Effects of Physical Activity or Exercise on Depressive Symptoms and Self-Esteem in Older Adults: A Systematic Review

Abstract

There is a high prevalence of depression in older adults, and it is on the rise. However, exercise or physical activity can help improve mental health conditions, specifically depression and self-esteem. Therefore, the objective of this systematic review (INPLASY202360094) is to describe and analyze the effects of physical activity or exercise interventions on depressive symptoms and self-esteem in older adults. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a search strategy was carried out in four databases (PubMed, SciELO, WoS, and Scopus). Inclusion criteria: Studies that used physical activity or exercise as an intervention to improve depressive symptoms and self-esteem in older adults. The Physiotherapy Evidence Database scale and the Risk of Bias 2 tool were used to evaluate the quality of the articles. To synthesize the information from the studies, it was ordered based on author names, intervention, frequency, analysis, and results. Seven investigations met the selection criteria. It is concluded that physical activity or exercise improves self-esteem, depression, anxiety, physical fitness, and functionality in older adults. Therefore, it is a viable option for additional or complementary treatment aimed at achieving a comprehensive improvement in the lives of this population.

1. Introduction

The International Psychogeriatric Association (IPA) established a consensus classification for older adults: persons between the ages of 55 and 64 years are considered as young older adults; persons between the ages of 65 and 74 years are considered as mature older adults; persons between the ages of 75 and 84 years are considered older adults; and persons older than 85 years are considered as elderly, nonagenarians, and centenarians [1]. However, at present, the concept of older adults is established from the age of 60 years [2].

Globally, the population of older adults has been increasing over several decades; it is estimated that the number of people over 60 years of age will increase from 1 billion in 2020 to 1.4 billion by 2030 [3]. As the years go by, older adults experience physical and mental deterioration [4]. Within the field of mental health, depression is a very present problem in the world today, affecting 5% of the adult population and 5.7% of older adults [5]. In Latin America, depressed older adults have a 44% risk of death compared to those who do not have the condition [6]. In Chile, one in five people over 60 years of age suffer from depression, dementia, or another condition that may affect mental health, thoughts, feelings, emotions, mood, or behavior [7].

In older adults, a relationship has been found between self-esteem, anxiety, and depression [8]. Throughout the literature, a significant and negative relationship has been found between levels of self-esteem and psychopathological symptoms, such as depressive symptoms [9]. In older adults, lower self-esteem is associated with higher levels of depression [8], potentially leading the person to commit suicide [5]. However, these neuropsychiatric diseases are modifiable through the development of healthy habits, focusing on the future, maintaining family ties, and staying physically active, among others [10]. Currently, international recommendations highlight the benefits of physical activity and structured exercise as therapeutic and preventative interventions for addressing the needs of the elderly. These recommendations pertain to muscle function, functional capacity, mobility, mental health, quality of life, and other factors that facilitate their complete autonomy in participating in activities aligned with their personal or social motivations aimed at disease prevention and health promotion [11].

Physical activity (PA) is a term that requires attention from educators, researchers, and policy developers because its definition is related to the development of movements that are performed by the body (musculoskeletal system) at different intensities and related to the needs and interests of individuals, which may be oriented towards activities of daily living, social participation, mobility or health, among others [12]. It has been shown that the practice of PA demonstrates a reduction in mild cognitive impairment in those who practice it, producing improvements in the psychological health of people [13]. Also, international recommendations for exercise for older adults mention that the practice of PA and structured exercise can be used as strategies to prevent chronic diseases, improve mental health, reduce mortality, and other benefits that allow functional improvements in older people [14]. In addition, the World Health Organization suggests that older adults perform various PAs and multicomponent activities, with an emphasis on functional work, strength, and balance for the prevention of falls [15].

On the other hand, there is evidence of specific physical exercise interventions, which are structured, planned, and repetitive, considering volume, intensity, speed of execution, pauses, and workloads with a specific objective to obtain physical condition benefits, either for its development or maintenance [16]. From this point of view, aquatic exercise allows for improvements in cognitive function, mood, and quality of life in older adults [17]. Similarly, it has been shown that supervised and structured exercise facilitates a reduction in depressive symptoms, having similar effects to antidepressant drugs [18,19]. From this point of view, it is possible to consider exercise as a non-pharmacological tool that can contribute to the modulation of cognitive deterioration related to the aging process in older adults [20]. This is because it has been proven that, after performing exercise for 12 weeks, there is a significant reduction in depressive symptoms in both young and older adults [21]. On the other hand, a study conducted in older adult women with increased body mass showed that exercise and a balanced diet facilitate a reduction in body weight and positively influence levels of self-esteem [22]. In relation to the above, the present research aims to describe and analyze the effects of physical activity or exercise interventions on depressive symptoms and self-esteem in older adults through the evidence present in the scientific literature.

2. Materials and Methods

2.1. Search Strategy for Item Identification

The development of the present systematic review registered in INPLASY (Code: INPLASY202360094) was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guide [23] (Supplementary Table S1). When searching for articles, the following databases were used: PubMed, SciELO, WoS, and Scopus. A research question was established through the PICO strategy to identify keywords [24]. Subsequently, the following keywords and the use of the following Boolean operators were identified: “Older adults” OR “Elderly” AND “Physical activity” OR “Physical Exercise” AND “Depression” AND “Self-esteem” (

Table 1. Search strategy.

Key Words	PubMed	SciELO	WoS	Scopus
“Older adults” OR “Elderly” AND “Physical activity” OR “Physical Exercise” AND “Depression” AND “Self-esteem”	52	01	66	37

Own elaboration.

).

2.2. Selection Criteria

Using keywords and their respective Boolean operators and through the four databases, the search for information was carried out on 14 March 2024. The search considered articles up to July 2023. Inclusion criteria were (a) older adults; (b) randomized controlled trials (RCTs), pre-experimental trials, or quasi-experimental clinical trials that used exercise or physical activity interventions; and (c) articles published in English and Spanish. Exclusion criteria were (a) review papers, letters from editors, meta-analysis, and book chapters, and (b) subjects younger than 60 years of age (Figure 1).

2.3. Data Extraction and Quality Assessment

Based on the selection criteria, the investigators independently reviewed and selected the articles (M.M.P., F.M.-V., C.F.-V. and P.F.H.). In the case of differences, a third researcher (A.C.-P.) acted as a mediator for inclusion or exclusion criteria, as appropriate.

The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of research articles [25,26,27]. This instrument comprises 10 criteria for assessing internal validity by statistical analysis, allowing for the allocation of one point for each criterion met, while non-compliance results in a score of zero. This instrument scores criteria from 2 to 11, classifying articles as excellent (9 to 10 points), good (6 to 8 points), fair (4 to 5 points), and low (1 to 3 points) (Table 2). These scores are determined by three criteria: selection (maximum of three points), comparability (maximum of three points), and results (maximum of four points).

The Cochrane Risk of Bias (RoB-2) tool (ROB2_IRPG_beta_v9) [28] facilitates the evaluation of each research article through ten domains and an overall assessment, which is related to the randomization process, deviations from intended interventions, missing outcome data, outcome measurement, and selection of reported and overall outcomes. Finally, all articles are classified as having “some concerns” or a “low” or “high” risk of bias.

Table 2. Methodological analysis of the articles using the PEDro scale.

Authors	1	2	3	4	5	6	7	8	9	10	11	Total
Aguiñaga et al. [29]	Yes	Yes	No	Yes	No	No	No	Yes	Yes	Yes	Yes	6
Araque-Martínez et al. [30]	Yes	No	No	No	No	No	No	Yes	Yes	Yes	Yes	4
Borbón-Castro et al. [31]	Yes	No	No	Yes	No	No	No	Yes	Yes	Yes	Yes	5
Blumenthal et al. [32]	Yes	Yes	No	Yes	No	No	No	Yes	Yes	Yes	Yes	6
Escolar and De Guzman [33]	Yes	Yes	No	Yes	No	No	No	Yes	Yes	Yes	Yes	6
Motl et al. [34]	Yes	Yes	No	Yes	No	No	No	Yes	Yes	Yes	Yes	6
Sung [35]	Yes	Yes	No	Yes	No	No	No	Yes	Yes	Yes	Yes	6

Table 2. Methodological analysis of the articles using the PEDro scale.

Authors	1	2	3	4	5	6	7	8	9	10	11	Total
Aguiñaga et al. [29]	Yes	Yes	No	Yes	No	No	No	Yes	Yes	Yes	Yes	6
Araque-Martínez et al. [30]	Yes	No	No	No	No	No	No	Yes	Yes	Yes	Yes	4
Borbón-Castro et al. [31]	Yes	No	No	Yes	No	No	No	Yes	Yes	Yes	Yes	5
Blumenthal et al. [32]	Yes	Yes	No	Yes	No	No	No	Yes	Yes	Yes	Yes	6
Escolar and De Guzman [33]	Yes	Yes	No	Yes	No	No	No	Yes	Yes	Yes	Yes	6
Motl et al. [34]	Yes	Yes	No	Yes	No	No	No	Yes	Yes	Yes	Yes	6
Sung [35]	Yes	Yes	No	Yes	No	No	No	Yes	Yes	Yes	Yes	6

2.4. Summary of Information

The data from the selected articles were summarized in two tables. The first table considers the author, population, objective, and duration of the intervention. The second considers the intervention, the frequency of the sessions, the evaluation instrument, and the main results obtained.

3. Results

3.1. Study Selection

After the first search, 156 results were found in the PubMed, SciELO, WoS, and Scopus databases; 30 articles were discarded because they were duplicates, leaving 126 articles. After reading the titles and abstracts, 117 of the articles were eliminated, leaving 9, of which 2 were eliminated by inclusion and exclusion criteria for the following reasons: 1 for not addressing one of the variables and 1 for not including the intervention, leaving 7 articles selected for this systematic review (Figure 1).

3.2. PEDro Scale

The PEDro scale was performed in the seven articles included; two articles obtained fair methodological quality, and five had good methodological quality.

PEDro scale: Detailed selection criteria and items excluded from the total (first); randomization of participants into groups (second); concealed allocation (third); groups similar to key predictors (fourth); participants entirely blinded (fifth); all therapists blinded (sixth); at least one relevant outcome measured in blinded participants (seventh); 85% of outcomes classified as key outcomes (eighth); at least one key outcome for intervention participants was reported (ninth); at least one key outcome from statistical comparisons between groups (tenth); and at least one main outcome of the intervention obtained through point measures and variability (eleventh).

3.3. Risk of Bias

The risk of bias in the included studies is presented in Figure 2. Regarding the selected studies, these seven had a high risk of bias. Furthermore, the percentages derived from the studies for each domain regarding the assessed items classified as low risk, moderate concerns, or high risk are illustrated in Figure 3.

3.4. Characteristics of the Studies

A total of seven research articles performed multicomponent training interventions encompassing multidimensional exercise, walking, flexibility, and muscle strength activities (

Table 3. Summary of selected articles.

Authors	Subjects	Study Design/Objective	Duration of the Intervention
Aguiñaga et al. [29]	A total of 307 older adults. FTB group (113 women and 45 men) and control group (123 women and 26 men).	Quasi-experimental: To examine the effect of a DVD-delivered exercise intervention on secondary outcomes of depression and anxiety in older adults and the extent to which physical self-esteem mediated the relationship between leisure-time physical activity and depression and anxiety.	6 months
Araque-Martínez et al. [30]	A total of 70 older adults (65 women and 5 men).	Pre-experimental: To analyze the effects of a multicomponent exercise program on physical fitness, self-esteem, anxiety, and depression in older adults.	8 months
Borbón-Castro et al. [31]	A total of 45 older adults (22 in the control group and 23 in the experimental group).	Quasi-experimental: To investigate the effects of participation in a 12-week multidimensional exercise program on the health behavior and psychological factors of older adults living in northeastern Mexico.	12 weeks
Blumenthal et al. [32]	A total of 156 men and women (exercise group: 53; antidepressant medication group: 48; exercise and medication group: 55).	Randomized controlled trial: To evaluate the effectiveness of an aerobic exercise program compared with standard medication for the treatment of major depressive disorders in older adults.	16 weeks
Escolar and De Guzman [33]	A total of 40 older adults (15 older adults in the control group and 25 older adults in the experimental group).	Quasi-experimental: To assess the effectiveness of community-based learning programs for the elderly on life satisfaction, self-esteem, and depression level of a selected group of elderly Filipinos in a community setting.	4 months
Motl et al. [34]	A total of 174 men and women (walking group: 85 seniors; muscle-strengthening group: 89 seniors).	Randomized controlled trial: To evaluate the effectiveness of an exercise intervention for the sustained reduction in depressive symptoms among sedentary older adults and physical self-esteem as a potential mediator of this effect.	6 months
Sung [35]	A total of 37 women > 65 years (16 women aged 65 to 75 years and 21 women > 75 years).	Randomized controlled trial: To compare the effects of a 16-week group exercise program on physical function and mental health of older women with younger older women.	16 weeks

). In addition, regarding depression diagnoses, the study by Aguiñaga et al. [29] indicated that the recruitment criteria and other study variables were explained by two previously cited studies. Those studies revealed that participants were assessed via telephone to determine cognitive impairment using the Telephone Interview of Cognitive Status (TICS-M) comprising 13 items. Conversely, the research conducted by Araque-Martínez et al. [30] did not provide confirmation of the participant’s condition. In the study by Borbón-Castro et al. [31], an interview was conducted with participants to verify compliance with the selection criteria, with the authorization of each participant’s personal physician; the Geriatric Depression Scale (GDS-15) was used to assess the presence of depressive symptoms. Blumenthal et al. [32] used the HAM-D test to confirm and quantify the severity of depression, Escolar and De Guzman [33] used the Geriatric Depression Scale Short Form (GDS-SF), a 15-item self-report assessment, along with the Rosenberg Self-Esteem Scale (RSES) to assess self-esteem, as did Motl et al. [34] and Sung [35]. Depressive symptoms were assessed using the 30-item Geriatric Depression Scale (GDS).

Table 4. Summary of the interventions carried out.

Authors	Intervention	Frequency	Analysis	Results
Aguiñaga et al. [29]	Physical exercise through DVDs (FlexToBa).	No mention of weekly frequency.	HADS; Godin’s Leisure Time; Exercise Questionnaire; PSW.	Self-esteem ↑ Depression ↓ Anxiety ↓
Araque-Martínez et al. [30]	Tasks designed to work on physical, cognitive, and/or emotional levels through movement.	Two sessions of 1 h per week.	SFT; Test de Rosenberg; HADS.	Fitness ↑ Self-esteem ↑ Anxiety ↓ Depression ↓
Borbón-Castro et al. [31]	An exercise program based on improving aerobic capacity, muscular strength, speed, agility, flexibility, and coordination.	Five days a week for 1 h.	GDS-15; Test de Rosenberg.	Self-esteem ↑ Depression ↓
Blumenthal et al. [32]	A treadmill walking or jogging program.	Three days a week for 50 min.	HAM-D test; Rosenberg test; BDI test; Aerobic capacity.	Depression ↓ Self-esteem ↑ Anxiety ↓ Aerobic capacity ↑
Escolar and De Guzman [33]	A physical conditioning program based on muscular strength and cardiovascular endurance.	One session per week lasting between 30 and 40 min.	Test de Rosenberg; GDS-15; LSITA-SF test.	Depression ↓ Self-esteem ↑ Level of life satisfaction ↑
Motl et al. [34]	A walking program focused on cardiovascular endurance or muscular flexibility and strength.	Three times per week, from 10 min to 45 min.	GDS-15; PSPP.	Depression ↓ Self-esteem ↑
Sung [35]	A functional exercise program combined with health education.	Three times a week for 40 min.	Rosenberg Test; GDS-15; Sit And Reach Test; Standing on one leg with eyes open and closed (balance); Sitting and standing on a chair for 30 s.	Functionality ↑ Flexibility ↑ Strength ↑ Self-esteem ↑ Depression ↔

Own elaboration. Acronyms: HADS—The Hospital Anxiety and Depression Scale; PSW—physical self-worth; SFT—Senior Fitness Test; GDS-15—Geriatric Depression Scale; LSITA-SF—Life Satisfaction Index for the third age-short form; PSPP—physical self-perception profile. ↑—Significant increase; ↓—significant decrease; ↔—no significant change; DVD—digital video disk.

summarizes the intervention, training frequency, analysis method, and results.

3.5. Description of Results

In Aguiñaga et al.’s study [29], participants were divided into two groups: the intervention group, which performed the exercise with a DVD, and the control group, which watched a healthy aging DVD. The DVD includes an exercise program called “FlexToBa”, which includes exercises for flexibility, toning, and balance. The sessions included on the DVD are composed of two sets of 11 to 12 different exercises; all sessions include a warm-up and a cool-down. The sessions should be performed three times a week, non-consecutively, and are guided by a recorded specialist. Among the exercises used are bicep curls with an elastic band, a one-legged chair stand, a shoulder press, and a triceps extension. Assessments were conducted at the beginning and end of the program (HADS, Godin’s Leisure Time Exercise Questionnaire, and PSW), where it was concluded that a physical activity intervention performed at home could improve symptoms of depression and anxiety in older adults with elevated levels of depression and anxiety.

The research conducted by Araque-Martínez et al. [30] developed a multicomponent training program for eight months. Weekly, two sessions of 60 min each were carried out, where activities were developed to work at a physical, cognitive, and/or emotional level through movement. The activities were oriented toward working on strength resistance, aerobics, coordination, flexibility, and/or balance. In addition, the Rosenberg Test (Self-Esteem)—The Hospital Anxiety and Depression Scale (HAD), and the Senior Fitness Test (SFT) were used. The researchers pointed out that the development of multicomponent exercise interventions allows improvements in self-esteem and a decrease in depressive symptoms.

In addition, Borbón-Castro et al. [31] developed a multidimensional exercise program for 12 weeks (60 sessions in total, distributed over 5 days a week). Each session was a duration of 60 min (10 min of warm-up, 40 min of exercises, and 10 min of return to calm). Each session was divided into six modules (identified with letters) with an increase in intensity every two weeks. The exercises were aimed at producing improvements in the participants’ aerobic capacity, muscular strength, speed, agility, flexibility, and coordination. In addition, activities for the development of cognitive function (twice a week) were applied to improve memory. The tests used were anthropometry (BMI), nutritional status (mini nutritional assessment—MNA), blood profiles (HDL, LDL, VLDL, HbA1c), blood pressure, depressive symptoms (GDS-15), self-esteem (Rosenberg Self-Esteem Scale), physical activity level (CAFAM), sociodemographic survey, and socioeconomic level (AMAI). The researchers pointed out that the development of a multidimensional exercise program allows improvements in self-esteem and a decrease in depressive symptoms.

Similarly, the research developed by Blumenthal et al. [32] carried out an exercise program for 16 weeks (three sessions per week). Each session consisted of a 10 min warm-up, 30 min of continuous walking or jogging with an intensity of 70% to 85% of the heart rate reserve, and 5 min of return to calm. In addition, the HAM-D scale and BDI (depression), additional psychometric measures (State-Trait Anxiety Inventory, Rosenberg Self-Esteem Scale, Life Satisfaction Index, and Dysfunctional Attitudes Scale), and assessments to measure aerobic capacity (modified Balke protocol) were used. The researchers concluded that the development of an aerobic exercise program is feasible and effective for a decrease in depression. In terms of self-esteem, there were no significant changes.

In addition, Escolar Chua and De Guzman [33] developed three programs: the first one was related to wellness, the second one was a physical conditioning activity, and the third one was a livelihood training program. Regarding the second program, which lasted two months, 30 and 40 min sessions of physical conditioning were introduced. Prior to the development of the activities, muscular strength and cardiovascular endurance were evaluated. In addition, the instruments used were the Life Satisfaction Index for the Elderly (LSITA-SF), the Rosenberg Self-Esteem Scale (RSES), and the Geriatric Depression Scale (GDS). The researchers concluded that there were positive results in self-esteem and a decrease in depression. However, the active participation of this age group in programs of physical activity, cognitive learning, recreation, and social interaction can improve the psychological and psychosocial health of individuals.

As for the research developed by Motl et al. [34], the participants were divided into two groups: one was a walking group focused on aerobics, and the other focused on muscle toning, i.e., muscular resistance training. The program for the resistance training group included low-intensity resistance exercises based on a set of 8 to 12 repetitions per major muscle, using elastic bands to provide resistance. In addition, flexibility exercises were performed for all major muscle groups, where maintenance was sought to the point of causing slight muscle discomfort for 20 to 30 s between 5 and 10 sets. The walking group program consisted of 10 to 15 mins of walking and progressively increased per session until participants exercised between 40 and 45 min per session. Two tests were performed to evaluate the GDS-15 and the PSPP. In addition to the final evaluation, measurements were made at 6 months, 12 months, and 60 months after the intervention, where they conclude that physical training helps in the sustained reduction in depressive symptoms among non-depressed older adults and physical self-esteem as an important factor underlying changes in depressive symptoms in older adults.

On the other hand, in Sung’s [35] intervention, the experimental group participated in a program based on two parts, one on health education and the other on physical exercise. The exercise included low to moderate-intensity activities, with a duration of 40 min per day, 3 times per week for 16 weeks. The sessions included a 10 min warm-up, a 10 min muscle strengthening, a 20 min exercise to music, and a 10 min cool-down. During the first week of the program, participants started at 40% of their maximum heart rate (220 minus age = maximum heart rate), and each week it was increased by 5%; by the fourth week, participants were able to maintain between 50% and 55% of their maximum heart rate. For the evaluation of the intervention, different tests were performed; among them were the Rosenberg test, GDS-15, Sit and Reach test, standing on one leg with eyes open and closed test, and sitting and standing on a chair for 30 s test. In conclusion, it is mentioned that self-esteem improves with participation in this program, but not depressive symptoms. In addition, it is mentioned that group exercise seems to be an effective and safe intervention that can be used in older women to prevent deterioration of their functional status.

4. Discussion

Our research objective was to describe and analyze the effects of physical activity or exercise interventions on depressive symptoms and self-esteem in older adults through the evidence presented in the scientific literature. We found seven articles that met our selection criteria.

Based on the results obtained and the interpretation of the selected studies, the authors will perform an analysis. In this way, the discussion and future implications for the future contribution to the development or strengthening of the study variables are developed.

4.1. Depressive Symptoms and Self-Esteem

Regarding the seven investigations, four exercise interventions were identified: Aguiñaga et al. [29], Borbón-Castro et al. [31], Escolar and De Guzman [33], and Sung [35]. Three physical activity interventions were identified: Araque-Martínez et al. [30], Blumenthal et al. [32], and Motl et al. [34]. Of the seven interventions, five carried out their exercise program in a group: Araque-Martínez et al. [30], Borbón-Castro et al. [31], Escolar and De Guzman [33], Motl et al. [34], and Sung [35]. Two carried out their exercise programs individually: Aguiñaga et al. [29] and Blumenthal et al. [32].

It was observed that through PA sessions or exercise, depression symptoms can be reduced [29,30,31,32,33,34], except for the results of one study [35]. The results were significant, which is important since there is a high prevalence of depression in older adults [36], and depression in this population is strongly associated with mortality [37] and cardiovascular diseases [38,39]. On the other hand, significant improvements in self-esteem were observed [29,30,31,32,33,34,35], which is very important since self-esteem is considered the central core of quality of life [40].

Intervention programs are varied; among them, we find a multicomponent exercise program that contributes to improving self-esteem and decreasing anxiety and depression levels [30], an exercise program, considering interpersonal factors of the participants, team activities, and communication [31]. Also, there was evidence of a sustained decrease in depressive symptoms in sedentary older adults following exercise intervention [34]. Two of the studies did not demonstrate clinically significant results in measures of self-esteem [32,34]. While it is positive to find that various interventions achieve an improvement in all the parameters mentioned, it makes comparison difficult to determine which may be better or more advisable for this population. As in the particular case of the research by Aguiñaga et al. [29], where they consider the use of DVD as part of an intervention with their participants, it has been shown that this could be considered a barrier rather than a facilitator for the practice of exercise in the older adult population because adequate training is required for the use of these technologies that can benefit health variables in this particular population [41].

This systematic review showed that the practice of exercise or physical activity produces improvements in the levels of self-esteem and a decrease in depressive symptoms in older adults. However, despite the positive results found, it is necessary to be cautious with the interpretation; according to the PEDro scale, five articles obtained a good methodological quality, but two resulted with a regular methodological quality, and no articles with an excellent methodological quality were found on this topic. On the other hand, according to the risk of bias, all articles presented a high risk of bias. Therefore, it is necessary to continue strengthening the methodology used in this type of study.

The practice of exercise is associated with clinically significant improvements in depression, with effects comparable to those of the use of antidepressants in older adults [18,19,42]. The findings of this review are consistent with previous studies that consider the practice of exercise or physical activity as beneficial to increase self-esteem levels and decrease depressive symptoms in older adults [33] and that its regular practice can improve life satisfaction and self-efficacy in this population [43]. However, an integrative review has concluded that exercise is key to the treatment of diseases associated with mental health deterioration. Specifically, aerobic and resistance training could be used in a complementary manner for the treatment of depression and anxiety; in this way, the interaction of neurobiological and behavioral processes that interact during the development of exercise would allow benefits to be obtained at the individual level [44].

4.2. Other Study Variables

Although the variables of interest for this review were depression and self-esteem, studies reported improvements in decreased anxiety [29,30,32], improvements in fitness [30], improvements in aerobic capacity [32], Level of life satisfaction [33], and improvements in functionality, flexibility, and strength [35]. These results are important since this population has a high prevalence of anxiety [45], and anxiety ends up being a factor as important as depression when it comes to the quality of life of older adults [46]. Additionally, older adults who are more physically active are less likely to experience functional limitations than their more sedentary peers [47]. Therefore, it is necessary to continue seeking to increase participation in physical activity and physical fitness. Similarly, a review has indicated that according to the analysis of scientific evidence, the practice of physical activity in any of its manifestations, such as meditation, yoga, and exercise as complementary therapies, is effective in producing improvements in variables associated with the deterioration of mental health, including stress, depression, anxiety, schizophrenia and substance abuse such as alcohol consumption [48]. Therefore, caution should be exercised when replicating the results obtained in the present review.

4.3. Limitations and Strengths

Like all studies, our review is not free of limitations and strengths. The first limitation is that due to the heterogeneity of samples, interventions, duration, and variables of the study, it was not possible to perform a meta-analysis of the results obtained. Furthermore, it is very difficult to compare results with each other, which does not allow us to mention which intervention is more effective; therefore, we cannot make a specific recommendation on which PA or exercise intervention can generate the best results.; the second limitation is related to the PA and exercise interventions developed. Although most of the studies propose improvements in self-concept with a minimum duration of 10 min, in this case, a decrease in depression was not confirmed with this duration, frequency, and intervention. The third limitation is that due to the date of publication of the articles, the definition of older adults and their age classification has changed over the years, so caution is required in assuming the beneficial results for this age group. The fourth limitation is related to the lack of articles of excellent methodological quality according to the PEDro scale on this topic and to the high risk of bias of the articles included in this review. The fifth limitation is that the ideal scenario of the PEDro scale is to evaluate randomized clinical trials. However, it was decided to use the same PEDro due to the few articles that talk about this very specific population; therefore, there is a downward trend in the methodological quality of an article without a control group. Finally, our last limitation is related to the name of the intervention that each investigation received, according to the objectives and experience of the researchers whose sample was composed of older adults (We have stated the type of intervention that the investigators noted).

In terms of strengths, the benefits of PA or exercise for the reduction in depression and increase in self-esteem in older adults were evidenced; as a second strength, we can point out the multidimensional benefits obtained from the interventions related to other physical variables such as flexibility, strength, fitness, among others; and as a third strength of our review, it is related to the identification of reduced scientific evidence on this area of study, which could allow addressing the benefits of PA or exercise at present. As a fourth strength, there is a broad similarity in the tests used despite the difference in the years of research, which allows for better interpretation of the results of the evaluations.

4.4. Future Implications

As for future studies, it is suggested that variables related to self-valence in older adults, as well as aspects related to life satisfaction or other study variables that are transversal to the development of autonomy and self-valence in older adults, be taken into consideration. In addition, the development of other interventions, such as forest baths, recreational activities, and sports activities for the elderly, could also be considered. Finally, the level of physical activity of this population should be considered, and precautions should always be taken regarding the intensity of exercise.

Finally, future research could clarify the justification of the intervention that was applied to the sample, for example, the reason that motivated the researchers to carry out a PA or exercise program, in simple words to specify the reason for this type of program and not to use these definitions as synonyms, highlighting the importance of the correct use of the word or variables of the study and confirming the use of these through thesauri, whether in the areas of health or education. Another point of great relevance is the adequate use of keywords and translation of the words from the original language of the researchers to English because we have used the words “physical activity” and “physical exercise” because the studies we have consulted were identified through these keywords, as in the specific case of some studies [31] that have used that word in that way in their research.

5. Conclusions

Finally, the present systematic review allows us, through the evidence, to conclude that interventions based on the practice of physical activity or exercise could generate improvements in the possible increase in the levels of self-esteem and a possible decrease in depressive symptoms in older adults. Although there are also possible improvements in the decrease in anxiety levels, physical condition, and functionality of older adults, these results should be considered with caution because the interventions, samples, and instruments used to evaluate the improvements are heterogeneous among the studies. Therefore, if older adults participate in programs associated with the practice of physical activity or physical exercise, they can obtain these benefits as long as they follow the recommendations of experts.