The DOI matches its Crossref record; 88 of the 88 references it cites were found in a registry or an index; 5 of the 37 sources its claims cite were checked for support.
The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials
Open accessAbstract
Objective: To determine the effectiveness of exercise as an intervention in the management of depression. Design: Systematic review and meta-regression analysis of randomised controlled trials obtained from five electronic databases (Medline, Embase, Sports Discus, PsycLIT, Cochrane Library) and through contact with experts in the field, bibliographic searches, and hand searches of recent copies of relevant journals. Main outcome measures: Standardised mean difference in effect size and weighted mean difference in Beck depression inventory score between exercise and no treatment and between exercise and cognitive therapy. Results: All of the 14 studies analysed had important methodological weaknesses; randomisation was adequately concealed in only three studies, intention to treat analysis was undertaken in only two, and assessment of outcome was blinded in only one. The participants in most studies were community volunteers, and diagnosis was determined by their score on the Beck depression inventory. When compared with no treatment, exercise reduced symptoms of depression (standardised mean difference in effect size −1.1 (95% confidence interval −1.5 to −0.6); weighted mean difference in Beck depression inventory −7.3 (−10.0 to −4.6)). The effect size was significantly greater in those trials with shorter follow up and in two trials reported only as conference abstracts. The effect of exercise was similar to that of cognitive therapy (standardised mean difference −0.3 (95% confidence interval −0.7 to 0.1)). Conclusions: The effectiveness of exercise in reducing symptoms of depression cannot be determined because of a lack of good quality research on clinical populations with adequate follow up. What is already known on this topic: Depression is common Management is often inadequate and many patients do not comply with antidepressant medication The effect of exercise on depression has been a subject of interest for many years What this study adds: Most studies of the effect of exercise on depression are of poor quality, have brief follow up, and are undertaken on non-clinical volunteers Exercise may be efficacious in reducing symptoms of depression in the short term but its effectiveness in clinical populations is unknown A well designed, randomised controlled trial with long term follow up is needed
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This systematic review and meta-regression of 14 randomised controlled trials found that exercise reduced depressive symptoms compared with no treatment, but the evidence base was methodologically weak. The authors conclude that the effectiveness of exercise in managing depression cannot be determined because of a lack of good-quality research in clinical populations with adequate follow-up.
Key findings
- Across 14 included studies, most had important methodological weaknesses: allocation concealment was adequate in only 3 studies, intention-to-treat analysis was done in only 2, and outcome assessment was blinded in only 1.
- Exercise compared with no treatment reduced depressive symptoms: standardised mean difference in effect size −1.1 (95% CI −1.5 to −0.6); weighted mean difference in Beck depression inventory −7.3 (95% CI −10.0 to −4.6).
- The effect was significantly greater in trials with shorter follow-up and in two trials reported only as conference abstracts; pooled SMD was −0.7 (−1.0 to −0.5; n=8) for journal papers/dissertations versus −2.3 (−2.9 to −1.8; n=2) for conference abstracts.
- Exercise was similar to cognitive therapy: standardised mean difference −0.3 (95% CI −0.7 to 0.1), with homogeneous results (Q=2.9, P=0.4).
Methods
- Systematic review and meta-regression of randomised controlled trials identified from Medline, Embase, Sports Discus, PsycLIT, Cochrane Library, plus expert contact, bibliographic searches, and hand searches.
- Inclusion criteria: adults aged 18 or above diagnosed with depression by any method/severity, randomised controlled trial, depression as an outcome, any language; exclusions included studies comparing different exercise types, single exercise sessions, and anxiety/other neurotic disorders.
- From 72 potentially relevant studies, 56 were excluded and 14 studies (16 reports) were included; analyses used Cohen’s effect sizes and standardised mean differences, with random-effects meta-analysis for exercise versus no treatment and fixed-effects inverse-variance meta-analysis for exercise versus cognitive therapy.
Limitations
- The paper states that most studies were of poor quality, with inadequate allocation concealment, intention-to-treat analysis, and blinding; participants in most studies were community volunteers, and diagnosis was often determined by Beck depression inventory score rather than clinical interview.
- The paper states that only one study followed patients beyond the intervention period, and that the evidence does not support a sustained effect of exercise beyond the intervention period; it concludes that effectiveness in clinical populations is unknown.
- The paper also notes that screening out unmotivated individuals, using non-clinical volunteers, and lacking intention-to-treat analysis suggest the results overestimate what would happen in real life; evident from the text are the small number of trials, heterogeneity, and the influence of conference abstracts and short follow-up on effect size.
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Verification
Claims the paper makes
30 Own result · 11 Own interpretation · 8 No full text of the sources · 7 Not checked yet · 6 No basis given · 2 Couldn’t confirm · 2 Sources not found · 2 Own method · 1 Supported · 1 Partly supported · accuracy not yet measured
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“randomisation was adequately concealed in only three studies”
- Also stated in: § Quality assessment · hedged
“allocation might have been adequately concealed in only three studies. 74 75 82”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Abstract
What the sources say
- Could not verifycites [74] Singh, 1997, A randomized controlled trial of progressive resistance training in depressed elders., J Gerontol A Biol Sci Med Sci sourceExperimental — accuracy not yet measured
The Study design section describes randomization in this single trial using a computer-generated list, but does not assess whether allocation was adequately concealed. Searches for the three-of-14-studies claim and for allocation concealment found no passage assessing concealment across included studies. Page numbers were not available in our copy. (LLM, conf=0.76)
- Not checked — no full text of the sourcecites [75] source
- Could not verifycites [82] Martinsen, 1985, Effects of aerobic exercise on depression: a controlled study., BMJ sourceExperimental — accuracy not yet measured
The Patients, methods, and results section describes one trial and says its patients were allocated by block randomisation. It does not assess whether allocation was concealed or report a finding about three of 14 studies. Searches for adequate concealment and 14 included studies found no such passage in our copy. (LLM, conf=0.78)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Quality assessment · hedged
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“intention to treat analysis was undertaken in only two”
- Also stated in: § Quality assessment · plain
“Intention to treat analysis was undertaken in two studies.73 74”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Abstract
What the sources say
- Not checked — no full text of the sourcecites [73] source
- Could not verifycites [74] Singh, 1997, A randomized controlled trial of progressive resistance training in depressed elders., J Gerontol A Biol Sci Med Sci sourceExperimental — accuracy not yet measured
The Statistical analysis section describes the trial’s analyses but does not identify them as intention-to-treat. The Results section says all randomized subjects completed the study, but that does not establish whether an intention-to-treat analysis was undertaken. This individual trial also does not address the claim that only two of 14 included studies used that approach; searches for intention-to-treat analysis and all-randomized-subject analyses found no confirming passage. Page numbers are unavailable in our copy. (LLM, conf=0.75)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Quality assessment · plain
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Compliance with antidepressant treatment is often poor: studies have shown that between 20% and 59% of patients in primary care stop taking antidepressants within three weeks of the drugs being prescribed. 1 2”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Introduction
What the sources say
- Not checked — no full text of the sourcecites [1] Thompson, 1982, The treatment of depression in general practice: a comparison of L-tryptophan, amitriptyline and a combination of L-tryptophan and amitriptyline with placebo., Psychol Med source
- Partly supportedcites [2] Johnson, 1973, Treatment of depression in general practice., BMJ sourceExperimental — accuracy not yet measured
The Results (Drug Treatment) report that 59% of patients stopped taking their drugs within 21 days, supporting the upper end of the cited range and the three-week timeframe. This paper does not report that 20% stopped within three weeks, so it does not establish the full range attributed to the two citations. (LLM, conf=0.87)
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“When compared with no treatment, exercise reduced symptoms of depression (standardised mean difference in effect size -1.1 (95% confidence interval -1.5 to -0.6)”
- Also stated in: § Study populations · plain
“The pooled standardised mean difference in effect size, calculated using the random effects model, was -1.1 (95% confidence interval -1.5 to -0.6).”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Study populations · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and in two trials reported only as conference abstracts”
- Also stated in: § Study populations · plain
“The reported effect of treatment was significantly higher in conference abstracts than in peer reviewed journals or doctoral dissertations (P < 0.01).”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Study populations · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All of the 14 studies analysed had important methodological weaknesses”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The effect size was significantly greater in those trials with shorter follow up”
- Also stated in: § Study populations · plain
“Length of follow up was significantly negatively associated with the size of effect”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Study populations · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The effect of exercise was similar to that of cognitive therapy (standardised mean difference -0.3 (95% confidence interval -0.7 to 0.1))”
- Also stated in: § Exercise compared with standard treatments for depression · plain
“the difference in effect size between exercise and cognitive therapy was not significant (standardised mean difference -0.3 (95% confidence interval -0.7 to 0.1)).”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Abstract
plainn = 4- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Exercise compared with standard treatments for depression · plain
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“assessment of outcome was blinded in only one”
- Also stated in: § Quality assessment · plain
“assessment of outcome was blind in only one of the 14 studies.”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Quality assessment · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“weighted mean difference in Beck depression inventory -7.3 (-10.0 to -4.6)”
- Also stated in: § Study populations · plain
“Pooling the nine studies that used the Beck depression inventory as a measure of depression gave a weighted mean difference in the score of -7.3 (-10.0 to -4.6).”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Study populations · plain
- Probably not a substantial claim. 16
- It may state two separate claims as one. 17
- The quote only partly states this claim. 1
Every source the paper cites for this claim was checked and supports it.
In the paper
“One of the studies in which depression was confirmed by clinical interview also included patients with dysthymia (depressed mood, without the full range of symptoms of clinical depression).74”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Study populations
What the sources say
- Supportedcites [74] Singh, 1997, A randomized controlled trial of progressive resistance training in depressed elders., J Gerontol A Biol Sci Med Sci source
The Study population section states that eligible participants could meet DSM-IV criteria for dysthymia. The measures section states that psychiatric diagnoses were assessed by structured clinician interview, supporting both parts of the cited claim. (LLM, conf=0.93)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The participants in most studies were community volunteers”
- Also stated in: § Study populations · plain
“Nine of the studies involved non-clinical populations, 73 74 77 79-81 84 85 87and most participants were recruited through the media.”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Also stated in: § Study populations · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“diagnosis was determined by their score on the Beck depression inventory”
- Also stated in: § Study populations · plain
“the remainder using a cut-off point on the self reported Beck depression inventory score”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Also stated in: § Study populations · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Eight of the 14 studies compared an exercise group with a no treatment group, 74 75 77-79 82 and six compared exercise directly with an established form of therapy: four with cognitive therapy, 80 81 84 87 one with psychotherapy, 88 and one with antidepressant treatment.73”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Study inclusion and characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Through contact with authors we were able to obtain adequate data for a further five.”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Missing data and contact with authors
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although the effect size remained significant when the two conference abstracts were excluded and when we analysed only those studies of more than eight weeks' duration, the effect was reduced.”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Study populations
plaindirectn = 8- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of 72 potentially relevant studies, we excluded 56”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Study inclusion and characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Authors of 11 of the 14 studies responded to our request to provide missing data, 73-78 80 82-86 88”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Missing data and contact with authors
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Its main outcome measure -the Hamilton rating scale of depression-did not differ significantly between the groups of patients receiving the exercise intervention, medication, or both; and at the end of the intervention period the proportion of patients diagnosed as no longer depressed was similar in each group.”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Exercise compared with standard treatments for depression
What the sources say
- Not checked — no full text of the sourcecites [73] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“This was the only study that found no effect of exercise, compared with the control group, at the end of the intervention period (12 weeks); at nine months' follow up the reduction in symptoms remained similar in the exercise intervention, control (meditation), and cognitive therapy groups.84”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Quality of the studies
What the sources say
- Not checked — no full text of the sourcecites [84] Klein, 1985, A comparative outcome study of group psychotherapy vs. exercise treatments for depression., Int J Ment Health source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Pooling studies according to type of publication gave standardised mean differences, calculated using the fixed effects model, of -0.7 (-1.0 to -0.5; n = 8) for journal papers and dissertations and -2.3 (-2.9 to -1.8; n = 2) for conference abstracts”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Study populations
plaincorrelationaln = 8- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Only four of the nine studies with non-clinical participants used clinical interview to confirm the presence of depression, 73 74 79 84 the remainder using a cut-off point on the self reported Beck depression inventory score (each study using a different value).”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Study populations
plainn = 9- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“None of the participants in the studies we reviewed exercised alone: they were either with other participants or with a coach.”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Type of exercise
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Table 1 summarises the 11 studies that compared exercise with no treatment, 10 of which had data available for analysis.”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Study populations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“thus in total 11 studies compared exercise with no treatment and six compared it with an established treatment (fig 1).”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Study inclusion and characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“pooling according to duration of intervention gave -1.8 (-2.3 to -1.3; n = 2) for less than eight weeks, -1.3 (-1.8 to -0.9; n = 4) for eight weeks, and -0.6 (-0.9 to -0.3; n = 4) for more than eight weeks”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Study populations
plaincorrelationaln = 4- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Table 2 summarises the six studies that compared exercise and standard interventions, four of which”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Exercise compared with standard treatments for depression
plainn = 6- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one. The quote only partly states this claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, the fact that most studies used non-clinical participants means that the results may be less generalisable.”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Implications
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Three people independently reviewed titles and available abstracts to retrieve potentially relevant studies; studies needed to be identified by only one person to be retrieved.”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > JAMA, Archives of Internal Medicine, New England Journal of Medicine, Journal of the Royal Society of Medicine, Comprehensive Psychiatry, British Journal of Psychiatry, Acta
plainn = 3- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“However, these analyses pooled data from a range of study types that included uncontrolled studies and randomised as well as non-randomised controlled trials.They also pooled data from trials that compared exercise and no treatment with data from trials that compared exercise and other forms of treatment, and they did not explicitly assess the quality of the studies.”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Introduction
What the sources say
- Not checked — no full text of the sourcecites [9] North, 1990, Effect of exercise on depression., Exerc Sports Sci Rev source
- Not matchedcites [10] Carlson DL .The effects of exercise on depression: a review and meta-regression analysis [dissertation]. In: Milwaukee:University of Wisconsin,1991.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [11] Craft, 1998, The effects of exercise on clinical depression and depression resulting from mental illness: a meta-regression analysis., J Sport Exerc Psychol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Three meta-analyses have looked at the effect of exercise on depression, and all found a benefit.[9][10][11]”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Introduction
What the sources say
- Not checked — no full text of the sourcecites [9] North, 1990, Effect of exercise on depression., Exerc Sports Sci Rev source
- Not matchedcites [10] Carlson DL .The effects of exercise on depression: a review and meta-regression analysis [dissertation]. In: Milwaukee:University of Wisconsin,1991.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [11] Craft, 1998, The effects of exercise on clinical depression and depression resulting from mental illness: a meta-regression analysis., J Sport Exerc Psychol source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“In the past decade”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Introduction
What the sources say
- Not matchedcites [4] Biddle S Fox K Edmund L .Physical activity in primary care in England. London:Health Education Authority,1994.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
In the paper
“McNeil et al included a social contact control group and found no significant difference in the effect on depressive symptoms between this group and the exercise group.77”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Type of exercise
What the sources say
- Not checked — no full text of the sourcecites [77] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Other health benefits could accrue to patients who do become more active.92 93”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Implications
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, this may be because the effect is due to psychosocial factors, such as learning a new skill or socialising, rather than to the exercise itself.”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Type of exercise
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“for these we used a random effects model based on DerSimonian and Laird's method to calculate the pooled effect size.15”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Statistical analysis
What the sources say
- Not checked — no full text of the sourcecites [15] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The two authors independently extracted data (the quality criteria, participant details, intervention details, outcome measures, baseline and post-intervention results, and main conclusions), using a structured form.”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Data extraction
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The size of the effect is increased by results from two unpublished conference abstracts and studies with a shorter follow up period, suggesting that results may be sustained only in the short term.”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Quality of the studies
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The authors state this as an assumption.
Compliance among patients with depression in exercise-on-prescription schemes would be similar to or worse than the 20-50% compliance observed among patients with any referral criteria.
“It is reasonable to assume that compliance among patients with depression would be similar or worse.”
The paper relies on this without support.
Other studies on exercise and depression have been completed since the most recent previous meta-analysis was published.
“Other studies have been completed since the most recent of these meta-analyses was published.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source says what the claim attributes to it.
In the citing paper
“Two meta-analyses which included assessments of study quality both cautiously concluded that exercise may be effective, but recommended that further welldesigned trials are required (Sjosten 2006;Lawlor 2001).”
From Exercise for depression (2009) · cites this paper as Lawlor 2001
The cited source says what the claim attributes to it.
In the citing paper
“A total of 28 trials fulfilled our criteria, of which 14 had already been identified in 2001 (Lawlor 2001).”
From Exercise for depression (2009) · cites this paper as Lawlor 2001
The cited source says what the claim attributes to it.
In the citing paper
“The literature was systematically searched in 2001 (Lawlor 2001).”
From Exercise for depression (2009) · cites this paper as Lawlor 2001
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.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > What this study adds
“| Reuter et al, | Conference | 18 | University students | N/A | N/A | 1. Counselling plus | 10 | Mean difference in BDI | No | No | No |”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > References
“86. Reuter M, Mutrie N, Harris DV. Running as an adjunct to counseling in the treatment of depression [dissertation]. Pennsylvania: Pennsylvania State University, 1984.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > Implications
“Reuter et al 86 (8)”
§ The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials > What this study adds
“| Reuter et al, | Conference | 18 | University students | N/A | N/A | 1. Counselling plus | 10 | Mean difference in BDI | No | No | No |”
Citations
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Metadata
- Authors
- Lawlor, D. A., & Hopker, S. W.
- Affiliations
- University of Bristol (GB)
- Corresponding author
- Lawlor, Debbie A
- ORCID
- Lawlor, Debbie A
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2001-03-31
- Volume
- 322
- Issue
- 7289
- Pages
- 763
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC30551
- OpenAlex
- W2111373412
- Cited by
- 995
- References
- 88
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 19 · 2023: 20 · 2022: 16 · 2021: 28 · 2020: 31 · 2019: 34 · 2018: 35 · 2017: 40 · 2016: 45 · 2015: 46 · 2014: 44 · 2013: 68 · 2012: 61
- FWCI
- 1.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (submittedVersion)
- PubMed Central (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- physical activity, depression, depression treatment, exercise therapy, cognitive therapy, treatment efficacy, methodological quality of trials, follow-up duration
- MeSH terms
- Data Collection, Depressive Disorder, Exercise Therapy, Humans, Randomized Controlled Trials as Topic, Treatment Outcome
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.
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