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

In the paper

“Evidence from 2 reviews [80, 81], including 48 studies found that exercise effectively increased abstinence rates, particularly for nicotine”

What the sources say

• Disputed

  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.

  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. sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  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. sourceExperimental — accuracy not yet measured

In the paper

“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].”

What the sources say

• Partly supported

  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)

  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. sourceExperimental — accuracy not yet measured
• Disputed

  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.

  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. sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [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

In the paper

“two independent authors assessed the quality of the systematic reviews and meta-analyses using the AMSTAR and AMSTAR+ tool [53][54][55].”

What the sources say

• Supported

  The Methods section says two reviewers applied AMSTAR to systematic reviews, including meta-analyses. The Discussion identifies AMSTAR as an instrument for assessing the methodological quality of systematic reviews. This citation supports identification of the AMSTAR tool; it does not establish what the citing authors did or identify AMSTAR+. (LLM, conf=0.90)

  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
• Supported

  The Background and Methods (Objective 2; pages not provided) describe the development of AMSTAR as a tool for assessing the methodological quality of systematic reviews. In this sentence, the citation identifies the AMSTAR tool; the statement that two authors used it describes the citing authors’ own procedure, while the other citations may address AMSTAR+. (LLM, conf=0.89)

  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
• ?Not checked — no full text of the sourcecites [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.

In the paper

“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.”

What the sources say

• Partly supported

  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)

  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. sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  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. sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [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

In the paper

“Three RCTs reported adverse events and no difference in the exercise or control interventions.”

What the sources say

• Partly supported

  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)

  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. sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Partly supported

  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)

  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. sourceExperimental — accuracy not yet measured
• Supported

  The Methods describe six additional AMSTAR-Plus Content items assessing content quality, with a score ranging from 0 to 8. The Results say only one strategy scored above 4, and the Discussion identifies that strategy as the exception to generally low content quality, supporting the stated cutoff. (LLM, conf=0.88)

  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

In the paper

“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].”

What the sources say

• Supported

  The Conclusions and Recommendations section acknowledges residual symptoms despite treatment and recommends discussing the probability of relapse whether antipsychotics are stopped or continued. The Individual Differences section also says only a minority of patients stabilized after an acute episode may discontinue treatment without relapse. These passages support the claim for patients with schizophrenia treated with antipsychotics; page numbers were not provided for the passages. (LLM, conf=0.88)

  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
• Partly supported

  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)

  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. sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  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. sourceExperimental — accuracy not yet measured

In the paper

“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%).”

What the sources say

• Supported

  The Meta-analysis of exercise versus control conditions (Alcohol consumption) reports no evidence that exercise reduced average daily alcohol consumption or AUDIT total scores. The paper’s Results section also uses the same wording as the claim. (LLM, conf=0.95)

  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

In the paper

“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].”

What the sources say

• Partly supported

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

  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. sourceExperimental — accuracy not yet measured
• Partly supported

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

  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. sourceExperimental — accuracy not yet measured

In the paper

“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].”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• Supported

  The Discussion (p. 9) says supervised exercise in the management of anorexia nervosa may have psychological and physiological benefits without a negative impact on weight. The Abstract (p. 1) reports improved strength and cardiovascular fitness with no detrimental effect on anthropometric measures. The claim's tentative wording is consistent with the study limitations noted on p. 10. (LLM, conf=0.91)

  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

In the paper

“Available evidence indicates that moderate-to-vigorous intensity exercise may improve SUD abstinence rates and anxiety/ depressive symptoms across multiple SUDs [80,81].”

What the sources say

• Partly supported

  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)

  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. sourceExperimental — accuracy not yet measured
• Supported

  The Abstract Results report increased abstinence rates and reduced anxiety and depression symptoms in a meta-analysis of exercise interventions. The Abstract Conclusions identify moderate- and high-intensity aerobic exercise as effective for people with substance use disorders, and the Conclusions specify alcohol, nicotine, and illicit drugs. Depression findings varied by disorder, consistent with the citing sentence’s cautious wording. (LLM, conf=0.87)

  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

In the paper

“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].”

What the sources say

• Partly supported

  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)

  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. sourceExperimental — accuracy not yet measured

In the paper

“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.”

What the sources say

• Partly supported

  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)

  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. sourceExperimental — accuracy not yet measured

In the paper

“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].”

What the sources say

• Partly supported

  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)

  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. sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [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
• Supported

  The Results report improved cognitive and academic performance in several trials and less depression and greater self-esteem in a trial measuring mental health. The Discussion says the review excluded studies of specific populations to improve population-level generalizability. It also cautions that only one study examined mental-health outcomes and that some improvements were small or nonsignificant (page numbers unavailable). (LLM, conf=0.90)

  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

In the paper

“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.”

What the sources say

• Supported

  The introductory passage reports that depression affects over 50% of people with schizophrenia and that specific treatment guidance is lacking. The Conclusions add that evidence for antidepressant treatment is mixed and based on a small number of studies, supporting the claim that treatment options are limited. (LLM, conf=0.90)

  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

In the paper

“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].”

In the paper

“The mean AMSTAR and AMSTAR+ scores were 9.71 (range 7-11), 1.71 (range 1-4), respectively.”

In the paper

“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.”

In the paper

“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%).”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“Overall, the mean AMSTAR and AMSTAR+ scores were 6.66 (range 5-9) and 3 (range 1-3), respectively.”

In the paper

“Across several subgroup analyses exercise did not improve speed of processing; attention/ vigilance; working memory; verbal learning and memory and reasoning and problem solving.”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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].”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

In the paper

“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].”

What the sources say

• ?Not matched

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

  cites [76][77][78]

In the paper

“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].”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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.

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“Finally, there is a paucity of data on potential adverse events and cost-effectiveness data from exercise interventions.”

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

“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].”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

In the paper

“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].”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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].”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

In the paper

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

In the paper

“Limited number of RCTs”

In the paper

“use of | self-report measures”

In the paper

“Paucity of data, participants”

In the paper

“Paucity of intervention studies | (no RCTs)”

In the paper

“6 studies | showed improved psychologi- | cal wellbeing”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“Diversity of studies”

In the paper

“insufficient evidence to | make any firm conclusions”

In the paper

“Data extraction was undertaken by four pairs of authors.”

In the paper

“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.”

In the paper

“Additionally, a broad spectrum of mental disorders are associated with cognitive dysfunction, for which current treatments are limited [39][40][41][42][43].”

What the sources say

• ?Not checked — no full text of the sourcecites [39] Kahn RS, Keefe RS. Schizophrenia is a cognitive illness: time for a change in focus. JAMA Psychiatry. 2013;70(10):1107–12. source
• ?Not checked — no full text of the sourcecites [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
• ?Not matched

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

  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.

In the paper

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

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

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

In the paper

“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.”

In the paper

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

In the paper

“the | evidence does not confirm | a cause-effect relationship | between mood and exercise”