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Cited by 368Physical Activity and HealthTreatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Exercise for depression

Open access
Mead, Gillian E, Morley, Wendy, Campbell, Paul, Greig, Carolyn A, McMurdo, Marion, Lawlor, Debbie A·2009·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd004366.pub4
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Abstract

BACKGROUND: Depression is a common and important cause of morbidity and mortality worldwide. Depression is commonly treated with antidepressants and/or psychotherapy, but some people may prefer alternative approaches such as exercise. There are a number of theoretical reasons why exercise may improve depression. OBJECTIVES: To determine the effectiveness of exercise in the treatment of depression. SEARCH STRATEGY: We searched Medline, Embase, Sports Discus, PsycINFO, the Cochrane Controlled Trials Register, and the Cochrane Database of Systematic Reviews for eligible studies in March 2007. In addition, we hand-searched several relevant journals, contacted experts in the field, searched bibliographies of retrieved articles, and performed citation searches of identified studies. We also searched www.controlled-trials.com in May 2008. SELECTION CRITERIA: Randomised controlled trials in which exercise was compared to standard treatment, no treatment or a placebo treatment in adults (aged 18 and over) with depression, as defined by trial authors. We excluded trials of post-natal depression. DATA COLLECTION AND ANALYSIS: We calculated effect sizes for each trial using Cohen's method and a standardised mean difference (SMD) for the overall pooled effect, using a random effects model. Where trials used a number of different tools to assess depression, we included the main outcome measure only in the meta-analysis. MAIN RESULTS: Twenty-eight trials fulfilled our inclusion criteria, of which 25 provided data for meta-analyses. Randomisation was adequately concealed in a minority of studies, most did not use intention to treat analyses and most used self-reported symptoms as outcome measures. For the 23 trials (907 participants) comparing exercise with no treatment or a control intervention, the pooled SMD was -0.82 (95% CI -1.12, -0.51), indicating a large clinical effect. However, when we included only the three trials with adequate allocation concealment and intention to treat analysis and blinded outcome assessment, the pooled SMD was -0.42 (95% CI -0.88, 0.03) i.e. moderate, non-significant effect. The effect of exercise was not significantly different from that of cognitive therapy. There was insufficient data to determine risks and costs. AUTHORS' CONCLUSIONS: Exercise seems to improve depressive symptoms in people with a diagnosis of depression, but when only methodologically robust trials are included, the effect sizes are only moderate and not statistically significant. Further, more methodologically robust trials should be performed to obtain more accurate estimates of effect sizes, and to determine risks and costs. Further systematic reviews could be performed to investigate the effect of exercise in people with dysthymia who do not fulfil diagnostic criteria for depression.

AI snapshot

Written from the paper’s full text.

TL;DR

This Cochrane review found that exercise reduced depressive symptoms compared with no treatment/control, but the effect became moderate and non-significant when only methodologically robust trials were pooled. Exercise was not significantly different from cognitive therapy or antidepressants, and evidence was insufficient to determine optimal exercise parameters, risks, or costs.

Key findings

  • For 23 trials (907 participants) comparing exercise with no treatment/control, the pooled SMD was -0.82 (95% CI -1.12 to -0.51), indicating a large clinical effect; heterogeneity was significant (I² = 77%).
  • For the 3 trials (216 participants) with adequate allocation concealment, intention-to-treat analysis, and blinded outcome assessment, the pooled SMD was -0.42 (95% CI -0.88 to 0.03), a moderate but non-significant effect.
  • Exercise versus cognitive therapy showed no significant difference (6 trials, 152 participants; SMD -0.17, 95% CI -0.51 to 0.18), and exercise versus antidepressants also showed no significant difference (2 trials, 201 participants; SMD -0.04, 95% CI -0.31 to 0.24). One trial found exercise superior to bright light therapy (WMD -6.40, 95% CI -10.20 to -2.60).
  • At follow-up, 5 trials (218 participants) found a moderate effect (SMD -0.44, 95% CI -0.71 to -0.18), suggesting benefits may diminish after the intervention ends.

Methods

  • Systematic review and meta-analysis of randomised controlled trials; searched Medline, Embase, Sports Discus, PsycINFO, the Cochrane Controlled Trials Register, and the Cochrane Database of Systematic Reviews in March 2007, plus handsearching, author contact, citation searches, and www.controlled-trials.com in May 2008.
  • Included adults aged 18 and over with depression as defined by trial authors; excluded trials of post-natal depression; compared any exercise with no treatment/waitlist/placebo or other treatments. Twenty-eight trials met inclusion criteria, and 25 provided data for meta-analyses.
  • Calculated effect sizes using Cohen’s method and pooled standardised mean differences (SMD) with a random effects model; sensitivity analyses examined publication type, allocation concealment, intention-to-treat analysis, and blinding.

Limitations

  • The paper states that most trials had methodological weaknesses: randomisation was adequately concealed in a minority, most did not use intention-to-treat analyses, and most used self-reported outcome measures; publication bias is possible, and data on risks and costs were insufficient.
  • The paper states that it cannot determine the optimum type, frequency, or duration of exercise, nor whether exercise should be supervised or unsupervised, indoors or outdoors, or group versus individual; it also cannot comment on dysthymia or sub-clinical depression, and made several post-hoc exclusions.
  • Evident from the text: the main comparison had significant heterogeneity (I² = 77%); funnel plot inspection suggested asymmetry, though Begg’s test (p = 0.13) and Egger’s test (p = 0.09) were not conclusive; one trial stopped recruitment when the main outcome became statistically significant, which the review states probably biased results in favour of exercise.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/14651858.cd004366.pub4

Cites

132 of 132 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

8 of 42 cited sources checked · 6 supported · 0 flagged · accuracy not yet measured

  • Findingcitation

    One trial found no difference between supervised and home-based exercise.

    “One trial found no difference between supervised and home-based exercise (Blumenthal 2007).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Blumenthal 2007 source

      The Discussion reports no difference in depression remission rates between supervised and home-based exercise, but cautions that the trial was not powered to establish that they were comparable for depressive symptoms. The Results also report better aerobic fitness with supervised exercise, so the unqualified claim of 'no difference' is too broad. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • Findingown data

    Exercise compared with antidepressants shows no significant difference in reducing depressive symptoms (SMD -0.04, 95% CI -0.31 to 0.24) across two trials (201 participants).

    “For the two trials (201 participants) that compared exercise with antidepressants (Blumenthal 1999; Blumenthal 2007) the SMD was -0.04 (95% CI -0.31, 0.24), indicating no significant difference between the two interventions.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Blumenthal 1999 source
    • cites Blumenthal 2007 source
  • Findingcitation

    In one trial, rates of diarrhoea and loose stool were significantly higher in the sertraline group than in the exercise group.

    “One trial found significantly higher rates of diarrhoea and loose stool in the sertraline than the exercise group (Blumenthal 2007).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Blumenthal 2007 source
  • Findingown data

    Randomisation was adequately concealed in a minority of the included studies.

    “Randomisation was adequately concealed in a minority of studies, most did not use intention to treat analyses and most used self-reported symptoms as outcome measures.”
    Quote in the paperSubstantial claim
  • Findingnone given

    The effect of exercise was not significantly different from that of cognitive therapy.

    “The effect of exercise was not significantly different from that of cognitive therapy.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 24
  • May combine two claims. 30
  • The quote only partly states this claim. 6

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    A total of 28 trials fulfilled the criteria, of which 14 had already been identified in 2001.

    “A total of 28 trials fulfilled our criteria, of which 14 had already been identified in 2001 (Lawlor 2001).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Lawlor 2001 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One trial provided data in graphical form only which we were able to include after manually converting the graph into mean and SD values.

    “One trial (Nabkasorn 2005) provided data in graphical form only which we were able to include after manually converting the graph into mean and SD values.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Nabkasorn 2005 source

      The Results (page unavailable) direct readers to Figure 1 for changes in CES-D depression scores, supporting the claim that relevant outcome data were presented graphically. But the Results also give numerical baseline CES-D scores, and other outcomes appear in a table, so “data in graphical form only” is too broad. The citing authors’ manual conversion is their own action, not something this trial could document. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Findingown data

    Three trials provided data on whether patients fulfilled diagnostic criteria for depression at the end of the study, as well as depression scales.

    “Three trials (Blumenthal 1999, Blumenthal 2007;Mather 2001) provided data on whether patients fulfilled diagnostic criteria for depression at the end of the study, as well as depression scales.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Blumenthal 1999 source
    • cites Blumenthal 2007 source
    • cites Mather 2001

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Two meta-analyses which included assessments of study quality both cautiously concluded that exercise may be effective, but recommended that further well-designed trials are required.

    “Two meta-analyses which included assessments of study quality both cautiously concluded that exercise may be effective, but recommended that further welldesigned trials are required (Sjosten 2006;Lawlor 2001).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Sjosten 2006 source
    • cites Lawlor 2001 source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    The literature was systematically searched in 2001 and extensively in 2007, including electronic searches, hand-searching, contact with authors, reference lists, citation searches, and controlled-trials.com.

    “The literature was systematically searched in 2001 (Lawlor 2001).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Lawlor 2001 source

  • May combine two claims.

    Findingown data

    Twenty-eight trials fulfilled the inclusion criteria, of which 25 provided data for meta-analyses.

    “Twenty-eight trials fulfilled our inclusion criteria, of which 25 provided data for meta-analyses.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For the 23 trials (907 participants) comparing exercise with no treatment or a control intervention, the pooled SMD was -0.82 (95% CI -1.12, -0.51), indicating a large clinical effect.

    “For the 23 trials (907 participants) comparing exercise with no treatment or a control intervention, the pooled SMD was -0.82 (95% CI -1.12, -0.51), indicating a large clinical effect.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Amongst these 116 excluded studies, there were 67 papers describing clinical trials.

    “Amongst these 116 excluded studies, there were 67 papers describing clinical trials.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Preliminary information published in abstract form is included in the systematic review but data are not currently available for meta-analysis.

    “Preliminary information published in abstract form is also included in the systematic review but data are not currently available for meta-analysis, but may be available for future versions of the review (Vickers 2005).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Vickers 2005

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of the 144 potentially relevant papers retrieved for scrutinisation, 116 studies were excluded.

    “Of the 144 potentially relevant papers retrieved for scrutinisation, we excluded 116 studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of the 28 included trials, 19 were peer-reviewed papers.

    “19 were peer reviewed papers”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Six trials recruited participants from clinical populations.

    “Six trials recruited participants from clinical populations (i.e.hospital in-patients or”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of the 28 included trials, three were published in abstract form only.

    “three were published in abstract form only (Mutrie 1988;Reuter 1984;Vickers 2005)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    21 trials recruited participants from non-clinical populations.

    “21 trials recruited participants from non-clinical populations”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For type of exercise, aerobic exercise has a moderate clinical effect (SMD -0.63, 95% CI -0.95 to -0.30), while mixed exercise (SMD -1.47, 95% CI -2.56 to -0.37) and resistance exercise (SMD -1.34, 95% CI -2.07 to -0.61) have large effect sizes with wide confidence intervals.

    “The SMD for aerobic exercise indicated a moderate clinical effect (SMD -0.63, 95% CI -0.95, -0.30), whilst the SMDs for both mixed exercise (SMD -1.47, 95% CI -2.56, -0.37) and resistance exercise (SMD -1.34, 95% CI -2.07, -0.61) indicated large effect sizes, but confidence intervals were wide.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of the 28 included trials, six were doctoral dissertations.

    “six were doctoral dissertations (Bonnet 2005;Epstein 1986;Fetsch 1979;Hess-Homeier 1981;Setaro 1985;Orth 1979)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of eight trials measuring fitness and mood, four found mood correlated with fitness and four found no relationship.

    “Eight trials measured indices of fitness and correlated these with mood (Blumenthal 1999;Doyne 1987;Fremont 1987;Knuppen 2007;Martinsen 1985;Pinchasov 2000;Singh 2005; Veale 1992).Of these, four trials found that mood correlated with fitness ( Blumenthal 1999;Pinchasov 2000;Martinsen 1985;Singh 2005) whilst the other four trials found no relationship.”
    • Also stated in: § Summary of main results · plain
      “Only half of the trials which related mood to indices of physical fitness found significant correlations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At long-term follow-up, exercise compared with control has a moderate effect on depressive symptoms (SMD -0.44, 95% CI -0.71 to -0.18) in five trials (218 participants), with no statistical heterogeneity.

    “The pooled SMD from the five trials (Klein 1985;Blumenthal 1999;Singh 1997;Mather 2001;Fremont 1987) (218 participants) that provided long-term follow-up data found only a moderate effect (SMD -0.44, 95% CI -0.71 to -0.18).No statistical heterogeneity was indicated.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In a sensitivity meta-analysis restricted to studies with allocation concealment, intention-to-treat analysis, and blinded outcome assessment comparing exercise with control for depression, the pooled standardised mean difference in reduction of depression symptoms post-treatment was -0.42 (95% CI -0.88 to 0.03), not statistically significant (Z=1.84, P=0.066).

    “Total (95% CI) 111 105 100.0 % -0.42 [ -0.88, 0.03 ] Heterogeneity: Tau 2 = 0.09; Chi 2 = 4.84, df = 2 (P = 0.09); I 2 =59% Test for overall effect: Z = 1.84 (P = 0.066)”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    In a sensitivity meta-analysis restricted to peer-reviewed journal publications and doctoral theses comparing exercise with control for depression, the pooled standardised mean difference in reduction of depression symptoms post-treatment was -0.66 (95% CI -0.95 to -0.37), favouring exercise (Z=4.46, P<0.00001).

    “Total (95% CI) 452 415 100.0 % -0.66 [ -0.95, -0.37 ] Heterogeneity: Tau 2 = 0.29; Chi 2 = 73.10,df = 20 (P<0.00001);I 2 =73% Test for overall effect: Z = 4.46 (P < 0.00001)”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    A further review included only older people (Sjosten 2006), whereas this review included all ages.

    “A further review included only older people (Sjosten 2006), whereas we included all ages of participants.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Sjosten 2006 source

  • May combine two claims.

    Findingown data

    In a meta-analysis of two trials comparing exercise with antidepressants for depression, the pooled standardised mean difference in reduction of depression symptoms post-treatment was -0.04 (95% CI -0.31 to 0.24), not statistically significant (Z=0.27, P=0.79).

    “Total (95% CI) 104 97 100.0 % -0.04 [ -0.31, 0.24 ] Heterogeneity: Tau 2 = 0.0; Chi 2 = 0.49, df = 1 (P = 0.48); I 2 =0.0%Test for overall effect: Z = 0.27 (P = 0.79)”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    In a sensitivity meta-analysis restricted to studies with adequate allocation concealment comparing exercise with control for depression, the pooled standardised mean difference in reduction of depression symptoms post-treatment was -0.77 (95% CI -1.12 to -0.42), favouring exercise (Z=4.31, P=0.000016).

    “Total (95% CI) 226 204 100.0 % -0.77 [ -1.12, -0.42 ] Heterogeneity: Tau 2 = 0.16; Chi 2 = 20.15,df = 7 (P = 0.01); I 2 =65% Test for overall effect: Z = 4.31 (P = 0.000016)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In trials with adequate allocation concealment, intention-to-treat analysis and blinded outcome assessment, exercise versus control has a moderate clinical effect that is not statistically significant (SMD -0.42, 95% CI -0.88 to 0.03) across three trials (216 participants).

    “For the three trials (Blumenthal 2007, DOSE 2002, Mather 2001) (216 participants) with adequate allocation concealment and intention to treat analyses and blinded outcome assessment, the SMD was -0.42 (95% CI -0.88, 0.03) i.e. a moderate clinical effect, which was not statistically significant.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Altogether, 144 full references were obtained and scrutinised, of which 28 trials fulfilled inclusion criteria.

    “Altogether, 144 full references were obtained and carefully scrutinised, of which 28 trials fulfilled our criteria.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    In a sensitivity meta-analysis restricted to studies using intention-to-treat analysis comparing exercise with control for depression, the pooled standardised mean difference in reduction of depression symptoms post-treatment was -0.63 (95% CI -1.16 to -0.10), favouring exercise (Z=2.34, P=0.020).

    “Total (95% CI) 210 193 100.0 % -0.63 [ -1.16, -0.10 ] Heterogeneity: Tau 2 = 0.43; Chi 2 = 39.32,df = 8 (P<0.00001);I 2 =80% Test for overall effect: Z = 2.34 (P = 0.020)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Only five trials reported adverse events; adverse events were generally uncommon.

    “Only five trials reported adverse events (DOSE 2002, Knuppen 2007, Singh 1997, Singh 2005;Blumenthal 2007); adverse events were generally uncommon.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingown data

    Exercise reduces depression symptoms more than bright light therapy post-treatment (mean difference -6.4, 95% CI -10.20 to -2.60; 1 study, 18 participants).

    “1 Reduction in depression symptoms post-treatment 1 18 Mean Difference (IV, Random, 95% CI) -6.4 [-10.20,-2.60]”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The different depression outcome scales used across included studies measure the same underlying construct and can be validly pooled using standardized mean differences.

  • May combine two claims.

    Findingown data

    Visual inspection of the funnel plot for exercise versus control suggested asymmetry, indicating a relationship between intervention effect and study size, suggesting either publication bias or a systematic difference between small and larger studies; however, there was no conclusive statistical evidence for small study bias (Beggs test p=0.13, Egger test p=0.09).

    “Visual inspection suggested asymmetry, indicating a relationship between intervention effect and study size, suggesting either publication bias or a systematic difference between small and larger studies (small study effects).However, there was no conclusive statistical evidence for small study bias (Beggs test p = 0.13, Egger test p = 0.09).”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In a meta-analysis of trials comparing exercise with talking therapy for depression, the pooled standardised mean difference in reduction of depression symptoms post-treatment was -0.17 (95% CI -0.51 to 0.18), not statistically significant (Z=0.96, P=0.34).

    “Total (95% CI) 74 78 100.0 % -0.17 [ -0.51, 0.18 ] Heterogeneity: Tau 2 = 0.02; Chi 2 = 5.50, df = 5 (P = 0.36); I 2 =9% Test for overall effect: Z = 0.96 (P = 0.34)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A substantial number of people dropped out from both exercise and control interventions, and even those who remained in the trial until outcome assessments were not able to attend all exercise sessions.

    “A substantial number of people dropped out from both the exercise and control interventions, and even those who remained in the trial until the outcome assessments were not able to attend all exercise sessions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    There were more women than men, and there was a wide range in mean ages (22 years to 87.5 years).

    “There were more women than men, and there was a wide range in mean ages (22 years to 87.5 years).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    When only methodologically robust trials are included, the effect sizes are only moderate and not statistically significant.

    “Exercise seems to improve depressive symptoms in people with a diagnosis of depression, but when only methodologically robust trials are included, the effect sizes are only moderate and not statistically significant.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Interpretationown data

    Exercise seems to improve depressive symptoms in people with a diagnosis of depression.

    “Exercise seems to improve depressive symptoms in people with a diagnosis of depression, but when only methodologically robust trials are included, the effect sizes are only moderate and not statistically significant.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Physical activity may have physiological effects such as changes in endorphin and monoamine levels, or reduction in the levels of the stress hormone cortisol, which may improve mood.

    “Physical activity may have physiological effects such as changes in endorphin and monoamine levels, or reduction in the levels of the stress hormone cortisol (Duclos 2003) which all may improve mood.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Duclos 2003 source

  • May combine two claims.

    Premisecitation

    Recent studies have suggested that exercise stimulated growth of new nerve cells and release of proteins known to improve health and survival of nerve cells.

    “Recent studies have suggested that exercise stimulated growth of new nerve cells and release of proteins known to improve health and survival of nerve cells, e.g.brainderived growth neurotrophic factor (Cotman 2002;Ernst 2005).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Cotman 2002 source
    • cites Ernst 2005

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent systematic review of Exercise on Prescription Schemes found limited evidence about their effectiveness.

    “However, a recent systematic review of Exercise on Prescription Schemes found limited evidence about their effectiveness and recommended further research (Sorensen 2006).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Sorensen 2006 source

  • May combine two claims.

    Premisecitation

    Several meta-analyses have looked at the effect of exercise on depression and all found that exercise was of benefit.

    “Several meta-analyses (Craft 1998;Carlson 1991;North 1990;Lawlor 2001;Stathopoulou 2006;Sjosten 2006) have looked at the effect of exercise on depression and all found that exercise was of benefit.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Craft 1998 source
    • cites Carlson 1991

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites North 1990 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Depression is a well-recognised reason for seeking alternative therapies.

    “Depression is a well-recognised reason for seeking alternative therapies (Astin 1998).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Astin 1998 source

  • May combine two claims.

    Premisecitation

    Three of these reviews pooled data from a range of study types that included uncontrolled studies and randomised as well as non-randomised controlled trials, and pooled data from trials that compared exercise and no treatment with data from trials that compared exercise and other forms of treatment.

    “However, three of these reviews pooled data from a range of study types that included uncontrolled studies and randomised as well as non-randomised controlled trials, and pooled data from trials that compared exercise and no treatment with data from trials that compared exercise and other forms of treatment (Craft 1998;Carlson 1991;North 1990).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Craft 1998 source
    • cites Carlson 1991

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites North 1990 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mastery of a new skill may be important in how exercise improves mood.

    “Exercise may act as a diversion from negative thoughts, and the mastery of a new skill may be important (LePore 1997).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites LePore 1997 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    NICE concluded that there was insufficient evidence to recommend Exercise Referral Schemes other than as part of research studies to evaluate their effectiveness.

    “NICE (NICE 2006) concluded that there was insufficient evidence to recommend Exercise Referral Schemes other than as part of research studies to evaluate their effectiveness.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites NICE 2006

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    It is possible that the review missed unpublished trials.

    “However, it is possible that we have missed unpublished trials.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The review's subgroup analyses do not provide accurate information about how effective exercise might be, nor allow recommendations about the relative benefits of aerobic, resistance, or mixed exercise, group versus individual exercises, or the optimum duration of exercise.

    “Based on our subgroup analyses, we have stated that 'we cannot give people accurate information about how effective exercise might be, nor can recommendations be made about the relative benefits of aerobic exercise, resistance exercise or mixed exercise, whether group or individual exercises are better, nor about the optimum duration of exercise'.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Seven trials included blinding of outcome assessor.

    “Seven trials included blinding of outcome assessor (Blumenthal 1999;Blumenthal 2007;DOSE 2002;Klein 1985;Mather 2001;Singh 2005, Knuppen 2007).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Previous systematic reviews that found exercise improved depression included uncontrolled trials, so their results are probably biased in favour of exercise.

    “Previous systematic reviews which found that exercise improved depression included uncontrolled trials (North 1990;Craft 1998;Carlson 1991, so the results of these reviews are probably biased in favour of exercise.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites North 1990 source
    • cites Craft 1998 source
    • cites Carlson 1991

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    Some publication bias is inevitable and likely leads to an overestimate of effect sizes.

    “However, we accept that some publication bias is inevitable.This is likely to lead to an overestimate of effect sizes, because positive trials are more likely to be published than negative trials.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Positive trials are more likely to be published than negative trials.

  • May combine two claims.

    Interpretationown data

    The data on feasibility suggest that a large number of people need to be screened to identify suitable participants, unless recruiting from a clinical population such as in-patients with depression.

    “The data we extracted on aspects of feasibility (see additional Table 1) suggest that a large number of people need to be screened to identify suitable participants, unless recruiting from a clinical population e.g.in-patients with depression.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Effect sizes were higher for mixed exercise and resistance exercise than aerobic exercise alone, but confidence intervals were wide and other methodological aspects may have confounded these analyses.

    “Effect sizes were higher for mixed exercise and resistance exercise than aerobic exercise alone, but confidence intervals were wide and other methodological aspects of the trials may have confounded these analyses.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The review attempted to avoid bias by comprehensive systematic searching and contacting authors.

    “We attempted to avoid bias by ensuring that we had identified all relevant studies through comprehensive systematic searching of the literature and contact with authors of the trials to identify other trials, both published and unpublished.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    If participants do not actually attend exercise sessions, trial results are more likely to be negative.

    “If participants do not actually attend exercise sessions, trial results are more likely to be negative.”
    Quote in the paperNot a substantial claim
51 of 51

  • The paper relies on this without support.

    Further randomised trials have been published since the prior systematic reviews and meta-analyses.

    “We have become aware that futher randomised trials have been published since these systematic reviews and meta-analyses.”

  • The paper relies on this without support.

    Positive trials are more likely to be published than negative or inconclusive trials.

    “even though it is widely acknowledged that positive trials are more likely to be published than negative or inconclusive trials.”

  • The paper relies on this without support.

    Antidepressants may have adverse side effects, adherence can be poor, and there is a lag time between starting antidepressants and improvements in mood.

    “Furthermore, antidepressants may have adverse side effects, adherence can be poor, and there is a lag time between starting antidepres-sants and improvements in mood.”

  • The paper relies on this without support.

    Social contact may be part of the mechanism by which exercise improves mood.

    “Social contact may be part of the mechanism.”

  • The paper relies on this without support.

    Positive trials are more likely to be published than negative trials.

    “because positive trials are more likely to be published than negative trials.”

  • The paper relies on this without support.

    The different depression outcome scales used across included studies measure the same underlying construct and can be validly pooled using standardized mean differences.

    “Std.Mean Difference (IV, Random, 95% CI)”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Singh 1997 has conflicting data and effect sizes in the same comparison

    Major

    The main exercise-versus-control analysis gives Singh 1997 standard deviations of 2.4 and 2 and an effect size of -1.75. The publication-type sensitivity analysis uses standard deviations of 9.8 and 7.7 for the same group sizes and means, changing the effect size to -0.44.

  • Reuter 1984 is counted in two categories of two-arm trials

    Minor

    The description places Reuter 1984 both among trials comparing exercise with CBT and among trials comparing CBT plus exercise with CBT alone. Its study entry describes only running plus counselling versus counselling alone.

  • Blinded-assessment analysis reports two participant totals

    Minor

    The narrative reports 411 participants for the seven blinded-assessment trials, whereas the corresponding analysis table reports 418.

  • Two different maximum mean ages are reported

    Minor

    One section states that mean ages reached 87.5 years; another gives 82.7 years as the upper end of the mean-age range.

  • Shortest intervention is stated as both 10 days and one week

    Minor

    The reported intervention-duration range starts at 10 days, but the included Pinchasov 2000 study specifies a one-week exercise intervention.

5 of 5

Cites

Flagged first, then by citations

Research works printed but not linked: 36

  1. Bonnet, 2005, Effects of aerobic exercise in combination with cognitive therapy on self reported depression [dissertation]
  2. Epstein, 1986, Aerobic activity versus group cognitive therapy: an evaluative study of contrasting interventions for the alleviation of clinical depression [dissertation]
  3. Fetsch, 1979, Dissertation
  4. Hess-Homeier, 1981, A comparison of Beck's cognitive therapy and jogging as treatments for depression [dissertation]
  5. Mutrie N Exercise as a treatment for moderate depression in the UK National Health Service [abstract] Proceedings of sport, health psychology and exercise symposium 1988 96 105
  6. Reuter, 1984, Running as an adjunct to counseling in the treatment of depression [unpublished manuscript]
  7. Setaro, 1985, Aerobic exercise and group counseling in the treatment of anxiety and depression [dissertation]
  8. Antonelli, 1982, Sport and depression therapy, International Journal of Sport Psychology, 13, 187
  9. Berlin, 2003, The effect of Aquatic Therapy Interventions on Patients with Depression: A Comparison Study, Annual in Therapeutic Recreation, 12, 7
  10. Bosscher, 1993, Running and mixed physical exercises with depressed psychiatric patients, International Journal of Sport Psychology, 24, 170
  11. Boyll, 1986, The effects of active and passive electronic muscle stimulation on self-concept, anxiety and depression [dissertation]
  12. Buffone, 1980, Pyschological changes associated with cognitive-behavioural therapy and an aerobic running programme in the treatment of depression, Dissertation Abstracts International, 41, 0102
  13. D'Amato, 1990, The relative efficacy of structured reminiscence and physical exercise on clinically depressed geriatric inpatients [dissertation]
  14. Dalton, 1981, Effects of exercise and Vitamin B12 supplementation on the depression scale scores of a wheelchair confined population [dissertation]
  15. DeVaney, 1991, Comparative effects of exercise reduction and relaxation training on Type A behaviour and dysphoric mood states in habitual aerobic exercisers [dissertation]
  16. Giardinelli, 1996, Depression and psychomotor retardation: exercise intervention combined with a pharmacological treatment of inpatients, Minerva Psichiatrica, 37, 179
  17. Hembree, 2001, Exercise and its effect on hopelessness and depression in an aging female population in eastern Oklahoma [dissertation]
  18. Herrera, 1994, The efficacy of a psychological intervention for depression in patients on haemodyalysis, Psiquis, 15, 39
  19. Kupecz, 2001, Effects of a structured exercise program in older veteran patients [dissertation]
  20. Kurz, 1998, Effect of early morning exercises on mood and circadian rhythm in seasonal affective disorder, International Journal of Sports Medicine, 19, S81
  21. Lacombe, 1987, The role of aerobic conditioning and psychosocial factors in mediating the effect of exercise on depression [dissertation]
  22. Margolis, 1981, The use of exercise and group cognitive therapy in the treatment of depression [depression]
  23. Moreau, 1981, The effectiveness of jogging as a treatment for depression [dissertation]
  24. Passmore, 2006, Exercise as a treatment for depression: A therapeutic recreation intervention, American Journal of Recreation Therapy, 5, 31
  25. Pezzarossa, 1991, Physical activity and psychopathological variables, Psichiatria e Psicoterapia Analitica, 10, 163
  26. Rhodes, 1980, Mens Sana Corpore Sano: A study of the effect of jogging on depression anxiety and self concept [dissertation]
  27. Roth, 1986, An experimental comparison of the cardiovascular and self-reported health effects of aerobic exercise and progressive relaxation [dissertation]
  28. Sanstead, 1983, The treatment of depression through a graduated aerobic exercise intervention [dissertation]
  29. Stein, 1989, The differential effects of aerobic and non aerobic exercise on affect and self-concept [dissertation]
  30. Tenorio, 1986, Effects of aerobic exercise on symptoms of depression in women [dissertation]
  31. Veale, 1992, Aerobic exercise in the adjunctive treatment of depression: A randomised controlled trial, Journal of the Royal Society of Medicine, 85, 541, 10.1177/014107689208500910 · DOI · Paper page
  32. Wieman, 1980, Running as a treatment for depression: a theoretical basis [dissertation]
  33. Williams, 1979, The effects of aerobic training and a mood control workshop on depression in male college students [dissertation]
  34. Williams, 1992, Acute mood and EEG effects of aerobic exercise in depressed and non-depressed adults [dissertation]
  35. Carlson, 1991, UnThe effects of exercise on depression: a review and meta-regression analysis [dissertation]
  36. Moncrieff, 2003, Active placebo versus antidepressants for depression, Cochrane Database of Systematic Reviews

Cited by

Sorted by citations

Related

Authors
Mead, G. E., Morley, W., Campbell, P., Greig, C. A., McMurdo, M., & Lawlor, D. A.
Affiliations
  • Edinburgh Royal Infirmary (GB)
  • University of Edinburgh (GB)
  • University of Dundee (GB)
  • University of Bristol (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
John Wiley & Sons, Ltd
Published
2009-07-08
Issue
3
Pages
CD004366-CD004366
ISSN
1361-6137 (ISSN-L)
DOI
10.1002/14651858.cd004366.pub4
OpenAlex
W4211045040
Semantic Scholar
cf8567b35012b31afc3a118a0f152e76ad257625
Cited by
364
References
130
Citations by year
2026: 2 · 2025: 4 · 2024: 6 · 2023: 14 · 2022: 4 · 2021: 13 · 2020: 13 · 2019: 9 · 2018: 18 · 2017: 17 · 2016: 29 · 2015: 32 · 2014: 19 · 2013: 41 · 2012: 54
Type
reference entry
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Discovery Research Portal (University of Dundee) (publishedVersion)
  • Discovery Research Portal (University of Dundee) (submittedVersion, other-oa)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
physical activity, depression, exercise therapy, antidepressant effects, cognitive therapy, methodological quality of trials, allocation concealment, intention-to-treat analysis, depressive symptoms, adults with depression, exercise duration, exercise frequency, exercise intensity
MeSH terms
Adult, Depression, Humans, Middle Aged, Exercise, Randomized Controlled Trials as Topic, Treatment Outcome, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-16.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-16.

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Statistics and arithmetic are recomputed, not judged.

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