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Cited by 169Physical Activity and HealthTreatment of Major DepressionChild and Adolescent Psychosocial and Emotional Development

Systematic review and meta-analysis of the effects of exercise on depression in adolescents

Open access
Wang, Xiang, Cai, Zhi-dong, Jiang, Wan-ting, Fang, Yan-yan, Sun, Wen-xin, Wang, Xing·2022·Child and Adolescent Psychiatry and Mental Health
DOI 10.1186/s13034-022-00453-2PMC PMC8886903
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Abstract

Background: Depression is widespread among adolescents and seriously endangers their quality of life and academic performance. Developing strategies for adolescent depression has important public health implications. No systematic review on the effectiveness of physical exercise for adolescents aged 12–18 years with depression or depressive symptoms has previously been conducted. This study aims to systematically evaluate the effect of physical exercise on adolescent depression in the hope of developing optimum physical exercise programs. Methods: Nine major databases at home and abroad were searched to retrieve randomized controlled trials (RCTs) on exercise interventions among adolescents with depression or depressive symptoms. The retrieval period started from the founding date of each database to May 1, 2021. The methodological quality of the included articles was evaluated using the modified PEDro scale. A meta-analysis, subgroup analysis, sensitivity analysis, and publication bias tests were then conducted. Results: Fifteen articles, involving 19 comparisons, with a sample size of 1331, were included. Physical exercise significantly reduced adolescent depression (standardized mean difference [SMD] = − 0.64, 95% CI − 0.89, − 0.39, p < 0.01), with a moderate effect size, in both adolescents with depression (SMD = -0.57, 95% CI − 0.90, − 0.23, p < 0.01) and adolescents with depressive symptoms (SMD = − 0.67, 95% CI − 1.00, − 0.33, p < 0.01). In subgroups of different depression categories (depression or depressive symptoms), aerobic exercise was the main form of exercise for the treatment of adolescents with depression. For adolescents with depression, interventions lasting 6 weeks, 30 min/time, and 4 times/week had optimum results. The effects of aerobic exercise and resistance + aerobic exercise in the subgroup of adolescents with depressive symptoms were significant, while the effect of physical and mental exercise (yoga) was not significant. For adolescents with depressive symptoms, aerobic exercise lasting 8 weeks, 75–120 min/time, and 3 times/week had optimum results. Physical exercise with moderate intensity is a better choice for adolescents with depression and depressive symptoms. Conclusions: Physical exercise has a positive effect on the improvement of depression in adolescents. The protocol for this study was registered with INPLASY (202170013). DOI number is 10.37766/inplasy2021.7.0013. Registration Date:2021.7.06.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis found that physical exercise significantly reduces depression in adolescents, with a moderate overall effect. Aerobic exercise was the main effective modality, and the paper suggests specific program durations, session lengths, and frequencies for adolescents with depression versus depressive symptoms.

Key findings

  • Across 15 articles, 19 comparisons, and 1331 participants, exercise significantly reduced adolescent depression: SMD = −0.64, 95% CI −0.89 to −0.39, p < 0.01, a moderate effect size.
  • Effects were significant in both adolescents with depression (SMD = −0.57, 95% CI −0.90 to −0.23, p < 0.01) and adolescents with depressive symptoms (SMD = −0.67, 95% CI −1.00 to −0.33, p < 0.01, as reported in the abstract).
  • For adolescents with depression, the suggested optimal program was 6 weeks, 30 min/time, 4 times/week, with aerobic exercise; for adolescents with depressive symptoms, it was 8 weeks, 75–120 min/time, 3 times/week, with aerobic exercise.
  • Aerobic exercise and resistance + aerobic exercise were significant for depressive symptoms, while yoga was not significant (SMD = −0.12, 95% CI −0.30 to 0.07, p = 0.22). Moderate intensity was reported as a better choice.

Methods

  • Systematic review and meta-analysis following PRISMA 2020; nine databases were searched from inception to May 1, 2021, for RCTs of exercise interventions in adolescents aged 12–18 with depression or depressive symptoms.
  • Fifteen articles involving 19 comparisons and 1331 participants were included; methodological quality was assessed with a modified PEDro scale, with scores of 5–8 (mean 6; 4 medium-quality and 11 high-quality articles).
  • Analyses in Stata 16.0 used standardized mean difference (SMD), heterogeneity testing with I² and Cochran’s Q, subgroup analysis, sensitivity analysis, Egger’s test, and trim-and-fill.

Limitations

  • The paper states that only published Chinese and English articles were included; only two included articles fully described allocation concealment and only one mentioned blinded outcome assessment; all outcomes were subjective self-reports without objective biomarkers; heterogeneity was high among depressive-symptom studies; exercise intensity lacked uniform standards and controls; participants’ physical activity level was not included; and optimal programs were based on current evidence, requiring more RCTs.
  • Evident from the text: several subgroup analyses relied on very few comparisons (e.g., resistance + aerobic exercise n = 2; depression intensity subgroups n = 1 each), limiting precision.
  • Evident from the text: publication bias was indicated in the depressive-symptom group (Egger’s test t = −3.12, p = 0.01), although trim-and-fill suggested the effect estimate did not change substantially.

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Integrity signals

Registry

Crossref · 10.1186/s13034-022-00453-2

Cites

97 of 97 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 85 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Among adolescents with depressive symptoms, moderate intensity exercise produced a greater benefit than high intensity exercise.

    “Moderate and high intensity exercise had a significant effect on depressive symptoms among adolescents with moderate intensity interventions producing the greater benefit.”
    Quote in the paperSubstantial claim
  • Findingown data

    Among adolescents with depression, aerobic exercise had a significant effect on depression.

    “Regarding exercise type, the effect of aerobic exercise among adolescents with depression was significant.”
    Quote in the paperSubstantial claim
  • Findingown data

    No adverse events were reported among the included studies.

    “There were no adverse events among the included studies.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Fifteen articles, involving 19 comparisons, with a sample size of 1331, were included in the meta-analysis.

    “Fifteen articles, involving 19 comparisons, with a sample size of 1331, were included.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Among adolescents with depressive symptoms, aerobic exercise had a significant effect.

    “The effects of aerobic exercise and resistance + aerobic exercise among adolescents with depressive symptoms were also significant”
    Quote in the paperSubstantial claim
  • May combine two claims. 47
  • Classified as probably not a substantial claim. 36

  • May combine two claims.

    Findingown data

    The mean dropout rate was 8.33% in the exercise group and 9.21% in the control group, with no significant difference (t = -0.18, p = 0.86).

    “The mean dropout rate of the exercise group was 8.33% and that of the control group was 9.21%, with no significant difference (t = -0.18, p = 0.86).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The methodological quality of the included articles was good overall (PEDro scores 5-8, mean 6; 4 medium and 11 high-quality articles).

    “The PEDro score among the 15 included articles was 5–8 points. There were 4 medium and 11 high-quality articles, with a mean of 6 points. The overall research quality was good.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Physical exercise significantly reduced adolescent depression overall (SMD = −0.64, 95% CI −0.89, −0.39, p < 0.01), with a moderate effect size.

    “Physical exercise significantly reduced adolescent depression (standardized mean difference [SMD] = − 0.64, 95% CI − 0.89, − 0.39, p < 0.01), with a moderate effect size”
    • Also stated in: § Meta-analysis of the impact of exercise on depression in adolescents · plain
      “A total of 19 studies included I2 = 75.05%, combined effect size SMD = − 0.64, 95% CI (− 0.89, − 0.39, P < 0.01).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: There were no significant differences in the outcome variables between the groups in each comparison at baseline.

  • May combine two claims.

    Findingown data

    Five comparisons included a follow-up period; three showed significant differences between exercise and control groups during follow-up.

    “Five comparisons (depression: 4; depressive symptoms: 1) included a follow-up period after the experiment. Two of these comparisons (depression: 1; depressive symptoms: 1) showed that the depression scores during the follow-up period were not significantly different between the exercise and control groups, while 3 comparisons (depression: 3) showed significant differences.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Regarding depression type, 6 comparisons were on depression and 13 were on depressive symptoms.

    “Regarding depression type, 6 comparisons were on depression and 13 were on depressive symptoms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Wunram et al. found a significant difference at week 26 in depression scores between exercise and control groups, with depression remission rate in both exercise groups (67.8%) significantly higher than in the control group (26.8%).

    “the two comparisons by Wunram et al. (one involving aerobic exercise and the other involving whole-body muscle vibration) both found that there was a significant difference at week 26 in depression scores between the exercise and control groups. The depression remission rate in both the exercise groups (67.8%) was significantly higher than that in the control group (26.8%) [39].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] Noggle JJ, Steiner NJ, Minami T, Khalsa SBS. Benefits of yoga for psychosocial well-being in a US high school curriculum: a preliminary randomized controlled trial. J Dev Behav Pediatr. 2012;33:193–201. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Among adolescents with depression, 3-4 times/week was significant, and 4 times/week was better.

    “Regarding exercise frequency, 3–4 times/week among adolescents with depression was significant, and 4 times/week was better.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Four articles mentioned exercise intensity control, 1 mentioned blinded outcome evaluation, 2 mentioned intention-to-treat analysis, and 7 mentioned dropout rate < 15%.

    “Additionally, 4 articles mentioned “exercise intensity control”, 1 article mentioned “blinded outcome evaluation”, 2 articles mentioned using “intention-to-treat analysis”, and 7 articles mentioned “dropout rate < 15%” (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Nine comparisons showed no significant difference in depression scores between exercise and control groups at the end of the study, while 10 comparisons showed significant differences.

    “Nine comparisons (depression: 3; depressive symptoms: 6) showed that there was no significant difference in depression scores between the exercise and control groups at the end of the study, while 10 comparisons (depression: 3; depressive symptoms: 7) showed significant differences.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    The mean age of the participants was 15.90 ± 1.23 years old.

    “The mean age of the participants was 15.90 ± 1.23 years old.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All included articles mentioned eligibility criteria, random allocation, baseline similarity between groups, statistical analysis comparing groups, and point and variability measures.

    “All articles mentioned “eligibility criteria”, “random allocation”, “baseline similarity between groups”, “statistical analysis comparing groups”, and “point and variability measures”.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    This study shows that physical exercise, as an alternative or complementary treatment, has a positive effect on alleviating depression in adolescents, with a moderate effect size.

    “This study shows that physical exercise, as an alternative or complementary treatment, has a positive effect on alleviating depression in adolescents, with a moderate effect size.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The single included article on self-selected exercise intensity among adolescents with severe depression found no significant difference in depression scores between the exercise and control groups after 6 weeks of intervention, but the exercise group had a significantly higher improvement at the 6-month follow-up.

    “The single included article on self-selected exercise intensity among adolescents with severe depression found that there was no significant difference in depression scores between the exercise and control groups after 6 weeks of intervention, but the exercise group had a significantly higher improvement at the 6-month follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Sensitivity analysis showed that the effect size of the depression group and depressive symptom group were not significantly changed after eliminating single studies one by one, indicating that the study results were relatively stable.

    “the effect size of the depression group and the depressive symptom group were not significantly changed after eliminating single studies one by one, indicating that the study results were relatively stable.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] Zhang SH. Meta analysis should reasonably set up subgroup analysis and sensitivity analysis to accurately interpret the results. Chin J Mod Nerv Dis. 2016;16(1):1–2.

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    After trim-and-fill, the combined effect estimate was −0.65 (95% CI −0.87, −0.58), and the difference before and after trim-and-fill did not change significantly, suggesting publication bias has little effect and the meta-analysis results are relatively robust.

    “The random-effects model calculates the point estimate of the combined RR and 95% CI was − 0.65 (− 0.87, -0.58) after trim-and-fill, and the effect size RR difference before and after trim-and-fill did not change significantly, suggesting that publication bias has little effect on the results, and the meta-analysis results are relatively robust.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] Zhang TS, Zhong WZ. The realization of non-parametric clipping and compensation method in Stata. Evid Based Med. 2009;9(4):240–2.

      Not checked in the free run.

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

    Premisecitation

    Cross-sectional studies over the past 30 years have suggested that low physical activity is an important risk factor for the development of depression.

    “Cross-sectional studies over the past 30 years have suggested that low physical activity is an important risk factor for the development of depression [11, 12].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [11] Stubbs B, Koyanagi A, Schuch FB, Firth J, Rosenbaum S, Veronese N, Solmi M, Mugisha J, Vancampfort D. Physical activity and depression: a large cross-sectional, population-based study across 36 low- and middle-income countries. Acta Psychiatr Scand. 2016;134(6):1–11. source

      Not checked in the free run.

    • cites [12] Mc Dowell CP, Carlin A, Capranica L, Dillon C, Harrington JM, Lakerveld J, Loyen A, Ling FCM, Brug J, MacDonncha C, Herring MP. Associations of self-reported physical activity and depression in 10,000 Irish adults across harmonised datasets: a DEDIPAC-study. BMC Public Health. 2018;18:779–88. source

      Not checked in the free run.

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

    Study design and conductnone given

    The protocol for this study was registered with INPLASY (202170013).

    “The protocol for this study was registered with INPLASY (202170013). DOI number is 10.37766/inplasy2021.7.0013. Registration Date:2021.7.06.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Psychotherapy is more resource-intensive and is associated with perceived stigma from attending the therapist.

    “Psychotherapy is more resource-intensive and is associated with perceived stigma from attending the therapist [22].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Wang LP, Wang HP. Challenge to traditional therapy: three new progresses in psychological treatment of adolescent depression. Med Philos. 2019;40(3):51–4.

      Not checked in the free run.

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

    Study design and conductcitation

    The study adhered to the PRISMA 2020 guidelines.

    “The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (Fig. 1) [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Page M, McKenzie J, Bossuyt P. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;6:1743–9191.

      Not checked in the free run.

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

    Premisecitation

    Human and animal experiments showed that exercise can exert an antidepressant effect by increasing mitochondrial activity in brain neurons, stimulating the secretion of monoamine neurotransmitters, increasing the concentration of neurotrophic factors, inhibiting the overexpression of inflammatory factors, and regulating the expression of microRNAs.

    “Human and animal experiments showed that exercise can exert an antidepressant effect by increasing mitochondrial activity in brain neurons, stimulating the secretion of monoamine neurotransmitters, increasing the concentration of neurotrophic factors, inhibiting the overexpression of inflammatory factors, and regulating the expression of microRNAs [15].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Ma K, Liu JM, Fu CY. Research progress on the intervention effect and mechanism of exercise on depression. China Sports Technology. 2020;56(11):13–24.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    RCTs have shown that structured exercise programs can effectively alleviate depressive symptoms, and there is a dose-response relationship.

    “RCTs have also shown that structured exercise programs can effectively alleviate depressive symptoms, and there is a dose–response relationship [17, 18].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [17] Doose M, Reim D, Ziert Y. Self-selected intensity exercise in the treatment of major depression: a pragmatic RCT. Int J Psychiatry Clin Pract. 2015;5:1–19.

      Not checked in the free run.

    • cites [18] de Bruin EI, van der Zwan JE, Bögels SM. A RCT Comparing daily mindfulness meditations, biofeedback exercises, and daily physical exercise on attention control, executive functioning, mindful awareness, self-compassion, and worrying in stressed young adults. Mindfulness. 2016;6:1–11.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Exercise can reduce depressive symptoms by improving self-efficacy, reducing negative emotions, and stimulating positive behaviors in depressed patients.

    “It can also reduce depressive symptoms by improving self-efficacy, reducing negative emotions, and stimulating positive behaviors in depressed patients [16].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Hu L, Han YQ. The new development of the research on the neurobiological mechanism of sports anti-depression. J Shanxi Norm Univ (Natural Science Edition) 2019;47(3):9–20+125.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The use of exercise to prevent and treat depression in adolescents is feasible and acceptable.

    “the use of exercise to prevent and treat depression in adolescents is feasible and acceptable.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Exercise has similar benefits to psychological and drug therapy.

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

    Premisecitation

    Prospective cohort studies have suggested that regular exercise reduces the risk of developing depression.

    “Prospective cohort studies have suggested that regular exercise reduces the risk of developing depression [13, 14].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [13] Mammen G, Faulkner G. Physical activity and the prevention of depression: a systematic review of prospective studies. Am J Prev Med. 2013;45(5):649–57. source

      Not checked in the free run.

    • cites [14] 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

      Not checked in the free run.

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

    Premisecitation

    For adults, depression is usually regarded as the mental health problem most likely to be positively affected by exercise.

    “For adults, depression is usually regarded as the mental health problem most likely to be positively affected by exercise [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Malcom E, Evans-Lacko S, Little K, Henderson C, Thornicroft G. The impact of exercise projects to promote mental wellbeing. J Ment Health. 2013;22(6):519–27. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Although RCTs in children and young people have shown that physical exercise can relieve depression and depressive symptoms, the dose-response relationship remains unclear.

    “Although RCTs in children and young people have shown that physical exercise can relieve depression and depressive symptoms [25, 26], the dose–response relationship remains unclear.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [25] Larun L, Nordheim LV, Ekeland E, Hagen KB, Heian F. Exercise in prevention and treatment of anxiety and depression among children and young people (review). Cochrane Database Syst Rev. 2009;1:1–49.

      Not checked in the free run.

    • cites [26] Brown HE, Pearson N, Braithwaite RE, Brown WJ, Biddle SJH. Physical activity interventions and depression in children and adolescents: a systematic review and meta-analysis. Sports Med. 2013;43:195–206. source

      Not checked in the free run.

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

    Study design and conductown data

    Two authors used a modified PEDro scale to evaluate methodological quality, with disagreements resolved by a third author.

    “Two authors used a modified version of the PEDro scale [31] to evaluate the methodological quality of the included studies. If there was a disagreement, a third author evaluated the issue, which was discussed until a consensus was reached.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Ludyga S, Gerber M, Brand S, Holsboer-Trachsler E, Pühse U. Acute effects of moderate aerobic exercise on specific aspects of executive function in different age and fitness groups: a meta-analysis. Psychophysiology. 2016;53(11):16–26. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Physical exercise is more cost-effective, convenient to implement within the community, and can potentially have wider reach and participation.

    “Comparatively, physical exercise is more cost-effective. It is convenient to implement within the community and can potentially have wider reach and participation [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Li A, Yau S, Machado S, et al. Enhancement of hippocampal plasticity by physical exercise as a polypill for stress and depression: a review. CNS Neurol Disord Drug Targets. 2019;18(4):294–306. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    We excluded studies which recruited individuals with comorbid diseases closely related to depression.

    “We also excluded studies which recruited individuals with comorbid diseases closely related to depression.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    Two authors used a pre-designed data extraction form to extract data.

    “Two authors used a pre-designed data extraction form to extract the following data and record it:”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    For adolescents with depression, moderate intensity and self-selected intensity may be better exercise options.

    “For adolescents with depression, moderate intensity and self-selected intensity may be better exercise options for them.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Six months of moderate-intensity aerobic exercise significantly increased the prefrontal cortex gray matter volume in patients with depression, which was directly proportional to the amount of exercise.

    “Six months of moderate-intensity aerobic exercise significantly increased the prefrontal cortex gray matter volume in patients with depression (decreased gray matter volume is a key physiological sign of depression [65]), which was directly proportional to the amount of exercise [66].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [65] Peng W, Chen Z, Yin L, Jia Z, Gong Q. Essential brain structural alterations in major depressive disorder: a voxel-wise meta-analysis on first episode, medication-naive patients. J Affect Disord. 2016;199(14):114–23. source

      Not checked in the free run.

    • cites [66] Matura S, Fleckenstein J, Deichmann R, Engeroff T, Füzéki E, Hattingen E, Hellweg R, Lienerth B, Pilatus U, Schwarz S, Tesky VA, Vogt L, Banzer W, Pantel J. Effects of aerobic exercise on brain metabolism and grey matter volume in older adults: results of the randomised controlled trial. Transl Psychiatry. 2017;7:1172–9. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Exercise alleviated hypothalamic-pituitary-adrenal feedback regulation obstacles by modulating cortisol and IL-6 levels, and thereby improved depression.

    “exercise alleviated hypothalamic–pituitary–adrenal feedback regulation obstacles by modulating cortisol and IL-6 levels, and thereby improved depression [69].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [69] Mihailova S, Ivanova-Genova E, Lukanov T, Stoyanova V, Milanova V, Naumova E. A study of TNF-α, TGF-β, IL-10, IL-6, and IFN-γ gene polymorphisms in patients with depression. J Neuroimmunol. 2016;293:123–8. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The effect of physical exercise on depression is influenced by the severity of depression and is significantly negatively correlated with the level of depression.

    “Studies have found that the effect of physical exercise on depression is influenced by the severity of depression, and is significantly negatively correlated with the level of depression [75, 76].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [75] Knapen J, Vancampfort D, Moriën Y, Marchal Y. Exercise therapy improves both mental and physical health in patients with major depression. Disabil Rehabil. 2015;37(16):1490–5. source

      Not checked in the free run.

    • cites [76] Machaczek KK, Allmark P, Goyder E, Grant G, Ricketts T, Pollard N, Booth A, Harrop D, de la Haye S, Collins K, Green G. A scoping study of interventions to increase the uptake of physical activity (PA) amongst individuals with mild-to-moderate depression (MMD). BMC Public Health. 2018;18(1):392. source

      Not checked in the free run.

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

    Premisecitation

    Most studies report that the cause of depression is related to the dysfunction of neurotransmitters such as serotonin, dopamine, and norepinephrine.

    “At present, most studies report that the cause of depression is related to the dysfunction of neurotransmitters such as serotonin (5-hydroxytryptamine), dopamine, and norepinephrine [61].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] Gujral S, Aizenstein H, Reynolds CF 3rd, Butters MA, Erickson KI. Exercise effects on depression: possible neural mechanisms. Gen Hosp Psychiatry. 2017;49:2–10. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Exercise among patients with depression upregulated brain-derived neurotrophic factor (BDNF) in the hippocampus and cortex, promoted hippocampal neurogenesis, and significantly enhanced synaptic plasticity.

    “exercise among patients with depression upregulated brain-derived neurotrophic factor (BDNF), which stimulates and mediates neurogenesis and regulates depressive behavior [67], in the hippocampus and cortex, promoted hippocampal neurogenesis, and significantly enhanced synaptic plasticity [68].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [67] Levy MJF, Boulle F, Steinbusch HW, van den Hove DLA, Kenis G, Lanfumey L. Neurotrophic factors and neuroplasticity pathways in the pathophysiology and treatment of depression. Psychopharmacology. 2018;235:2195–220. source

      Not checked in the free run.

    • cites [68] Himi N, Takahashi H, Okabe N, Nakamura E, Shiromoto T, Narita K, Koga T, Miyamoto O. Exercise in the early stage after stroke enhances hippocampal brain-derived neurotrophic factor expression and memory function recovery. J Stroke Cerebrovasc Dis. 2016;257:132–41.

      Not checked in the free run.

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

    Premisecitation

    Previous research showed that moderate- and high-intensity exercise has a stronger effect on depression than low-intensity exercise.

    “Previous research showed that moderate- and high-intensity exercise has a stronger effect on depression than low-intensity exercise [109].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [109] Zhu XT, Ren YC, Feng L, et al. Application of exercise intervention in the treatment of depression (review). Chin Ment Health J. 2021;35(1):26–31.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    After a 6-week jogging intervention for patients with depression, the plasma levels of GABA increased and the depression symptoms decreased.

    “After a 6-week jogging intervention for patients with depression, the plasma levels of gamma-aminobutyric acid (GABA) increased and the depression symptoms decreased [64].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [64] Du Y, Wang L, Zhang XL, et al. A controlled study on the effects of exercise on depression symptoms, cognitive function and γ-aminobutyric acid. Chin Gen Pract. 2019;17(9):1547–50.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A meta-analysis on exercise durations/frequencies showed that exercise lasting ≤45 min/session reduced depression symptoms more than >45 min/session, and ≥4 sessions/week had a greater effect than 2-3 sessions/week.

    “Furthermore, a meta-analysis on exercise durations/frequencies showed that exercise that lasted ≤ 45 min/session reduced depression symptoms more than > 45 min/session, and ≥ 4 sessions/week had a greater effect than 2–3 sessions/week [108].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [108] Carneiro L, Afonso J, Ramirez-Campillo R, Murawska-Ciałowciz E, Marques A, Clemente FM. The effects of exclusively resistance training-based supervised programs in people with depression: a systematic review and meta-analysis of randomized controlled trials. Int J Environ Res Public Health. 2020;17(18):6715. source

      Not checked in the free run.

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

    Premisecitation

    When adolescents with depressive symptoms or negative emotions do not receive timely intervention, they risk developing depression.

    “When adolescents with depressive symptoms or negative emotions do not receive timely intervention, they risk developing depression [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Rutter M, Kim-Cohen J, Maughan B. Continuities and discontinuities in psychopathology between childhood and adult life[J]. J Child Psychol Psychiatry. 2010;47(3–4):276–95.

      Not checked in the free run.

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

    Premisecitation

    In rats, swimming exercises over 10 weeks significantly increased the levels of serotonin, dopamine, and norepinephrine in the hippocampus.

    “In rats, swimming exercises over 10 weeks significantly increased the levels of serotonin, dopamine, and norepinephrine in the hippocampus [62].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [62] Cui DX. Effects of swimming exercise on neuroendocrine and behavior in experimental depression rats. East China Normal University. 2005.

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Exercise program duration, session duration, frequency, and intensity may moderate the effects of exercise.

    “Exercise program duration, session duration, frequency, and intensity may moderate the effects of exercise.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Study design and conductreasoning

    Due to the limited number of studies in this literature, vibration training currently needs stronger empirical evidence to investigate the effects of this approach in alleviating depression in adolescents.

    “Due to the limited number of studies in this literature, vibration training currently needs stronger empirical evidence to investigate the effects of this approach in alleviating depression in adolescents.”
    Quote in the paperNot a substantial claim

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

    Interpretationreasoning

    Kripalu Yoga has achieved significant intervention effects in one study, which may be related to its emphasis on obeying the wisdom of the body.

    “Kripalu Yoga has achieved significant intervention effects in one study, which may be related to its emphasis on obeying the wisdom of the body[40].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Butzer B, LoRusso A, Shin SH, Khalsa SBS. Evaluation of yoga for preventing adolescent substance use risk factors in a middle school setting: a preliminary group-randomized controlled trial. J Youth Adolesc. 2017;46:603–12. source

      Not checked in the free run.

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

    Study design and conductnone given

    There are a total of 6 comparisons in this article detailing the control of exercise intensity in the experiment.

    “In addition, there are a total of 6 comparisons in this article detailing the control of exercise intensity in the experiment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    There is some evidence that whole-body muscle vibration training can have a positive effect on maintaining stable cortisol secretion in adolescents with severe depression and reducing the activity of the HPA.

    “There is some evidence that whole-body muscle vibration training can have a positive effect on maintaining stable cortisol secretion in adolescents with severe depression and reducing the activity of the HPA [43].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Wunram HL, Hamacher S, Hellmich M, Volk M, Jänicke F, Reinhard F, Bloch W, Zimmer P, Graf C, Schönau E, Lehmkuhl G, Bender S, Fricke O. Whole body vibration added to treatment as usual is effective in adolescents with depression: a partly randomized, three-armed clinical trial in inpatients. Eur Child Adolesc Psychiatry. 2017;27(5):645–62. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    High-frequency exercise accelerated the serum BDNF peak, which promoted adaptation of central neurotransmitter release and was more effective at reducing depressive symptoms.

    “Moreover, high-frequency exercise accelerated the serum BDNF peak, which promoted adaptation of central neurotransmitter release and was more effective at reducing depressive symptoms [106].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [106] Perraton LG, Kumar S, Machotka Z. Exercise parameters in the treatment of clinical depression: a systematic review of randomized controlled trials. J Eval Clin Pract. 2010;16(3):597–604. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Costigan et al. found that resistance + aerobic exercise slightly improved subjective well-being among adolescents, but not depressive symptoms.

    “Second, Costigan et al. found that resistance + aerobic exercise slightly improved subjective well-being among adolescents, but not depressive symptoms [40].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Butzer B, LoRusso A, Shin SH, Khalsa SBS. Evaluation of yoga for preventing adolescent substance use risk factors in a middle school setting: a preliminary group-randomized controlled trial. J Youth Adolesc. 2017;46:603–12. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    All included articles used subjective self-reported outcomes, with a lack of objective evaluation such as biomarkers.

    “(3) All the articles used subjective self-reported outcomes, with a lack of objective evaluation (such as biomarkers).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Since only one comparison of each level of intensity was identified, further experiments are needed to strengthen any specific conclusions that can be drawn.

    “Since only one comparison of each level of intensity was identified, further experiments are needed to strengthen any specific conclusions that can be drawn.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    In depressed rats, a single 30-min session of wheel running reduced the serum corticosterone concentration compared to 20 min.

    “In depressed rats, a single 30-min session of wheel running reduced the serum corticosterone concentration compared to 20 min [104].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [104] Shiota N, Narikiyo K, Masuda A, Aou S. Water spray-induced grooming is negatively correlated with depressive behavior in the forced swimming test in rats. J Physiol Sci. 2016;66(3):265–73. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The reason for the insignificant effect of yoga intervention may lie in the characteristics of yoga exercise, the duration of yoga experiment and experiment control.

    “The reason for the insignificant effect of yoga intervention may lie in the characteristics of yoga exercise, the duration of yoga experiment and experiment control.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    The optimal exercise program in this research was based on the summary of current evidence.

    “(7) The optimal exercise program in this research was based on the summary of current evidence.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Physical exercise of moderate intensity is a better choice for adolescents with depression and depressive symptoms.

    “Physical exercise of moderate intensity is a better choice for adolescents with depression and depressive symptoms.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Yoga can improve negative emotions by regulating the hypothalamus-pituitary-adrenal axis and sympathetic nervous system, increasing thalamic GABA levels and reducing cortisol levels.

    “Yoga can improve negative emotions by regulating the hypothalamus–pituitary–adrenal axis and sympathetic nervous system, increasing thalamic GABA levels and reducing cortisol levels [93].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [93] Park CL, Finkelstein-Fox L, Groessl EJ, Elwy AR, Lee SY. Exploring how different types of yoga change psychological resources and emotional well-being across a single session. Complement Ther Med. 2020;49(2):102–14.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A single exercise session among individuals with depressive symptoms can significantly improve self-efficacy, thereby reducing negative emotions.

    “A single exercise session among individuals with depressive symptoms can significantly improve self-efficacy, thereby reducing negative emotions [79]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [79] Jaffery A, Edwards MK, Loprinzi PD. Randomized control intervention evaluating the effects of acute exercise on depression and mood profile: solomon experimental design. Mayo Clin Proc. 2017;92(3):480–1. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Adolescent males often resist participating in low-intensity exercise such as yoga and tend to choose more intense exercise types, so gender factors may impact the effect of yoga interventions.

    “Adolescent males often resist participating in low-intensity exercise such as yoga and tend to choose more intense exercise types, so gender factors may impact the effect of yoga interventions [97].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [97] Conboy LA, Noggle JJ, Frey JL, Kudesia RS, Khalsa SB. Qualitative evaluation of a high school yoga program: feasibility and perceived benefits. Explore. 2013;9(3):171–80. source

      Not checked in the free run.

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

    Premisecitation

    Hyperactive HPA axis in patients with major depression is one of the important reasons for its onset.

    “Hyperactive HPA axis in patients with major depression is one of the important reasons for its onset[91].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [91] Mello AF, Juruena MF, Pariante CM, et al. Depression and stress: is there an endophenotype? Braz J Psychiatry. 2007;29(Suppl1(1)):13–8. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    As our meta-analysis only included 2 articles on resistance + aerobic exercise, its effect on depression in adolescents needs to be verified by multiple additional RCTs.

    “As our meta-analysis only included 2 articles on resistance + aerobic exercise, its effect on depression in adolescents needs to be verified by multiple additional RCTs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Another study showed that maintaining regular exercise for 6-8 weeks significantly reduced negative emotions in adolescents, but with the prolongation of the program, the benefits did not significantly improve.

    “Another study showed that maintaining regular exercise for 6–8 weeks significantly reduced negative emotions in adolescents, but with the prolongation of the program, the benefits did not significantly improve [101].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [101] Stanton R, Reaburn P. Exercise and the treatment of depression: a review of the exercise program variables. J Sci Med Sport. 2014;17(2):177–82. source

      Not checked in the free run.

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

    Study design and conductnone given

    The physical activity level of the subjects may affect the intervention effect, while this variable was not found or included when compiling relevant data.

    “(6) The physical activity level of the subjects may affect the intervention effect, while this variable was not found or included when compiling relevant data.”
    Quote in the paperNot a substantial claim

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

    Interpretationreasoning

    Participants' physical health may also be an important factor affecting the effectiveness of the intervention.

    “Participants' physical health may also be an important factor affecting the effectiveness of the intervention.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    International public health physical activity guidelines stipulate that at least 150 min of moderate-intensity exercise should be performed every week to maintain health.

    “International public health physical activity guidelines stipulate that at least 150 min of moderate-intensity exercise should be performed every week to maintain health [102].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [102] Tremblay MS, Kho ME, Tricco AC, Duggan M. Process description and evaluation of Canadian Physical Activity Guidelines development. J Int Soc Sports Nutr. 2010;7(1):42.

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    For adolescents with depressive symptoms lasting for 8 weeks, 75-120 min/time of exercise 3 times/week, and aerobic exercise is better.

    “For adolescents with depressive symptoms lasting for 8 weeks, 75–120 min/time of exercise 3 times/week, and aerobic exercise is better.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Due to the inherent listlessness of patients with major depression, it is sometimes difficult to motivate them to take active exercise.

    “In addition, due to the inherent listlessness of patients with major depression, it is sometimes difficult to motivate them to take active exercise[89].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [89] Carter T, Morres I, Repper J, et al. Exercise for adolescents with depression: valued aspects and perceived change. J Psychiatr Ment Health Nurs. 2016;23:37–44. source

      Not checked in the free run.

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

    Premisereasoning

    Reduced energy level is a characteristic symptom in depressed patients, and long-term continuous exercise may be too demanding for them.

    “Reduced energy level is a characteristic symptom in depressed patients, and long-term continuous exercise may be too demanding for them.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Yoga has been found to reduce anxiety and stress.

    “Yoga, as a physical and mental exercise based on body posture exercises, has been found to reduce anxiety and stress [92].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [92] Weaver LL, Darragh AR. Systematic review of yoga interventions for anxiety reduction among children and adolescents. Am J Occup Ther. 2015;69(6):152–63. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Current practice of yoga among young people may limit its effectiveness due to the lack of specific standards for quality control of yoga implementation.

    “In addition, the current practice of yoga among young people may limit its effectiveness due to the lack of specific standards for quality control of yoga implementation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Long-term follow-up showed that yoga led to delayed transformation, leading to improvement in long-term self-control in emotion, though the short-term effect was not significant.

    “Long-term follow-up showed that yoga led to delayed transformation, leading to improvement in long-term self-control in emotion, though the short-term effect was not significant [36].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Hilyer JC, Wilson DG, Dillon C. Physical fitness training and counseling as treatment for youthful offenders. J Couns Psychol. 1982;29:292–303. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    Only two of the included articles fully described allocation concealment and only one mentioned blinded outcome assessment.

    “(2) Only two of the included articles fully described allocation concealment and only one mentioned blinded outcome assessment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    Only published Chinese and English articles were included, so the comprehensiveness of the search was limited.

    “(1) Only published Chinese and English articles were included, so the comprehensiveness of the search was limited.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The American Sports Medicine Association recommends 60-80% HRmax intensity to treat depression.

    “The American Sports Medicine Association recommends 60–80% HRmax intensity to treat depression [110].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [110] Pojednic RM, Polak R, Arnstein F, Kennedy MA, Bantham A, Phillips EM. Practice patterns, counseling and promotion of physical activity by sports medicine physicians. J Sci Med Sport. 2017;20(2):123. source

      Not checked in the free run.

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

    Premisecitation

    Given the low self-esteem and self-efficacy of depressed patients, moderate-intensity exercise is currently used more frequently.

    “Given the low self-esteem and self-efficacy of depressed patients, moderate-intensity exercise is currently used more frequently [113].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [113] Grabovac I, Stefanac S, Smith L, Haider S, Cao C, Jackson SE, Dorner TE, Waldhoer T, Rieder A, Yang L. Association of depression symptoms with receipt of healthcare provider advice on physical activity among US adults. J Affect Disord. 2019;8:262–9.

      Not checked in the free run.

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

    Premisecitation

    Exercise intensity is positively associated with BDNF and plasma endorphin release.

    “Exercise intensity is positively associated with BDNF and plasma endorphin release [111].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [111] Morikawa R, Kubota N, Amemiya S, Nishijima T, Kita I. Interaction between intensity and duration of acute exercise on neuronal activity associated with depression-related behavior in rats. J Physiol Sci. 2021;71(1):1–11. source

      Not checked in the free run.

74 of 74

  • The paper relies on this without support.

    No systematic review on the effectiveness of physical exercise for adolescents aged 12–18 years with depression or depressive symptoms has previously been conducted.

    “No systematic review on the effectiveness of physical exercise for adolescents aged 12–18 years with depression or depressive symptoms has previously been conducted.”

  • The paper relies on this without support.

    There were no significant differences in the outcome variables between the groups in each comparison at baseline.

    “There were no significant differences in the outcome variables between the groups in each comparison at baseline.”

  • The paper relies on this without support.

    Exercise has similar benefits to psychological and drug therapy.

    “Given that exercise has similar benefits to psychological and drug therapy”
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?

  • The displacement hypothesis posits that screen time may replace time adolescents spend engaging in physical activity, sleep, in-person interactions, and other beneficial pursuits demonstrated to help reduce depression and anxiety symptoms.

    “The displacement hypothesis posits that screen time may replace time adolescents spend engaging in physical activity, sleep, in-person interactions, and other beneficial pursuits demonstrated to help reduce depression and anxiety symptoms [118–120].”

    From Screen time and mental health: a prospective analysis of the Adolescent Brain Cognitive Development (ABCD) Study (2024) · cites this paper as [120]

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.

  • Six-week subgroup confidence interval does not match its effect estimate

    Major

    The reported confidence-interval endpoints have a midpoint of −0.46, not the reported SMD of −0.61. The interval also includes zero despite the reported P value of 0.01 and the conclusion that this subgroup's effect was significant.

    Reported -0.61 · recomputed -0.46

  • Publication-bias result is labeled RR instead of SMD

    Minor

    The Methods specify SMD as the effect size, but the trim-and-fill result is labeled RR. The reported negative value and confidence limits also cannot represent a risk ratio.

  • Conflicting confidence intervals for the depressive-symptoms subgroup

    Minor

    The abstract and Results report different 95% confidence intervals for the same subgroup effect estimate of −0.67.

  • Articles graded "good" are called "high-quality"

    Minor

    The paper defines scores of 6-8 as good and 9-10 as high quality. It then calls 11 articles high-quality even though it states that all included articles scored only 5-8.

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 17

  1. Li JL, Chen X, Zhao CH. Meta-analysis of the prevalence of depressive symptoms in Chinese children and adolescents. Chin J Child Health. 2016;24(3):295–8.
  2. Liu FR, Song XQ, Shang XQ. A meta-analysis of the detection rate of depressive symptoms in middle school students. Chin Ment Health J. 2020;34(2):123–8.
  3. Chen M, Zhang XB, Luo YZ, et al. Research progress on neurobiological related mechanisms of exercise to improve depression. China Sports Technol. 2021;57(4):89–97.
  4. Ma K, Liu JM, Fu CY. Research progress on the intervention effect and mechanism of exercise on depression. China Sports Technology. 2020;56(11):13–24.
  5. Hu L, Han YQ. The new development of the research on the neurobiological mechanism of sports anti-depression. J Shanxi Norm Univ (Natural Science Edition) 2019;47(3):9–20+125.
  6. Wang LP, Wang HP. Challenge to traditional therapy: three new progresses in psychological treatment of adolescent depression. Med Philos. 2019;40(3):51–4.
  7. Cai ZD, Lou SJ, Chen AG. Expert consensus on the dose-effect relationship of physical exercise delaying the cognitive decline of the elderly. J Shanghai Sport Univ. 2021;45(1):51–65+77.
  8. Cohen J. Statistical power analysis for the behavioral sciences. J Am Stat Assoc. 1988;2(334):499–500.
  9. Wang D, Zhai JX, Mou ZY. Heterogeneity in meta analysis and its treatment methods. Chin J Evid Based Med. 2009;9(10):1115–8.
  10. Mohammadi M. A study and comparison of the effect of team sports (soccer and volleyball) and individual sports (table tennis and badminton) on depression among high school students. Aust J Basic Appl Sci. 2011;5:1005–11.
  11. Zhang SH. Meta analysis should reasonably set up subgroup analysis and sensitivity analysis to accurately interpret the results. Chin J Mod Nerv Dis. 2016;16(1):1–2.
  12. Yu HQ, Zheng HJ, Li Y, et al. Meta-analysis published a study on the method of bias diagnosis. China Health Stat. 2011;28(4):402–5.
  13. Shi XQ, Wang ZZ. Comparison of efficacy differences between Egger’s test and Begg’s test and reason analysis. J Huazhong Univ Sci Technol (Medical Edition) 2009;38(1):91–3+102.
  14. Zhang TS, Zhong WZ. The realization of non-parametric clipping and compensation method in Stata. Evid Based Med. 2009;9(4):240–2.
  15. Asante K. Exploring age and gender differences in health risk behaviours and psychological functioning among homeless children and adolescents. Int J Ment Health. 2015;17:278–92.
  16. Du Y, Wang L, Zhang XL, et al. A controlled study on the effects of exercise on depression symptoms, cognitive function and γ-aminobutyric acid. Chin Gen Pract. 2019;17(9):1547–50.
  17. Zhu XT, Ren YC, Feng L, et al. Application of exercise intervention in the treatment of depression (review). Chin Ment Health J. 2021;35(1):26–31.

Cited by

Sorted by citations

Related

Authors
Wang, X., Cai, Z.-D., Jiang, W.-T., Fang, Y.-Y., Sun, W.-X., & Wang, X.
Affiliations
Shanghai University of Sport (CN)
Corresponding author
Wang, Xing
ORCID
Venue
Child and Adolescent Psychiatry and Mental Health
Publisher
Springer Science and Business Media LLC
Published
2022-02-28
Volume
16
Issue
1
Pages
16-16
ISSN
1753-2000 (ISSN-L)
DOI
10.1186/s13034-022-00453-2
PMC
PMC8886903
OpenAlex
W4214633363
Semantic Scholar
3d0b730468ff4d142f2f8c25bf48a381111e6834
Cited by
169
References
97
Citations by year
2026: 45 · 2025: 56 · 2024: 39 · 2023: 25 · 2022: 4
FWCI
4.27
Type
journal article
Language
en
Open access
Licence
Locations
  • Child and Adolescent Psychiatry and Mental Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
the Key Laboratory Project of Shanghai Science and Technology Commission (11DZ2261100)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
adolescent depression, depressive symptoms, physical activity, aerobic exercise, resistance training, yoga, exercise intervention, exercise dose, exercise intensity, treatment effect size, quality of life, academic performance, exercise dose-response, exercise frequency and duration

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 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

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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