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

In the paper

“Second, Costigan et al. found that resistance + aerobic exercise slightly improved subjective well-being among adolescents, but not depressive symptoms [40].”

What the sources say

• ?Could not verify

  The Results (Primary and Secondary Analyses; page unavailable) describe a yoga-versus-physical-education trial and report depression changes regardless of condition. Our copy does not report a Costigan study or findings on combined resistance and aerobic exercise and subjective well-being (searched: Costigan; resistance aerobic exercise subjective well-being). (LLM, conf=0.77)

  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. sourceExperimental — accuracy not yet measured

In the paper

“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).”

In the paper

“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.”

In the paper

“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).”

In the paper

“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.”

In the paper

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

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

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

In the paper

“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).”

In the paper

“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.”

In the paper

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

In the paper

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

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

What the sources say

• Not checked yetcites [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.

In the paper

“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.”

What the sources say

• Not checked yetcites [52] Zhang TS, Zhong WZ. The realization of non-parametric clipping and compensation method in Stata. Evid Based Med. 2009;9(4):240–2.

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“The protocol for this study was registered with INPLASY (202170013). DOI number is 10.37766/inplasy2021.7.0013. Registration Date:2021.7.06.”

In the paper

“Psychotherapy is more resource-intensive and is associated with perceived stigma from attending the therapist [22].”

What the sources say

• Not checked yetcites [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.

In the paper

“The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (Fig. 1) [27].”

What the sources say

• Not checked yetcites [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.

In the paper

“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].”

What the sources say

• Not checked yetcites [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.

In the paper

“RCTs have also shown that structured exercise programs can effectively alleviate depressive symptoms, and there is a dose–response relationship [17, 18].”

What the sources say

• Not checked yetcites [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 yetcites [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.

In the paper

“It can also reduce depressive symptoms by improving self-efficacy, reducing negative emotions, and stimulating positive behaviors in depressed patients [16].”

What the sources say

• Not checked yetcites [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.

In the paper

“the use of exercise to prevent and treat depression in adolescents is feasible and acceptable.”

In the paper

“Prospective cohort studies have suggested that regular exercise reduces the risk of developing depression [13, 14].”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“For adults, depression is usually regarded as the mental health problem most likely to be positively affected by exercise [20].”

What the sources say

• Not checked yetcites [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

In the paper

“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.”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“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.”

What the sources say

• Not checked yetcites [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

In the paper

“Comparatively, physical exercise is more cost-effective. It is convenient to implement within the community and can potentially have wider reach and participation [23].”

What the sources say

• Not checked yetcites [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

In the paper

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

In the paper

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

In the paper

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

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“exercise alleviated hypothalamic–pituitary–adrenal feedback regulation obstacles by modulating cortisol and IL-6 levels, and thereby improved depression [69].”

What the sources say

• Not checked yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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 yetcites [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.

In the paper

“Previous research showed that moderate- and high-intensity exercise has a stronger effect on depression than low-intensity exercise [109].”

What the sources say

• Not checked yetcites [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.

In the paper

“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].”

What the sources say

• Not checked yetcites [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.

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

“When adolescents with depressive symptoms or negative emotions do not receive timely intervention, they risk developing depression [7].”

What the sources say

• Not checked yetcites [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.

In the paper

“In rats, swimming exercises over 10 weeks significantly increased the levels of serotonin, dopamine, and norepinephrine in the hippocampus [62].”

What the sources say

• Not checked yetcites [62] Cui DX. Effects of swimming exercise on neuroendocrine and behavior in experimental depression rats. East China Normal University. 2005.

In the paper

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

In the paper

“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.”

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

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

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

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

In the paper

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

In the paper

“In depressed rats, a single 30-min session of wheel running reduced the serum corticosterone concentration compared to 20 min [104].”

What the sources say

• Not checked yetcites [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

In the paper

“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.”

In the paper

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

In the paper

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

In the paper

“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].”

What the sources say

• Not checked yetcites [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.

In the paper

“A single exercise session among individuals with depressive symptoms can significantly improve self-efficacy, thereby reducing negative emotions [79]”

What the sources say

• Not checked yetcites [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

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

“Hyperactive HPA axis in patients with major depression is one of the important reasons for its onset[91].”

What the sources say

• Not checked yetcites [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

In the paper

“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.”

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

“(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.”

In the paper

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

In the paper

“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].”

What the sources say

• Not checked yetcites [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.

In the paper

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

In the paper

“In addition, due to the inherent listlessness of patients with major depression, it is sometimes difficult to motivate them to take active exercise[89].”

What the sources say

• Not checked yetcites [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

In the paper

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

In the paper

“Yoga, as a physical and mental exercise based on body posture exercises, has been found to reduce anxiety and stress [92].”

What the sources say

• Not checked yetcites [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

In the paper

“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.”

In the paper

“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].”

What the sources say

• Not checked yetcites [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

In the paper

“(2) Only two of the included articles fully described allocation concealment and only one mentioned blinded outcome assessment.”

In the paper

“(1) Only published Chinese and English articles were included, so the comprehensiveness of the search was limited.”

In the paper

“The American Sports Medicine Association recommends 60–80% HRmax intensity to treat depression [110].”

What the sources say

• Not checked yetcites [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

In the paper

“Given the low self-esteem and self-efficacy of depressed patients, moderate-intensity exercise is currently used more frequently [113].”

What the sources say

• Not checked yetcites [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.

In the paper

“Exercise intensity is positively associated with BDNF and plasma endorphin release [111].”

What the sources say

• Not checked yetcites [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