The DOI matches its Crossref record; 131 of the 131 references it cites were found in a registry or an index; 8 of the 42 sources its claims cite were checked for support.
Exercise for depression
Open accessAbstract
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.
Overview
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
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Cites
Statistics
Verification
Claims the paper makes
8 of 42 cited sources checked · 6 supported · 0 flagged · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“One trial found no difference between supervised and home-based exercise (Blumenthal 2007).”
§ [Intervention Review] Exercise for depression > Intensity of exercise
What the sources say
- Partly supportedcites Blumenthal 2007 sourceExperimental — accuracy not yet measured
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)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > COMPARISON 4: EXERCISE VERSUS ANTIDEPRES-SANTS Primary outcome (Graph 4.1)
What the sources say
- Not checked — no full text of the sourcecites Blumenthal 1999 source
- Supportedcites Blumenthal 2007 source
The citation identifies the 2007 study as one of the two trials pooled by the citing paper; it does not attribute the pooled SMD to this individual trial. The cited paper’s Results report no significant difference in depressive-symptom scores between its exercise and medication groups (p = .514). (LLM, conf=0.91)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesEvery source the paper cites for this claim was checked and supports it.
In the paper
“One trial found significantly higher rates of diarrhoea and loose stool in the sertraline than the exercise group (Blumenthal 2007).”
§ [Intervention Review] Exercise for depression > Secondary outcomes
What the sources say
- Supportedcites Blumenthal 2007 source
The Results (Side Effects) report a statistically significant difference between treatment groups (p = .03) in worsening diarrhoea and loose stools. The rate was 31% with sertraline, versus 21% with home-based exercise and 10% with supervised exercise. (LLM, conf=0.91)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Main results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The effect of exercise was not significantly different from that of cognitive therapy.”
§ [Intervention Review] Exercise for depression > Main results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Main results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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, nonsignificant effect.”
§ [Intervention Review] Exercise for depression > Main results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There was insufficient data to determine risks and costs.”
§ [Intervention Review] Exercise for depression > Main results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Main results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“One trial found that exercise was superior to bright light therapy in reducing depression symptoms (Pinchasov 2000) (WMD -6.40, 95% CI -10.20, -2.60).”
§ [Intervention Review] Exercise for depression > COMPARISON 3: EXERCISE VERSUS BRIGHT LIGHT THERAPY Primary outcome (Graph 3.1)
What the sources say
- Not checked — no full text of the sourcecites Pinchasov 2000 source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- Probably not a substantial claim. 24
- It may state two separate claims as one. 30
- The quote only partly states this claim. 6
Every source the paper cites for this claim was checked and supports it.
In the paper
“A total of 28 trials fulfilled our criteria, of which 14 had already been identified in 2001 (Lawlor 2001).”
§ [Intervention Review] Exercise for depression > Results of the search
What the sources say
- Supportedcites Lawlor 2001 source
The cited 2001 paper’s Study inclusion and characteristics section reports that 16 articles describing 14 studies fulfilled its inclusion criteria. The citing paper attributes the earlier identification of 14 studies to Lawlor; its total of 28 trials is its own finding, not a total attributed to this source. (LLM, conf=0.93)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Results of the search
What the sources say
- Partly supportedcites Nabkasorn 2005 sourceExperimental — accuracy not yet measured
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)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Results of the search
What the sources say
- Not checked — no full text of the sourcecites Blumenthal 1999 source
- Supportedcites Blumenthal 2007 source
The Methods describe this paper as a randomized trial with depression assessments at baseline and after 16 weeks. The Results report both whether participants still met diagnostic criteria for major depressive disorder after treatment and their posttreatment HAM-D depression scores. This confirms the data attributed to Blumenthal 2007; it does not require this paper to document the other two trials. (LLM, conf=0.94)
- Not matchedcites Mather 2001
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“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).”
§ [Intervention Review] Exercise for depression > Why it is important to do this review
What the sources say
- Not checked — no full text of the sourcecites Sjosten 2006 source
- Supportedcites Lawlor 2001 source
The Study quality section describes an assessment of allocation concealment, intention-to-treat analysis, and blinding. The Quality of the studies section says exercise may be efficacious but cautions that much of the evidence is poor; the Implications section calls for well-designed randomised controlled trials. This confirms the portion of the two-analysis sentence attributed to Lawlor 2001, not the separate claim about Sjosten 2006. (LLM, conf=0.94)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
In the paper
“The literature was systematically searched in 2001 (Lawlor 2001).”
§ [Intervention Review] Exercise for depression > Overall completeness and applicability of evidence
What the sources say
- Supportedcites Lawlor 2001 source
The cited sentence attributes only the 2001 systematic literature search to Lawlor and Hopker. The paper’s Methods, under “Identification of the studies” (page not given in our copy), describes searches of multiple databases, examination of bibliographies, contact with experts, and hand-searching. The expanded claim’s reference to a 2007 search is not part of the printed citing sentence. (LLM, conf=0.92)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Twenty-eight trials fulfilled our inclusion criteria, of which 25 provided data for meta-analyses.”
§ [Intervention Review] Exercise for depression > Main results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Main results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Amongst these 116 excluded studies, there were 67 papers describing clinical trials.”
§ [Intervention Review] Exercise for depression > Results of the search
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
§ [Intervention Review] Exercise for depression > Results of the search
What the sources say
- Not matchedcites Vickers 2005
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the 144 potentially relevant papers retrieved for scrutinisation, we excluded 116 studies.”
§ [Intervention Review] Exercise for depression > Results of the search
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“19 were peer reviewed papers”
§ [Intervention Review] Exercise for depression > Results of the search
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Six trials recruited participants from clinical populations (i.e.hospital in-patients or”
§ [Intervention Review] Exercise for depression > Types of study design
Strength:plain· not yet calibratedn = 6Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“three were published in abstract form only (Mutrie 1988;Reuter 1984;Vickers 2005)”
§ [Intervention Review] Exercise for depression > Results of the search
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“21 trials recruited participants from non-clinical populations”
§ [Intervention Review] Exercise for depression > Types of study design
Strength:plain· not yet calibratedn = 21Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Subgroup analyses Type of exercise
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“six were doctoral dissertations (Bonnet 2005;Epstein 1986;Fetsch 1979;Hess-Homeier 1981;Setaro 1985;Orth 1979)”
§ [Intervention Review] Exercise for depression > Results of the search
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Intensity of exercise
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § Summary of main results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Reduction in symptom severity at follow-up (Graph 1.2)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ [Intervention Review] Exercise for depression > Characteristics of included studies [ordered by study ID]
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ [Intervention Review] Exercise for depression > Characteristics of included studies [ordered by study ID]
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
In the paper
“A further review included only older people (Sjosten 2006), whereas we included all ages of participants.”
§ [Intervention Review] Exercise for depression > Agreements and disagreements with other studies or reviews
What the sources say
- Not checked — no full text of the sourcecites Sjosten 2006 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ [Intervention Review] Exercise for depression > Characteristics of included studies [ordered by study ID]
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ [Intervention Review] Exercise for depression > Characteristics of included studies [ordered by study ID]
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Allocation concealment, intention to treat analysis and blinded outcome assessment (Graph 6.6)
Strength:plain· not yet calibratedn = 216Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Altogether, 144 full references were obtained and carefully scrutinised, of which 28 trials fulfilled our criteria.”
§ [Intervention Review] Exercise for depression > Overall completeness and applicability of evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ [Intervention Review] Exercise for depression > Characteristics of included studies [ordered by study ID]
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Only five trials reported adverse events (DOSE 2002, Knuppen 2007, Singh 1997, Singh 2005;Blumenthal 2007); adverse events were generally uncommon.”
§ [Intervention Review] Exercise for depression > Summary of main results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“1 Reduction in depression symptoms post-treatment 1 18 Mean Difference (IV, Random, 95% CI) -6.4 [-10.20,-2.60]”
§ [Intervention Review] Exercise for depression > Characteristics of included studies [ordered by study ID]
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ [Intervention Review] Exercise for depression > Publication bias
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ [Intervention Review] Exercise for depression > Characteristics of included studies [ordered by study ID]
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Summary of main results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There were more women than men, and there was a wide range in mean ages (22 years to 87.5 years).”
§ [Intervention Review] Exercise for depression > Overall completeness and applicability of evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Authors' conclusions
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Authors' conclusions
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > How the intervention might work
What the sources say
- Not checked — no full text of the sourcecites Duclos 2003 source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ [Intervention Review] Exercise for depression > How the intervention might work
What the sources say
- Not checked — no full text of the sourcecites Cotman 2002 source
- Not matchedcites Ernst 2005
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“However, a recent systematic review of Exercise on Prescription Schemes found limited evidence about their effectiveness and recommended further research (Sorensen 2006).”
§ [Intervention Review] Exercise for depression > Description of intervention
What the sources say
- Not checked — no full text of the sourcecites Sorensen 2006 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Why it is important to do this review
What the sources say
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Depression is a well-recognised reason for seeking alternative therapies (Astin 1998).”
§ [Intervention Review] Exercise for depression > Description of intervention
What the sources say
- Not checked — no full text of the sourcecites Astin 1998 source
Strength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ [Intervention Review] Exercise for depression > Why it is important to do this review
What the sources say
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Exercise may act as a diversion from negative thoughts, and the mastery of a new skill may be important (LePore 1997).”
§ [Intervention Review] Exercise for depression > How the intervention might work
What the sources say
- Not checked — no full text of the sourcecites LePore 1997 source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Description of intervention
What the sources say
- Not matchedcites NICE 2006
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, it is possible that we have missed unpublished trials.”
§ [Intervention Review] Exercise for depression > Overall completeness and applicability of evidence
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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'.”
§ [Intervention Review] Exercise for depression > Reply of Dr Gillian Mead, 10 November 2009
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Seven trials included blinding of outcome assessor (Blumenthal 1999;Blumenthal 2007;DOSE 2002;Klein 1985;Mather 2001;Singh 2005, Knuppen 2007).”
§ [Intervention Review] Exercise for depression > Incomplete outcome data
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Agreements and disagreements with other studies or reviews
What the sources say
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Potential biases in the review process
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: Positive trials are more likely to be published than negative trials.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Summary of main results
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Summary of main results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ [Intervention Review] Exercise for depression > Potential biases in the review process
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“If participants do not actually attend exercise sessions, trial results are more likely to be negative.”
§ [Intervention Review] Exercise for depression > Implications for research
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
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)”
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?
The cited source says what the claim attributes to it.
In the citing paper
“as well as to improve depressive symptoms to some degree,54”
From Association of depressive disorders, depression characteristics and antidepressant medication with inflammation (2012) · cites this paper as [54]
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
MajorThe 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.
“Singh 1997 17 9.8 (9.8) 15 13.8 (7.7) 5.2 % -0.44 [ -1.14, 0.26 ]”
“Singh 1997 17 9.8 (2.4) 15 13.8 (2) 4.4 % -1.75 [ -2.59, -0.92 ]”
Reuter 1984 is counted in two categories of two-arm trials
MinorThe 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.
“exercise was compared with CBT in two trials (Fetsch 1979;Reuter 1984), two trials compared CBT plus exercise versus CBT alone (Bonnet 2005, Reuter 1984)”
“1. Supervised running for at least 20 minutes 3 times a week for 10 weeks plus counselling 2. Counselling only”
Blinded-assessment analysis reports two participant totals
MinorThe narrative reports 411 participants for the seven blinded-assessment trials, whereas the corresponding analysis table reports 418.
“For the seven trials (411 participants) with blinded outcome assessments”
“5 Reduction in depression symptoms post-treatment: studies with blinded outcome assessment 7 418”
Two different maximum mean ages are reported
MinorOne section states that mean ages reached 87.5 years; another gives 82.7 years as the upper end of the mean-age range.
“there was a wide range in mean ages (22 years to 87.5 years).”
“mean age ranged from 22 years (Orth 1979) to 82.7 years (Tsang 2006).”
Shortest intervention is stated as both 10 days and one week
MinorThe reported intervention-duration range starts at 10 days, but the included Pinchasov 2000 study specifies a one-week exercise intervention.
“The duration of the intervention ranged from 10 days (Knuppen 2007) to 16 weeks (Blumenthal 1999;Blumenthal 2007;Tsang 2006).”
“54 minutes per day of cycling on stationary bicycle for 1 week”
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Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I.-M., Nieman, D. C., & Swain, D. P. (2011) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318213fefb · Cited by 9,319
Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases
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“The findings from the Cochrane Review (Thomas et al., 2006) agree with the conclusions from a 2001 meta-analysis, which also evaluated the impact of a minimum 8-week training program on glycemic control (Boule et al., 2001).”
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Metadata
- 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)
- 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)
- 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
- bronze
- doi.org
- 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 › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Pharmacology (medical) › 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
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