriani, A. et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet 391 (10128), 1357\u20131366 (2018).","journal-title":"Lancet"},{"issue":"3","key":"54397_CR51","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1080\/10790268.2018.1523776","volume":"43","author":"L Cadel","year":"2020","unstructured":"Cadel, L. et al. Self-management of pain and depression in adults with spinal cord injury: A scoping review. J. Spinal Cord Med. 43 (3), 280\u2013297. https:\/\/doi.org\/10.1080\/10790268.2018.1523776 (2020).","journal-title":"J. Spinal Cord Med."},{"key":"54397_CR52","doi-asserted-by":"crossref","unstructured":"Uphoff, E. et al. Behavioural activation therapy for depression in adults. Cochrane Database Syst. Rev. (7). (2020).","DOI":"10.1002\/14651858.CD013305.pub2"},{"issue":"5","key":"54397_CR53","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1097\/AJP.0b013e31825e1492","volume":"29","author":"H Cramer","year":"2013","unstructured":"Cramer, H., Lauche, R., Haller, H. & Dobos, G. A systematic review and meta-analysis of yoga for low back pain. Clin. J. Pain. 29 (5), 450\u2013460 (2013).","journal-title":"Clin. J. Pain"},{"issue":"1","key":"54397_CR54","doi-asserted-by":"publisher","first-page":"CD001703","DOI":"10.1002\/14651858.CD001703.pub3","volume":"2008","author":"DM Urquhart","year":"2008","unstructured":"Urquhart, D. M., Hoving, J. L., Assendelft, W. W., Roland, M. & van Tulder, M. W. Antidepressants for non-specific low back pain. Cochrane Database Syst. Rev. 2008 (1), CD001703. https:\/\/doi.org\/10.1002\/14651858.CD001703.pub3 (2008).","journal-title":"Cochrane Database Syst. Rev."},{"issue":"1","key":"54397_CR55","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1186\/s13643-021-01599-4","volume":"10","author":"MC Ferraro","year":"2021","unstructured":"Ferraro, M. C. et al. Efficacy, acceptability, and safety of antidepressants for low back pain: a systematic review and meta-analysis. Syst. Rev. 10 (1), 62. https:\/\/doi.org\/10.1186\/s13643-021-01599-4 (2021).","journal-title":"Syst. Rev."},{"issue":"22","key":"54397_CR56","doi-asserted-by":"publisher","first-page":"2540","DOI":"10.1097\/01.BRS.0000092372.73527.BA","volume":"28","author":"TO Staiger","year":"2003","unstructured":"Staiger, T. O., Gaster, B., Sullivan, M. D. & Deyo, R. A. Systematic review of antidepressants in the treatment of chronic low back pain. Spine (Phila Pa. 1976). 28 (22), 2540\u20132545. https:\/\/doi.org\/10.1097\/01.BRS.0000092372.73527.BA (2003).","journal-title":"Spine (Phila Pa. 1976)"},{"key":"54397_CR57","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.psychres.2016.04.054","volume":"241","author":"FB Schuch","year":"2016","unstructured":"Schuch, F. B. et al. Exercise improves physical and psychological quality of life in people with depression: A meta-analysis including the evaluation of control group response. Psychiatry Res. 241, 47\u201354 (2016).","journal-title":"Psychiatry Res."},{"issue":"1","key":"54397_CR58","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15171\/hpp.2019.01","volume":"9","author":"PD Hart","year":"2019","unstructured":"Hart, P. D. & Buck, D. J. The effect of resistance training on health-related quality of life in older adults: Systematic review and meta-analysis. Health Promot Perspect. 9 (1), 1\u201312. https:\/\/doi.org\/10.15171\/hpp.2019.01 (2019).","journal-title":"Health Promot Perspect."},{"issue":"2","key":"54397_CR59","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.sjpain.2011.01.005","volume":"2","author":"SJ Linton","year":"2011","unstructured":"Linton, S. J. & Bergbom, S. Understanding the link between depression and pain. Scandinavian J. Pain. 2 (2), 47\u201354 (2011).","journal-title":"Scandinavian J. Pain"},{"issue":"13","key":"54397_CR60","doi-asserted-by":"publisher","first-page":"5031","DOI":"10.2741\/3585","volume":"14","author":"MJ Robinson","year":"2009","unstructured":"Robinson, M. J. et al. Depression and pain. Front. Biosci. (Landmark Ed). 14 (13), 5031\u20135051. https:\/\/doi.org\/10.2741\/3585 (2009).","journal-title":"Front. Biosci. (Landmark Ed)"},{"issue":"7","key":"54397_CR61","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1161\/CIRCULATIONAHA.113.001590","volume":"129","author":"GC Rowe","year":"2014","unstructured":"Rowe, G. C., Safdar, A. & Arany, Z. Running forward: new frontiers in endurance exercise biology. Circulation 129 (7), 798\u2013810 (2014).","journal-title":"Circulation"},{"key":"54397_CR62","doi-asserted-by":"publisher","first-page":"102307","DOI":"10.1016\/j.msksp.2020.102307","volume":"51","author":"A Wun","year":"2021","unstructured":"Wun, A. et al. Why is exercise prescribed for people with chronic low back pain? A review of the mechanisms of benefit proposed by clinical trialists. Musculoskelet. Sci. Pract. 51, 102307 (2021).","journal-title":"Musculoskelet. Sci. Pract."},{"issue":"1","key":"54397_CR63","first-page":"130818","volume":"2013","author":"KJ Sherman","year":"2013","unstructured":"Sherman, K. J., Wellman, R. D., Cook, A. J., Cherkin, D. C. & Ceballos, R. M. Mediators of yoga and stretching for chronic low back pain. Evidence-Based Complement. Altern. Med. 2013 (1), 130818 (2013).","journal-title":"Evidence-Based Complement. Altern. Med."},{"issue":"4","key":"54397_CR64","doi-asserted-by":"publisher","first-page":"e10698","DOI":"10.2196\/10698","volume":"5","author":"N Haller","year":"2018","unstructured":"Haller, N. et al. Individualized Web-Based Exercise for the Treatment of Depression: Randomized Controlled Trial. JMIR Ment Health. 5 (4), e10698. https:\/\/doi.org\/10.2196\/10698 (2018).","journal-title":"JMIR Ment Health"},{"issue":"3","key":"54397_CR65","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1097\/01.pra.0000430504.16952.3e","volume":"19","author":"CD Rethorst","year":"2013","unstructured":"Rethorst, C. D. & Trivedi, M. H. Evidence-based recommendations for the prescription of exercise for major depressive disorder. J. Psychiatr Pract. 19 (3), 204\u2013212. https:\/\/doi.org\/10.1097\/01.pra.0000430504.16952.3e (2013).","journal-title":"J. Psychiatr Pract."},{"key":"54397_CR66","doi-asserted-by":"publisher","first-page":"305","DOI":"10.3389\/fpsyt.2018.00305","volume":"9","author":"L Nebiker","year":"2018","unstructured":"Nebiker, L. et al. Moderating Effects of Exercise Duration and Intensity in Neuromuscular vs. Endurance Exercise Interventions for the Treatment of Depression: A Meta-Analytical Review. Front. Psychiatry. 9, 305. https:\/\/doi.org\/10.3389\/fpsyt.2018.00305 (2018).","journal-title":"Front. Psychiatry"},{"key":"54397_CR67","doi-asserted-by":"publisher","first-page":"102199","DOI":"10.1016\/j.msksp.2020.102199","volume":"49","author":"Y M\u00fchlhauser","year":"2020","unstructured":"M\u00fchlhauser, Y., Vogt, L. & Niederer, D. How and how fast does pain lead to disability? A multilevel mediation analysis on structural, temporal and biopsychosocial pathways in patients with chronic nonspecific low back pain. Musculoskelet. Sci. Pract. 49, 102199. https:\/\/doi.org\/10.1016\/j.msksp.2020.102199 (2020).","journal-title":"Musculoskelet. Sci. Pract."},{"issue":"4","key":"54397_CR68","doi-asserted-by":"publisher","first-page":"e0294830","DOI":"10.1371\/journal.pone.0294830","volume":"19","author":"M Dunn","year":"2024","unstructured":"Dunn, M., Rushton, A. B., Mistry, J., Soundy, A. & Heneghan, N. R. The biopsychosocial factors associated with development of chronic musculoskeletal pain. An umbrella review and meta-analysis of observational systematic reviews. PLoS One. 19 (4), e0294830. https:\/\/doi.org\/10.1371\/journal.pone.0294830 (2024).","journal-title":"PLoS One"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54397-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54397-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54397-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:49:22Z","timestamp":1780487362000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54397-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":68,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["54397"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-54397-0","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,3]]},"assertion":[{"value":"20 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This systematic review with network meta-analysis was performed with an a priori defined protocol which is published in the PROSPERO database (ID: CRD42024523604).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study pre-registration statement"}},{"value":"Secondary analyses; all relevant studies were included irrespective of the study population. Among the five authors, only one is female (not balanced). The distribution is balanced and consists of junior and senior researchers. All authors are from Germany.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Equity, diversity, and inclusion statement"}}],"article-number":"17155"}}