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Cited by 446Schizophrenia research and treatmentPhysical Activity and HealthSleep and related disorders

Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes

Open access
Ashdown-Franks, Garcia, Firth, Joseph, Carney, Rebekah, Carvalho, Andre F., Hallgren, Mats, Koyanagi, Ai, Rosenbaum, Simon, Schuch, Felipe B. +4 more·2020·Sports Medicine
DOI 10.1007/s40279-019-01187-6
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Abstract

Background Exercise may improve neuropsychiatric and cognitive symptoms in people with mental disorders, but the totality of the evidence is unclear. We conducted a meta-review of exercise in (1) serious mental illness (schizophrenia spectrum, bipolar disorder and major depression (MDD)); (2) anxiety and stress disorders; (3) alcohol and substance use disorders; (4) eating disorders (anorexia nervosa bulimia nervosa, binge eating disorders, and (5) other mental disorders (including ADHD, pre/post-natal depression). Methods Systematic searches of major databases from inception until 1/10/2018 were undertaken to identify meta-analyses of randomised controlled trials (RCTs) of exercise in people with clinically diagnosed mental disorders. In the absence of available meta-analyses for a mental disorder, we identified systematic reviews of exercise interventions in people with elevated mental health symptoms that included non-RCTs. Meta-analysis quality was assessed with the AMSTAR/+. Results Overall, we identified 27 systematic reviews (including 16 meta-analyses representing 152 RCTs). Among those with MDD, we found consistent evidence (meta-analyses = 8) that exercise reduced depression in children, adults and older adults. Evidence also indicates that exercise was more effective than control conditions in reducing anxiety symptoms (meta-analyses = 3), and as an adjunctive treatment for reducing positive and negative symptoms of schizophrenia (meta-analyses = 2). Regarding neurocognitive effects, exercise improved global cognition in schizophrenia (meta-analyses = 1), children with ADHD (meta-analyses = 1), but not in MDD (meta-analyses = 1). Among those with elevated symptoms, positive mental health benefits were observed for exercise in people with pre/post-natal depression, anorexia nervosa/bulimia nervosa, binge eating disorder, post-traumatic stress disorder and alcohol use disorders/substance use disorders. Adverse events were sparsely reported. Conclusion Our panoramic meta-overview suggests that exercise can be an effective adjunctive treatment for improving symptoms across a broad range of mental disorders.

Integrity signals

Registry

Crossref · 10.1007/s40279-019-01187-6

Cites

135 of 135 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

76 of 193 cited sources checked · 29 supported · 2 flagged · accuracy not yet measured

  • Findingcitation

    In older people with depressive symptoms, aerobic exercise improves depressive symptoms.

    “However, the pooled data including older people with depressive symptoms found that aerobic exercise improved depressive symptoms (SMD = -0.90,95% CI -0.29 to -1.51, RCTs = 8, n intervention = 138, n control = 129).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [59] Schuch FB, Vancampfort D, Rosenbaum S, et al. Exercise for depression in older adults: a meta-analysis of randomized controlled trials adjusting for publication bias. Rev Bras Psiquiatr. 2016;38(3):247–54. source

      The Abstract Results and Results > Main analysis report the cited pooled effect and sample sizes for exercise in older adults. The Discussion distinguishes that pooled finding from aerobic exercise alone: mixed aerobic and strength training was effective, but aerobic exercise alone was not. The sentence therefore assigns the pooled result to a modality it does not establish. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
  • Findingcitation

    In adults with MDD, exercise reduces depressive symptoms compared with control conditions.

    “Among those with MDD, we found consistent evidence (meta-analyses = 8) that exercise reduced depression in children, adults and older adults.”
    • Also stated in: § 3.1.3 Adults · plain
      “The Cochrane review [62] (AMSTAR = 11, AMSTAR+ = 2) included 23 RCTs of people with MDD and found that exercise reduced depressive symptoms (SMD = -0.57,95% CI -0.81 to -0.32, n = 450, I 2 = 67%).”
    • Also stated in: § 3.1.3 Adults · plain
      “In a trial sequential meta-analysis [63] (AMSTAR = 10, AMSTAR+ = 1), exercise was more effective than control conditions across 35 RCTs (SMD = -0.66,95% CI -0.86 to -0.46,I 2 = 81%).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [62] Cooney GM, Dwan K, Greig CA, et al. Exercise for depression. Cochrane Database Syst Rev. 2013;9:CD004366. source
    • cites [61] Kvam S, Kleppe CL, Nordhus IH, Hovland A. Exercise as a treatment for depression: a meta-analysis. J Affect Disord. 2016;202:67–86. source
    • cites [63] Krogh J, Hjorthoj C, Speyer H, Gluud C, Nordentoft M. Exercise for patients with major depression: a systematic review with meta-analysis and trial sequential analysis. BMJ Open. 2017;7(9):e014820. source

      The Abstract reports that exercise reduced depression severity versus control in the pooled trials. But the effect disappeared when the analysis was restricted to trials less affected by bias, and the Conclusions say the authors have little confidence in the pooled estimate. The unqualified claim of a reduction therefore overstates the evidence this source provides for adults with MDD. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Findingcitation

    In schizophrenia spectrum disorders, exercise as an adjunctive treatment reduces negative symptoms compared with control.

    “as an adjunctive treatment for reducing positive and negative symptoms of schizophrenia (metaanalyses = 2)”
    • Also stated in: § 3.1.1 Major Depression · hedged
      “Data from one MA [34] suggest that versus control conditions, 90 min or more of MVPA reduces total, positive and improves negative symptoms.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [34] Firth J, Cotter J, Elliott R, French P, Yung AR. A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychol Med. 2015;45(7):1343–61. source
    • cites [69] Dauwan M, Begemann MJ, Heringa SM, Sommer IE. Exercise improves clinical symptoms, quality of life, global functioning, and depression in schizophrenia: a systematic review and meta-analysis. Schizophr Bull. 2016;42(3):588–99. source
  • Findingcitation

    In people with anxiety and stress-related disorders, exercise reduces anxiety symptoms compared with non-active control conditions.

    “Evidence also indicates that exercise was more effective than control conditions in reducing anxiety symptoms (meta-analyses = 3)”
    • Also stated in: § 3.1.5 Anxiety and Stress-Related Disorders · plain
      “Exercise reduced anxiety symptoms at the trial end point (SMD = -0.581,95% CI -1.0 to -0.76, p = 0.02, I 2 = 66%).”
    • Also stated in: § 3.1.5 Anxiety and Stress-Related Disorders · plain
      “Aylett et al. [67] (2018, AMSTAR = 9, AMSTAR+ = 3) meta-analysed four RCTs of people with anxiety disorders in primary care and found that exercise reduced anxiety symptoms (SMD = -0.32,95% CI -0.62 to -0.01).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [65] Stubbs B, Vancampfort D, Rosenbaum S, et al. An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: a meta-analysis. Psychiatry Res. 2017;249:102–8. source
    • cites [67] Aylett E, Small N, Bower P. Exercise in the treatment of clinical anxiety in general practice—a systematic review and meta-analysis. BMC Health Serv Res. 2018;18(1):559. source
  • Findingcitation

    In schizophrenia, exercise improves global cognition compared with control conditions.

    “exercise improved global cognition in schizophrenia (meta-analyses = 1)”
    • Also stated in: § 3.1.1 Major Depression · plain
      “MA of seven RCTs [33] found that exercise improved global cognition versus control conditions”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [33] Firth J, Stubbs B, Rosenbaum S, et al. Aerobic exercise improves cognitive functioning in people with schizophrenia: a systematic review and meta-analysis. Schizophr Bull. 2016;43(3):546–56. source
  • May combine two claims. 41
  • The quote only partly states this claim. 8
  • Classified as probably not a substantial claim. 13

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

    Findingcitation

    In people with substance use disorders grouped together (nicotine, alcohol, illicit drug users), exercise effectively increased abstinence rates (OR = 1.69, 95% CI 1.44-1.99), particularly for nicotine.

    “Evidence from 2 reviews [80, 81], including 48 studies found that exercise effectively increased abstinence rates, particularly for nicotine”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [81] Wang D, Wang Y, Li R, Zhou C. Impact of physical exercise on substance use disorders: a meta-analysis. PLoS One. 2014;9(10):e110728. source

      The Results (Effect of physical exercise on abstinence rate) support the pooled increase in abstinence (OR 1.69, 95% CI 1.44–1.99). But the same section says the effect was greater for illicit-drug users than for alcohol or nicotine users—the opposite of “particularly for nicotine.” This meta-analysis included 22 studies; the citing sentence attributes 48 to two reviews collectively. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [80] Colledge F, Gerber M, Puhse U, Ludyga S. Anaerobic exercise training in the therapy of substance use disorders: a systematic review. Front Psychiatry. 2018;9:644. source

      The Summary of Main Findings Regarding Primary Outcomes (page not provided) says six of nine nicotine studies reported at least some positive effect on abstinence, but explicitly says no conclusion about effectiveness can be drawn. It does not report the claimed pooled OR or establish increased abstinence across nicotine, alcohol, and illicit drug users. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    Psychosocial mechanisms also play a pivotal role in the mental health benefits of exercise, such as increased social support and reduced social isolation, improved self-esteem and body image.

    “However, psychosocial mechanisms also play a pivotal role in the mental health benefits of exercise, such as increased social support and reduced social isolation [88], improved self-esteem [89] and body image [90].”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [88] Gross J, Vancampfort D, Stubbs B, Gorczynski P, Soundy A. A narrative synthesis investigating the use and value of social support to promote physical activity among individuals with schizophrenia. Disabil Rehabil. 2016;38(2):123–50. source

      The Stage four discussion (page unavailable) says friendships develop during physical activity among people with schizophrenia and associates those friendships with reduced psychiatric symptoms. It does not report a measured reduction in social isolation. The paper also cautions that the effect of social support on health outcomes is difficult to establish, so the claim that these mechanisms play a pivotal role in exercise’s mental-health benefits is stronger and broader than its findings. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [89] Liu M, Wu L, Ming Q. How does physical activity intervention improve self-esteem and self-concept in children and adolescents? Evidence from a meta-analysis. PLoS One. 2015;10(8):e0134804. source

      Citation [89] is attached specifically to “improved self-esteem,” not to the separate claims about social support or body image. In Results, under “Meta-analysis of studies with intervention of PA alone” (page not provided), the paper reports improvements in self-concept and self-worth but no significant pooled effect on self-esteem. (LLM, conf=0.87)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [90] Bassett-Gunter R, McEwan D, Kamarhie A. Physical activity and body image among men and boys: a meta-analysis. Body Image. 2017;22:114–28. source

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Two independent authors assessed the quality of included systematic reviews and meta-analyses using the AMSTAR and AMSTAR+ tools.

    “two independent authors assessed the quality of the systematic reviews and meta-analyses using the AMSTAR and AMSTAR+ tool [53][54][55].”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [53] Shea BJ, Hamel C, Wells GA, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol. 2009;62(10):1013–20. source
    • cites [54] Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7:10–7. source
    • cites [55] Sharif MO, Janjua-Sharif FN, Ali H, Ahmed F. Systematic reviews explained: AMSTAR—how to tell the good from the bad and the ugly. Oral Health Dent Manag. 2013;12(1):9–16.

  • May combine two claims.

    Premisecitation

    Exercise may have important effects on psychiatric symptoms and neurocognitive functioning across many conditions, potentially acting as a transdiagnostic treatment for mental disorders.

    “there is increasing recognition that exercise may have important effects on psychiatric symptoms [32][33][34] and neurocognitive functioning [32], across many conditions, thus potentially acting as a transdiagnostic treatment for mental disorders.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [32] Firth J, Cotter J, Carney R, Yung AR. The pro-cognitive mechanisms of physical exercise in people with schizophrenia. Br J Pharmacol. 2017;174(19):3161–72. source

      The Introduction (page not available) reports cognitive benefits of exercise in schizophrenia and cites benefits in older adults, healthy adults and people with dementia. The paper therefore supports the neurocognitive part of the citation, but its review focuses on schizophrenia and does not establish exercise as a treatment for psychiatric symptoms across many mental disorders. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [33] Firth J, Stubbs B, Rosenbaum S, et al. Aerobic exercise improves cognitive functioning in people with schizophrenia: a systematic review and meta-analysis. Schizophr Bull. 2016;43(3):546–56. source

      The Discussion (page unavailable) reports cognitive benefits of exercise in people with schizophrenia and notes prior evidence of improved psychiatric symptoms in that population. The Methods’ Eligibility Criteria (page unavailable) limit this review to schizophrenia and related nonaffective psychosis; it does not establish effects across many conditions. The transdiagnostic-treatment proposal is the citing authors’ inference, not a finding of this review. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [34] Firth J, Cotter J, Elliott R, French P, Yung AR. A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychol Med. 2015;45(7):1343–61. source

  • May combine two claims.

    Findingcitation

    In adults with MDD, three RCTs reported adverse events and no difference in adverse events between exercise and control interventions.

    “Three RCTs reported adverse events and no difference in the exercise or control interventions.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [63] Krogh J, Hjorthoj C, Speyer H, Gluud C, Nordentoft M. Exercise for patients with major depression: a systematic review with meta-analysis and trial sequential analysis. BMJ Open. 2017;7(9):e014820. source

      The serious-adverse-events results report that three trials recorded death or suicide attempts, and the strengths and limitations section reports no statistically significant effect of exercise on those outcomes. The claim omits that these were *serious* adverse events: the non-serious-adverse-events section says ten trials reported those events. The review also cautions that the sparse data do not establish whether exercise changes adverse-event risk. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

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

    Premisecitation

    The AMSTAR+ has six additional items on the content validity of included meta-analyses, with scores ranging from 0 to 8, where >4 indicates high quality.

    “we used the AMSTAR+ which has six additional items on the content validity of included meta-analyses with scores ranging from 0 to 8 (> 4 indicating high quality).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [25] Vancampfort D, Firth J, Correll CU, et al. The impact of pharmacological and non-pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta-review of meta-analyses of randomized controlled trials. World Psychiatry. 2019;18(1):53–66. source

      The quality-assessment passage describes six additional AMSTARPlus Content items for assessing the content validity of included meta-analyses, with a score range of 0–8. It defines high quality as a score of 4 or higher, not greater than 4 as the citing sentence states. (LLM, conf=0.93)

      Experimental — accuracy not yet measured
    • cites [56] Correll CU, Rubio JM, Inczedy-Farkas G, Birnbaum ML, Kane JM, Leucht S. Efficacy of 42 Pharmacologic cotreatment strategies added to antipsychotic monotherapy in schizophrenia: systematic overview and quality appraisal of the aeta-analytic evidence. JAMA Psychiatry. 2017;74(7):675–84. source

  • May combine two claims.

    Premisecitation

    Even in patients who respond well to traditional treatments, some continue to experience residual symptoms and/or risk of future relapse.

    “Furthermore, even in those who respond well to traditional treatments, some continue to experience residual symptoms, and/or a risk of future relapse [35,36,38].”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites [35] Correll CU, Rubio JM, Kane JM. What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophrenia? World Psychiatry. 2018;17(2):149–60. source
    • cites [36] Jorm AF, Patten SB, Brugha TS, Mojtabai R. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry. 2017;16(1):90–9. source

      The United States section (page not specified in our copy) says that some people using treatment are in remission or partial remission and that continued treatment may be justified to prevent relapse. It does not establish that these are patients who responded well to traditional treatments, so that qualifier is unsupported. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [38] Bighelli I, Salanti G, Huhn M, et al. Psychological interventions to reduce positive symptoms in schizophrenia: systematic review and network meta-analysis. World Psychiatry. 2018;17(3):316–29. source

      The Discussion (page unavailable) says trial participants generally continued antipsychotic medication while receiving interventions for positive symptoms, supporting the point that symptoms can persist during traditional treatment. It does not establish that these patients had responded well to that treatment. The Secondary outcomes section (page unavailable) says very few relapse data were available, so it does not substantiate the relapse-risk part of the claim. (LLM, conf=0.80)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    In alcohol use disorder, exercise did not reduce daily alcohol consumption or total scores on the Alcohol Use Disorders Identification Test.

    “Whilst exercise did not reduce daily alcohol consumption or total scores on the Alcohol Use Disorders Identification Test, it reduced depressive symptoms when compared to controls (RCTs = 4; SMD = -0.867,p = 0.006, I 2 = 63%).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [79] Hallgren M, Vancampfort D, Giesen ES, Lundin A, Stubbs B. Exercise as treatment for alcohol use disorders: systematic review and meta-analysis. Br J Sports Med. 2017;51(14):1058–64. source

  • May combine two claims.

    Findingcitation

    In people with schizophrenia, potential positive effects on mental health and cognitive symptoms have been suggested to be related to increases in hippocampal volume, but these findings in mental disorders have not been replicated in a recent meta-analysis of RCTs.

    “Among people with schizophrenia, the potential positive effects on mental health and cognitive symptoms have been suggested to be related to increases in hippocampal volume [87], yet these findings in mental disorders have not been replicated in a recent meta-analysis of RCTs [8].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [87] Pajonk FG, Wobrock T, Gruber O, et al. Hippocampal plasticity in response to exercise in schizophrenia. Arch Gen Psychiatry. 2010;67(2):133–43. source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [8] Firth J, Stubbs B, Vancampfort D, et al. Effect of aerobic exercise on hippocampal volume in humans: a systematic review and meta-analysis. Neuroimage. 2018;166:230–8. source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    There is some tentative evidence that supervised exercise may be helpful for people with anorexia nervosa without negatively impacting BMI.

    “There is some tentative evidence that supervised exercise may be helpful for people with AN [72] without negatively impacting BMI [82] and may help improve ED symptoms in bulimia nervosa [72] whilst also potentially reducing binge eating disorder symptomology and depressive symptoms and improving psychological wellbeing in binge eating disorders [71].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [72] Moola FJGS, Amara CE. Exercise in the care of patients with anorexia nervosa: a systematic review of the literature. Ment Health Phys Act. 2013;6(2):59–68. source
    • cites [82] Ng LW, Ng DP, Wong WP. Is supervised exercise training safe in patients with anorexia nervosa? A meta-analysis. Physiotherapy. 2013;99(1):1–11. source

  • May combine two claims.

    Findingcitation

    Available evidence indicates that moderate-to-vigorous intensity exercise may improve substance use disorder abstinence rates and anxiety/depressive symptoms across multiple substance use disorders.

    “Available evidence indicates that moderate-to-vigorous intensity exercise may improve SUD abstinence rates and anxiety/ depressive symptoms across multiple SUDs [80,81].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [80] Colledge F, Gerber M, Puhse U, Ludyga S. Anaerobic exercise training in the therapy of substance use disorders: a systematic review. Front Psychiatry. 2018;9:644. source

      The Summary of Main Findings Regarding Primary Outcomes (page not provided) says vigorous exercise may benefit some outcomes, and the review reports positive abstinence findings for nicotine dependence and some reductions in anxiety and depression for drug dependence. But results across substance use disorders were mixed, and the Conclusions say exercise intensities were usually not measured well enough to determine their effects. The source therefore does not establish the claimed benefit specifically for moderate-to-vigorous intensity exercise across multiple disorders. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [81] Wang D, Wang Y, Li R, Zhou C. Impact of physical exercise on substance use disorders: a meta-analysis. PLoS One. 2014;9(10):e110728. source

  • May combine two claims.

    Findingcitation

    People with mental illness are significantly less active and more sedentary than the general population.

    “This is particularly relevant to psychiatric populations, as people with mental illness are significantly less active and more sedentary than the general population [94], and this has been identified as a transdiagnostic risk factor for the elevated cardio-metabolic risk [95][96][97].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [94] Vancampfort D, Firth J, Schuch FB, et al. Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis. World Psychiatry. 2017;16(3):308–15. source

      The paper reports significantly more sedentary behavior and less moderate and vigorous physical activity than matched healthy controls (Daily amount of sedentary behavior; Daily amount of moderate or vigorous physical activity). Its findings concern people with severe mental illness—schizophrenia, bipolar disorder or major depressive disorder—not people with mental illness generally. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    In a recent large-scale study (n = 945), aerobic exercise was equally as effective as internet-delivered CBT and better than usual care after 12 months.

    “Whilst the diagnoses of depression were identified through the Patient Health Questionnaire [104], a recent large-scale (n = 945) study [105] has partly addressed this concern, finding that aerobic exercise was equally as effective as internet delivered CBT and better than usual care after 12 months.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [105] Hallgren M, Helgadottir B, Herring MP, et al. Exercise and internet-based cognitive-behavioural therapy for depression: multicentre randomised controlled trial with 12-month follow-up. Br J Psychiatry. 2016;209(5):414–20. source

      The Results report 945 patients, and Depression severity reports that exercise produced greater reductions than usual care at 12 months. However, the Exercise section includes yoga and stretching as well as aerobics, so the finding cannot be attributed specifically to aerobic exercise. The paper also does not establish that exercise and internet-delivered CBT were equally effective; its Discussion says both were at least as effective as usual care. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In children in the general population, aerobic exercise has positive effects on cognition, mental health and academic achievement.

    “Similar positive effects of the benefits of aerobic exercise on cognition, mental health and academic achievement have been observed in children in the general population [5,6,115].”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [5] Lubans D, Richards J, Hillman C, et al. Physical activity for cognitive and mental health in youth: a systematic review of mechanisms. Pediatrics. 2016;138(3):e20161642. source

      The Conclusion (p. 21) says physical activity interventions can improve cognitive and mental health in young people, supporting those parts of the claim. It does not establish the same combined finding specifically for aerobic exercise in children in the general population, or report improved academic achievement; the achievement study listed in the References (p. 23) concerns overweight children. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [6] Lubans D, Plotnikoff R, Lubans N. A systematic review of the impact of physical activity programmes on social and emotional well-being in at-risk youth. Child Adolesc Ment Health. 2011;17(1):2–13. source
    • cites [115] Lees C, Hopkins J. Effect of aerobic exercise on cognition, academic achievement, and psychosocial function in children: a systematic review of randomized control trials. Prev Chronic Dis. 2013;10:E174. source

  • May combine two claims.

    Premisecitation

    Depression is highly comorbid in schizophrenia and treatment options are limited.

    “Depression is highly comorbid in schizophrenia and treatment options are limited [112]; thus, future well-powered RCTs are required that specifically include people with schizophrenia and depression to elucidate if exercise can improve depressive symptoms.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [112] Gregory A, Mallikarjun P, Upthegrove R. Treatment of depression in schizophrenia: systematic review and meta-analysis. Br J Psychiatry. 2017;211(4):198–204. source

  • May combine two claims.

    Findingown data

    The included articles comprised 16 meta-analyses of 152 RCTs in people with clinical disorders and 11 further systematic reviews in people with elevated symptoms.

    “This included 16 meta-analyses of 152 RCTs in people with clinical disorders [33,34,[57][58][59][60][61][62][63][64][65][66][67][68][69][70] and 11 further systematic reviews in people with elevated symptoms and areas not covered by the existing meta-analyses [71][72][73][74][75][76][77][78][79][80][81].”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The mean AMSTAR and AMSTAR+ scores for MDD meta-analyses were 9.71 (range 7-11) and 1.71 (range 1-4), respectively.

    “The mean AMSTAR and AMSTAR+ scores were 9.71 (range 7-11), 1.71 (range 1-4), respectively.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    The initial searches identified 4089 de-duplicated hits, of which 269 full-text screens were reviewed, and 27 articles were included.

    “The initial searches identified 4089 de-duplicated hits, of which 269 full text screens were reviewed.Following the full-text screening, a total of 27 articles were included.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In adults with clinical depression, across six RCTs with blinded group allocation, blinded outcome assessments, and ITT analysis, the effect of exercise on depressive symptoms is small, heterogeneous, and non-significant.

    “However, across six RCTs with 461 participants that had blinded group allocation, blinded outcome assessments, and ITT analysis, a small, heterogeneous but non-significant effect was evident (g = -0.26,95% CI -0.61 to 0.08, p = 0.14, I 2 = 68%).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [61] Kvam S, Kleppe CL, Nordhus IH, Hovland A. Exercise as a treatment for depression: a meta-analysis. J Affect Disord. 2016;202:67–86. source

  • The quote only partly states this claim.

    Findingcitation

    In children with ADHD, aerobic exercise improved social disorders (SMD = 0.59, 95% CI 0.03-1.16, 2 RCTs, n = 53, I2 = 0%).

    “Overall exercise improved multiple outcomes including attention (SMD = 0.84, 95% CI 0.48-1.20,I 2 = 0%), hyperactivity (SMD = 0.56, 95% CI 0.04-1.08,RCTs = 2, n = 62, I 2 = 0%), impulsivity (SMD = 0.56, 95% CI 0.04-1.08,RCTs = 2, n = 62, I 2 = 0%), anxiety symptoms (SMD = 0.66, 95% CI 0.13-1.18,RCTs = 2, n = 64, I 2 = 0%), executive function (SMD = 0.58, 95% CI 0.15-1.00,RCTs = 3, n = 102, I 2 = 8”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [68] Cerrillo-Urbina AJ, Garcia-Hermoso A, Sanchez-Lopez M, Pardo-Guijarro MJ, Santos Gomez JL, Martinez-Vizcaino V. The effects of physical exercise in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis of randomized control trials. Child Care Health Dev. 2015;41(6):779–88. source

  • May combine two claims.

    Findingown data

    The mean AMSTAR and AMSTAR+ scores for anxiety and stress-related disorder meta-analyses were 6.66 (range 5-9) and 3 (range 1-3), respectively.

    “Overall, the mean AMSTAR and AMSTAR+ scores were 6.66 (range 5-9) and 3 (range 1-3), respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In adults with MDD, exercise does not improve speed of processing, attention/vigilance, working memory, verbal learning and memory, or reasoning and problem solving.

    “Across several subgroup analyses exercise did not improve speed of processing; attention/ vigilance; working memory; verbal learning and memory and reasoning and problem solving.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [64] Brondino N, Rocchetti M, Fusar-Poli L, et al. A systematic review of cognitive effects of exercise in depression. Acta Psychiatr Scand. 2017;135(4):285–95. source

  • May combine two claims.

    Findingcitation

    Exercise may potentially reduce binge eating disorder symptomology and depressive symptoms and improve psychological wellbeing in binge eating disorder.

    “There is some tentative evidence that supervised exercise may be helpful for people with AN [72] without negatively impacting BMI [82] and may help improve ED symptoms in bulimia nervosa [72] whilst also potentially reducing binge eating disorder symptomology and depressive symptoms and improving psychological wellbeing in binge eating disorders [71].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [71] Melo MC, Daher Ede F, Albuquerque SG, de Bruin VM. Exercise in bipolar patients: a systematic review. J Affect Disord. 2016;198:32–8. source

  • May combine two claims.

    Findingnone given

    Limited data from interventions are available to support the use of moderate-to-vigorous intensity exercise in bipolar disorder, although observational data imply that exercise can have a positive impact on depressive symptomology.

    “Finally, limited data from interventions are available to support the use of moderate-to-vigorous intensity exercise in bipolar disorder, although observational data imply that exercise can have a positive impact on depressive symptomology.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    There is good evidence that moderate-to-vigorous intensity exercise in the pre- and postpartum period can reduce depressive symptoms and the odds of developing depression.

    “There is also good evidence that moderateto-vigorous intensity exercise in the pre-and postpartum period can reduce depressive symptoms and the odds of developing depression [76][77][78].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [76][77][78]

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

  • May combine two claims.

    Findingcitation

    In people with PTSD (as indicated by validated measures, but without confirmed diagnoses), preliminary evidence suggests that moderate-to-vigorous intensity exercise can reduce symptoms of both PTSD and depression.

    “Fourth, in people with PTSD (as indicated by validated measures, but without confirmed diagnoses), preliminary evidence suggests that moderate-to-vigorous intensity exercise can reduce symptoms of both PTSD and depression [75].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] Rosenbaum S, Vancampfort D, Steel Z, Newby J, Ward PB, Stubbs B. Physical activity in the treatment of Post-traumatic stress disorder: a systematic review and meta-analysis. Psychiatry Res. 2015;230(2):130–6. source

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

    Findingcitation

    Among people with anxiety and stress disorders, theories with modest amounts of data suggest that increasing self-esteem, adaptations in GABA levels, adaptations in norepinephrine and the serotonin neurotransmitter system may account for the anxiolytic effects.

    “Among people with anxiety and stress disorders, a number of theories with modest amounts of data have suggested that increasing self-esteem, adaptations in GABA levels, adaptations in norepinephrine and the serotonin neurotransmitter system may account for the anxiolytic effects [91].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [91] Herring M. Exercise for the management of anxiety and stress-related disorders. In: Stubbs B, Rosenbaum S, editors. Exercise based interventions for mental illness: physical activity as part of clinical treatment. London: Elsevier; 2018.

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Exercise was effective in high-quality RCTs when considering those with MDD and subthreshold depressive symptoms but not in MDD only, although limited to 2 RCTs.

    “For instance, Schuch et al. [60] found that exercise was effective in high-quality RCTs when considering those with MDD and subthreshold depressive symptoms but not in MDD only (although limited to 2 RCTs).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [60] Schuch FB, Vancampfort D, Richards J, Rosenbaum S, Ward PB, Stubbs B. Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J Psychiatr Res. 2016;77:42–51. source

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

    Findingnone given

    There is a paucity of data on potential adverse events and cost-effectiveness data from exercise interventions.

    “Finally, there is a paucity of data on potential adverse events and cost-effectiveness data from exercise interventions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    For many of the mental disorder categories, the number of RCTs and included participants was small and included samples that are unrepresentative of the realities of clinical practice.

    “Second, for many of the mental disorder categories, the number of RCTs and included participants was small and included samples that are unrepresentative of the realities of clinical practice.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    There was variation in the calculation and reporting of effect sizes, publication bias, heterogeneity and general reporting.

    “Fifth, owing to the complex nature of the field, there was variation in the calculation and reporting of effect sizes, publication bias, heterogeneity and general reporting.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingreasoning

    It has yet to be tested in experimental studies whether increasing an individual's physical activity behaviour can prevent the onset of psychiatric conditions.

    “However, this has yet to be tested in experimental studies, and so the key question remains as to whether increasing an individual's PA behaviour can actually prevent the onset of psychiatric conditions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    There was considerable heterogeneity in the exercise interventions across the included systematic reviews and specific details regarding the frequency, intensity, type and time of exercise were often lacking.

    “First, there was considerable heterogeneity in the exercise interventions across the included systematic reviews and specific details regarding the frequency, intensity, type and time of exercise were often lacking.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In schizophrenia/serious mental illness, adverse event reporting at a meta-analytical level is sparse, whilst dropout from exercise interventions appears higher than in control groups.

    “In schizophrenia/serious mental illness, adverse event reporting at a meta-analytical level is sparse, whilst dropout from exercise interventions appears higher than in control groups [113].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [113] Vancampfort D, Rosenbaum S, Schuch FB, Ward PB, Probst M, Stubbs B. Prevalence and predictors of treatment dropout from physical activity interventions in schizophrenia: a meta-analysis. Gen Hosp Psychiatry. 2016;39:15–23. source

  • May combine two claims.

    Findingnone given

    The RCTs in anxiety and stress disorders to date have included relatively few people and there are a small number of RCTs.

    “The RCTs in anxiety and stress disorders to date have included relatively few people and there are a small number of RCTs, clearly emphasising a need for larger-scaled RCTs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Significant effects on positive and negative symptoms were only observed in RCTs which administered at least 90 min per week of moderate-to-vigorous intensity exercise, with no symptomatic benefits observed from low-intensity training.

    “Similarly, significant effects on positive and negative symptoms were only observed in RCTs which administered at least 90 min per week of moderateto-vigorous intensity exercise (with no symptomatic benefits observed from low-intensity training) [34].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Firth J, Cotter J, Elliott R, French P, Yung AR. A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychol Med. 2015;45(7):1343–61. source

  • May combine two claims.

    Findingcitation

    Among people with mental disorders identified through clinically validated measures (but in absence of confirmed diagnoses), there is encouraging evidence for improved mental health outcomes in those with PTSD, anorexia nervosa, bulimia nervosa, binge eating disorder, alcohol use disorder, substance use disorders and pre/post-natal depression.

    “Among people with mental disorders identified through clinically validated measures (but in absence of confirmed diagnoses), there is encouraging evidence for improved mental health outcomes in those with PTSD [75], anorexia nervosa [72], bulimia nervosa [74], binge eating disorder [73], alcohol use disorder [79], substance use disorders [80,81] and pre/post-natal depression [76][77][78].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [75] Rosenbaum S, Vancampfort D, Steel Z, Newby J, Ward PB, Stubbs B. Physical activity in the treatment of Post-traumatic stress disorder: a systematic review and meta-analysis. Psychiatry Res. 2015;230(2):130–6. source
    • cites [72] Moola FJGS, Amara CE. Exercise in the care of patients with anorexia nervosa: a systematic review of the literature. Ment Health Phys Act. 2013;6(2):59–68. source
    • cites [74] Vancampfort D, Vanderlinden J, De Hert M, et al. A systematic review of physical therapy interventions for patients with anorexia and bulemia nervosa. Disabil Rehabil. 2014;36(8):628–34. source

  • May combine two claims.

    Findingown data

    Based on the current AMSTAR+ scores, publication bias was potentially problematic for the majority of the meta-analyses, potentially overestimating the pooled effect sizes.

    “Fourth, based on the current AMSTAR+ scores publication bias was potentially problematic for the majority of the meta-analyses, potentially overestimating the pooled effect sizes.”
    Quote in the paperSubstantial claim

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

    Findingnone given

    To date, most RCTs have focused on aerobic exercise in people with clinical anxiety/stress disorders.

    “To date, most RCTs have focussed on aerobic exercise in people with clinical anxiety/stress disorders.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingnone given

    For anorexia nervosa, there is a limited number of RCTs.

    “Limited number of RCTs”
    Quote in the paperNot a substantial claim

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

    Findingnone given

    For binge eating disorder, studies use self-report measures.

    “use of | self-report measures”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingnone given

    For bulimia nervosa, there is a paucity of data and participants.

    “Paucity of data, participants”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    For bipolar disorder, there is a paucity of intervention studies (no RCTs).

    “Paucity of intervention studies | (no RCTs)”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingcitation

    In anorexia nervosa, 6 studies showed improved psychological wellbeing with exercise.

    “6 studies | showed improved psychologi- | cal wellbeing”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [72] Moola FJGS, Amara CE. Exercise in the care of patients with anorexia nervosa: a systematic review of the literature. Ment Health Phys Act. 2013;6(2):59–68. source

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

    Findingnone given

    For binge eating disorder, there is diversity of studies.

    “Diversity of studies”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingreasoning

    For bulimia nervosa, there is insufficient evidence to make any firm conclusions.

    “insufficient evidence to | make any firm conclusions”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    Data extraction was undertaken by four pairs of authors.

    “Data extraction was undertaken by four pairs of authors.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Four independent pairs of authors searched MEDLINE/PubMed, PsycINFO and EMBASE from inception to 1/10/2018 for systematic reviews with meta-analyses of RCTs investigating exercise interventions across mental disorders.

    “Four independent pairs of authors searched MEDLINE/Pub-Med, PsycINFO and EMBASE from inception to 1/10/2018, for systematic reviews with meta-analyses of randomised controlled trials (RCTs) investigating exercise interventions (defined below) across a range of mental disorders.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    A broad spectrum of mental disorders is associated with cognitive dysfunction, for which current treatments are limited.

    “Additionally, a broad spectrum of mental disorders are associated with cognitive dysfunction, for which current treatments are limited [39][40][41][42][43].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [39] Kahn RS, Keefe RS. Schizophrenia is a cognitive illness: time for a change in focus. JAMA Psychiatry. 2013;70(10):1107–12. source
    • cites [40] Elias LR, Miskowiak KW, Vale AM, et al. Cognitive impairment in euthymic pediatric bipolar disorder: a systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 2017;56(4):286–96. source
    • cites [41] Bortolato B, Miskowiak KW, Kohler CA, Vieta E, Carvalho AF. Cognitive dysfunction in bipolar disorder and schizophrenia: a systematic review of meta-analyses. Neuropsychiatr Dis Treat. 2015;11:3111–25.

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

  • May combine two claims.

    Interpretationcitation

    Exercise may be an effective adjunct treatment for those with substance use disorders in terms of abstinence and withdrawal and also improve mood.

    “Exercise may be an effective adjunct treatment for those with substance use disorders in terms of abstinence and withdrawal and also improve mood”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Almost all included studies did not set out with the primary objective to influence cognition and no studies included people with cognitive dysfunction at baseline.

    “However, almost all the included studies did not set out with the primary objective to influence cognition and no studies included people with cognitive dysfunction at baseline.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationnone given

    The field of exercise science has in the space of 20 years made significant strides in establishing itself as an important adjunctive treatment for mental disorders.

    “Despite these aforementioned limitations, the field of exercise science has in the space of 20 years made significant strides in establishing itself as an important adjunctive treatment for mental disorders, underpinned by ever increasing robust science.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    There is consistent evidence that exercise can reduce depressive symptoms in children, adults and older adults, with encouraging evidence in anxiety and stress disorders, children with ADHD and people with schizophrenia spectrum.

    “There is consistent evidence that exercise can reduce depressive symptoms in children, adults and older adults with encouraging evidence in anxiety and stress disorders, children with ADHD and people with schizophrenia spectrum.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Among people with elevated mental health symptoms, exercise can improve multiple mental health outcomes in those with anorexia nervosa, binge eating disorder, bulimia nervosa, alcohol use disorders, substance use disorders and pre- and post-natal depression.

    “Among people with elevated mental health symptoms, exercise can improve multiple mental health outcomes in those with anorexia nervosa, binge eating disorder, bulimia nervosa, alcohol use disorders, substance use disorders and pre-and post-natal depression; however, further research is needed in these conditions.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Beyond MDD, we are not yet at the stage of making evidence-based bespoke recommendations on the optimal clinical delivery of exercise.

    “Beyond MDD, we are not yet at the stage of making evidence-based bespoke recommendations on the optimal clinical delivery of exercise.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    In people with mental disorders, there is promising evidence that exercise has a positive impact on mental health symptoms and tentative evidence for benefits for cognition in schizophrenia spectrum disorders.

    “In conclusion, in those with mental disorders, there is promising evidence that exercise has a positive impact on mental health symptoms and tentative evidence for benefits for cognition in schizophrenia spectrum disorders.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Interpretationcitation

    Exercise may be associated with improved depressive symptoms in bipolar disorder.

    “Exercise may be associated | with improved depressive | symptoms; however, the | evidence does not confirm | a cause-effect relationship | between mood and exercise”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Interpretationnone given

    The evidence does not confirm a cause-effect relationship between mood and exercise in bipolar disorder.

    “the | evidence does not confirm | a cause-effect relationship | between mood and exercise”
    Quote in the paperSubstantial claim
58 of 58

  • The paper relies on this without support.

    No existing research has examined the potential efficacy of exercise as a transdiagnostic intervention across all classes of mental illness.

    “Despite this rapid expansion of meta-analytic evidence on exercise interventions for improving mental and cognitive outcomes in individual classes of mental disorders, no existing research has examined the potential efficacy of exercise as a transdiagnostic intervention across all classes of mental illness.”

  • The paper relies on this without support.

    There is little systematic examination of the evidence for aerobic, resistance and combined exercise modalities, which precludes translation into practice and policy.

    “Furthermore, there is little systematic examination of the evidence for aerobic, resistance and combined exercise modalities, which precludes translation into practice and policy.”

  • The paper relies on this without support.

    The quality of these meta-analyses and the included trials has not been comprehensively evaluated.

    “Moreover, the quality of these meta-analyses and the included trials has not been comprehensively evaluated, which is an indispensable step before more rigorous exercise recommendations are made.”
3 of 3

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?

  • Physical activity interventions across 8 RCTs did not significantly reduce total symptoms in schizophrenia.

    “In schizophrenia and non-affective psychotic disorders, physical activity interventions across 8 RCTs did not significantly reduce total symptoms.”

    From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [77]

    Section 3.1.6 reports a meta-analysis of 11 RCTs in schizophrenia spectrum disorders and says interventions exceeding 90 minutes of moderate-to-vigorous physical activity per week significantly improved total symptoms. The claim instead attributes a nonsignificant total-symptom result across eight RCTs to this source; that result is not reported in the cited section. (LLM, conf=0.86)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • Exercise shows no overall cognitive benefits in major depression.

    “The cognitive benefits of exercise in major depression were examined in eight trials, showing no overall benefits.”

    From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [77]

    Section 4.3 reports that a meta-analysis found no main effect of aerobic exercise on cognitive functioning in people with major depressive disorder. The copy does not establish that this finding came from eight trials; §3.1.3 instead identifies a four-trial exercise-only subgroup that improved visual learning and memory. The review also says the evidence is insufficient to determine whether aerobic exercise can improve cognition in this population. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Exercise reduces symptoms in people receiving treatment for anxiety in primary care (SMD=0.32, 95% CI -0.62 to -0.01).

    “and in people receiving treatment for anxiety in primary care (n=4, SMD=0.32, 95% CI: -0.62 to -0.01).”

    From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [77]

    Section 3.1.5 reports that exercise reduced anxiety symptoms across four RCTs in primary care, with a 95% CI of -0.62 to -0.01. However, it gives the SMD as -0.32, not +0.32, and does not establish that all participants were already receiving treatment for anxiety. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Exercise significantly reduces depression in older adults with high levels of depression symptoms (SMD=-0.90, 95% CI -1.51 to -0.29).

    “although exercise did significantly reduce depression in older adults with high levels of depression symptoms (n=8, N=267, SMD=-0.90, 95% CI: -1.51 to -0.29, p=0.004).”

    From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [77]

    Section 3.1.4 (Older Adults; page unavailable) reports that aerobic exercise improved depressive symptoms in eight RCTs with 267 older participants, with the stated SMD and confidence interval. It describes participants as having depressive symptoms, but does not specify that they had high levels of symptoms. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In high-quality trials comparing exercise to active controls, benefits are small and non-significant (SMD=0.11, 95% CI -0.41 to 0.18).

    “However, only small, non-significant benefits were observed in four trials deemed of 'high quality' and comparing exercise to other active control conditions (SMD=0.11, 95% CI: -0.41 to 0.18, I²=62%).”

    From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [77]

    Section 3.1.3 (Adults) reports no difference between exercise and other active interventions across four high-quality RCTs, with a 95% CI of −0.41 to 0.18 and I²=62%. The cited sentence matches those details but gives the SMD as +0.11; the source reports −0.11. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

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.

  • Anxiety effect estimate lies outside its confidence interval

    Major

    The reported effect of −0.581 is outside the stated 95% confidence interval of −1.0 to −0.76. The midpoint of those interval limits is −0.88, so this is not a rounding difference.

    Reported -0.581 · recomputed -0.88

  • Schizophrenia depression result reverses later in the paper

    Minor

    The results section says aerobic exercise did not improve depressive symptoms in schizophrenia, while the discussion says it does.

  • Discussion cites substance-use reviews as schizophrenia reviews

    Minor

    The discussion identifies references 80 and 81 among four schizophrenia or serious-mental-illness meta-analyses, whereas the results identify references 69 and 70 for those two reviews.

  • Anxiety discussion cites schizophrenia analyses

    Minor

    The discussion cites references 33, 34 and 69 for the anxiety-disorder finding, but the results identify the three anxiety and stress-disorder meta-analyses as references 65-67.

  • Schizophrenia-review quality scores are not all identical

    Minor

    The text says every review in this section scored 5 and 3, but it gives the serious-mental-illness review scores of 4 and 2.

  • Reference 64 is described as two different reviews

    Minor

    The discussion calls reference 64 a Cochrane review of depressive symptoms; the results identify it as Brondino and colleagues' review of cognitive symptoms. The paper identifies the Cochrane depression review as reference 62.

6 of 6

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders—DSM-IV-TR. 4th edition. In: American Psychiatric Association; 2000.

Cited by

Sorted by citations

Related

Authors
Ashdown-Franks, G., Firth, J., Carney, R., Carvalho, A. F., Hallgren, M., Koyanagi, A., Rosenbaum, S., Schuch, F. B., Smith, L., Solmi, M., Vancampfort, D., & Stubbs, B.
Affiliations
  • The University of Melbourne (AU)
  • Greater Manchester Mental Health NHS Foundation Trust (GB)
  • Centre for Addiction and Mental Health (CA)
  • Karolinska Institutet (SE)
  • Parc Sanitari Sant Joan de Déu (ES)
  • Black Dog Institute (AU)
  • Universidade Federal de Santa Maria (BR)
  • Anglia Ruskin University (GB)
  • University of Padua (IT)
  • KU Leuven (BE)
  • King's College London (GB)
Corresponding author
Stubbs, Brendon
ORCID
Venue
Sports Medicine
Publisher
Springer Science and Business Media LLC
Published
2019-09-20
Volume
50
Issue
1
Pages
151-170
ISSN
  • 0112-1642 (ISSN-L)
  • 1179-2035
DOI
10.1007/s40279-019-01187-6
OpenAlex
W2972381227
Semantic Scholar
dd8fc6feeb89fead775c12a9ba526edecfb7be02
Cited by
446
References
129
Citations by year
2026: 43 · 2025: 65 · 2024: 78 · 2023: 70 · 2022: 56 · 2021: 65 · 2020: 41 · 2019: 3
FWCI
26.72
Type
journal article
Language
en
Open access
Licence
Locations
  • Sports Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion, other-oa)
  • Lirias (KU Leuven) (submittedVersion, other-oa)
  • Anglia Ruskin Research Online (Anglia Ruskin University) (submittedVersion)
  • Figshare (submittedVersion, cc-by-nc-nd)
  • Figshare (submittedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion)
Funders
  • Research Capability Fund via Greater Manchester West Mental Health NHS Foundation Trust
  • Health Education England and NIHR Integrated Clinical Academic (ICA) Programme (ICA-CL-2017-03-001)
  • Blackmores Institute Fellowship
  • Maudsley Charity and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust
  • Mitacs Canada Globalink
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
exercise medicine, mental illness, substance use disorders, severe mental illness, schizophrenia, bipolar disorder, major depressive disorder, anxiety disorders
MeSH terms
Systematic Reviews as Topic, Feeding and Eating Disorders, Mental Disorders, Exercise Therapy, Humans, Randomized Controlled Trials as Topic, Substance-Related Disorders

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 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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