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Cited by 80Physical Activity and HealthTreatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Comparative Effectiveness of Multiple Exercise Interventions in the Treatment of Mental Health Disorders: A Systematic Review and Network Meta-Analysis

Open access
Yu, Qian, Wong, Ka-Kit, Lei, On-Kei, Nie, Jinlei, Shi, Qingde, Zou, Liye, Kong, Zhaowei·2022·Sports Medicine - Open
DOI 10.1186/s40798-022-00529-5PMC PMC9617247
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Abstract

Background: The efficacy of exercise interventions in the treatment of mental health disorders is well known, but research is lacking on the most efficient exercise type for specific mental health disorders. Objective: The present study aimed to compare and rank the effectiveness of various exercise types in the treatment of mental health disorders. Methods: The PubMed, Web of Science, PsycINFO, SPORTDiscus, CINAHL databases, and the Cochrane Central Register of Controlled Trials as well as Google Scholar were searched up to December 2021. We performed pairwise and network meta-analyses as well as meta-regression analyses for mental health disorders in general and each type of mental health disorder, with alterations in symptom severity as the primary outcome. Results: A total of 6456 participants from 117 randomized controlled trials were surveyed. The multimodal exercise (71%) had the highest probability of being the most efficient exercise for relieving depressive symptoms. While resistance exercise (60%) was more likely to be the most effective treatment for anxiety disorder, patients with post-traumatic stress disorder (PTSD) benefited more from mind–body exercise (52%). Furthermore, resistance exercise (31%) and multimodal exercise (37%) had more beneficial effects in the treatment of the positive and negative symptoms of schizophrenia, respectively. The length of intervention and exercise frequency independently moderated the effects of mind–body exercise on depressive (coefficient = 0.14,p = .03) and negative schizophrenia (coefficient = 0.96,p = .04) symptoms. Conclusion: Multimodal exercise ranked best for treating depressive and negative schizophrenic symptoms, while resistance exercise seemed to be more beneficial for those with anxiety-related and positive schizophrenic symptoms. Mind–body exercise was recommended as the most promising exercise type in the treatment of PTSD. However, the findings should be treated with caution due to potential risk of bias in at least one dimension of assessment and low-to-moderate certainty of evidence. Trial Registration This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42022310237).

AI snapshot

Written from the paper’s full text.

TL;DR

In a systematic review and network meta-analysis of 117 RCTs with 6456 participants, multimodal exercise ranked best for depressive and negative schizophrenic symptoms, resistance exercise for anxiety and positive schizophrenic symptoms, and mind–body exercise for PTSD. Findings were tempered by high risk of bias in at least one dimension and low-to-moderate certainty of evidence.

Key findings

  • Across 117 RCTs and 6456 participants, multimodal exercise had a 71% probability of being best for depressive symptoms; resistance exercise had 60% for anxiety disorder; mind–body exercise had 52% for PTSD; resistance exercise had 31% for positive schizophrenia symptoms and multimodal exercise had 37% for negative schizophrenia symptoms.
  • Pairwise meta-analyses for mental health disorders in general found significant effects versus control for aerobic exercise (SMD 0.91, 95% CI 0.48–1.34), mind–body exercise (SMD 0.81, 95% CI 0.56–1.05), resistance exercise (SMD 1.72, 95% CI 0.49–2.95), and multimodal exercise (SMD 1.62, 95% CI 0.89–2.36).
  • Meta-regression showed the length of intervention moderated mind–body exercise effects on depressive symptoms (coefficient = 0.14, p = .03), and exercise frequency moderated mind–body exercise effects on negative schizophrenia symptoms (coefficient = 0.96, p = .04).
  • For PTSD, mind–body exercise (SMD 0.80, 95% CI 0.47–1.13) and multimodal exercise (SMD 1.25, 95% CI 0.78–1.72) both had significant positive effects versus control in pairwise analyses.

Methods

  • Systematic review and Bayesian network meta-analysis registered in PROSPERO (CRD42022310237); databases searched included PubMed, Web of Science, PsycINFO, SPORTDiscus, CINAHL, CENTRAL, and Google Scholar up to December 2021.
  • Included 117 RCTs with 6456 participants diagnosed with depression (n = 70), anxiety disorder (n = 5), PTSD (n = 11), or schizophrenia (n = 31); sample sizes ranged from 20 to 244 and ages from 19 to 76 years. Exercise categories were aerobic, resistance, mind–body, stretching, multimodal, and other.
  • Pairwise random-effects meta-analyses estimated standardized mean differences; Bayesian network meta-analysis used ADDIS with consistency/inconsistency models and rank probabilities; meta-regression examined age, exercise frequency, session duration, and length of intervention. Risk of bias was assessed with RoB 2.0 and certainty with GRADE.

Limitations

  • Stated by the authors: exercise intensity was not used as a moderator because reporting was inconsistent or nonnumeric; daily medication regimens varied and interactions among symptoms, exercise, and medication were not explored; many studies had high risk of bias in at least one dimension and low-to-moderate certainty of evidence; studies with fewer than 20 participants were excluded; and the protocol was not published a priori.
  • Evident from the text: the PTSD network had no closed loop and no direct comparisons among exercise types; anxiety disorder evidence came from only 5 RCTs; and some meta-regressions were limited by incomplete information and few studies.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s40798-022-00529-5

Cites

193 of 193 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 42 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Multimodal exercise had the highest probability (71%) of being the most efficient exercise for relieving depressive symptoms.

    “The multimodal exercise (71%) had the highest probability of being the most efficient exercise for relieving depressive symptoms.”
    • Also stated in: § Key Points · plain
      “The multimodal exercise had the highest probability of being the most effective exercise for relieving depression and negative symptoms of schizophrenia.”
    Quote in the paperSubstantial claim
  • Findingown data

    The length of intervention positively moderated the effects of mind-body exercise on depressive symptoms (coefficient = 0.14, p = .03).

    “The length of intervention and exercise frequency independently moderated the effects of mind–body exercise on depressive (coefficient = 0.14, p = .03) and negative schizophrenia (coefficient = 0.96, p = .04) symptoms.”
    • Also stated in: § Treatment for Depression · hedged
      “The meta-regression for MBE suggested that the length of intervention positively moderated the effectiveness of MBE on depressive symptoms (coefficient, 0.14; p = 0.03)”
    Quote in the paperNot a substantial claim
  • Findingown data

    Pairwise meta-analysis found no significant difference between aerobic exercise and other exercise types (HIIE) for mental health symptoms in general (SMD 0.55; 95% CI −0.53, 1.63).

    “AE versus others (HIIE) (SMD, 0.55; 95% CI − 0.53, 1.63)—were not significantly different”
    Quote in the paperNot a substantial claim
  • Findingown data

    Pairwise meta-analysis showed that aerobic exercise was superior to stretching for depressive symptoms (SMD 0.49; 95% CI 0.00, 0.99).

    “AE versus stretching (SMD, 0.49; 95% CI 0.00, 0.99)”
    Quote in the paperSubstantial claim
  • Findingown data

    Rank probabilities for depressive symptom improvement from best to worst were multimodal exercise, resistance exercise, mind-body exercise, aerobic exercise, and stretching.

    “The rank probabilities of all exercise interventions in terms of depressive symptom improvement were generated as follows (from the best to the worst): ME, RE, MBE, AE, and stretching”
    Quote in the paperSubstantial claim
  • May combine two claims. 21
  • Classified as probably not a substantial claim. 20

  • May combine two claims.

    Findingown data

    According to rank probabilities, multimodal exercise was most likely to rank best for mental health symptoms in general, followed by resistance exercise, mind-body exercise, aerobic exercise, and stretching.

    “ME was most likely to rank best, followed by RE, MBE, AE, and stretching.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The included studies comprised 70 trials for depression, 5 for anxiety disorder, 11 for PTSD, and 31 for schizophrenia.

    “(depression: n = 70 [34–39, 57–120]; anxiety disorder: n = 5 [121–125]; PTSD: n = 11 [43, 126–135]; and schizophrenia: n = 31 [136–166]”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The present review included 6456 participants from 117 RCTs published in the last 35 years.

    “The present review included 6456 participants from 117 RCTs published in the last 35 years.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    MBE was most likely to rank best for PTSD, followed by ME and RE.

    “The ranking probability plot indicated that the MBE was most likely to rank best, followed by ME and RE”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationown data

    Mind-body exercise is the most promising exercise type in the treatment of PTSD.

    “Mind–body exercise was recommended as the most promising exercise type in the treatment of PTSD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Network meta-analysis outperforms conventional pairwise meta-analysis by integrating and quantifying both direct and indirect evidence, estimating the relative effectiveness of multiple interventions simultaneously, and ranking treatments.

    “Network meta-analysis, a promising synthesis methodology in the field of sports science and health promotion, outperforms conventional pairwise meta-analysis by integrating and quantifying both direct and indirect evidence, estimating the relative effectiveness of multiple interventions simultaneously, and ranking treatments as part of the process of clinical decision-making [26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Su X, McDonough DJ, Chu H, Quan M, Gao Z. Application of network meta-analysis in the field of physical activity and health promotion. J Sport Health Sci. 2020;9(6):511–20. source

      Not checked in the free run.

    • Rests on an assumption: Traditional pairwise meta-analyses cannot pool evidence from multiple interventions.

  • May combine two claims.

    Premisecitation

    Different types of exercise interventions generate mental health benefits disproportionately and may have different effects on the same mental health disorder.

    “Notably, different types of exercise interventions generate mental health benefits through the above mechanisms disproportionately and may have different effects on the same mental health disorder [15, 16].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] Mikkelsen K, Stojanovska L, Polenakovic M, Bosevski M, Apostolopoulos V. Exercise and mental health. Maturitas. 2017;106:48–56. source

      Not checked in the free run.

    • cites [16] Smith PJ, Merwin RM. The role of exercise in management of mental health disorders: an integrative review. Annu Rev Med. 2021;72:45–62. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The findings should be treated with caution due to potential risk of bias in at least one dimension of assessment and low-to-moderate certainty of evidence.

    “However, the findings should be treated with caution due to potential risk of bias in at least one dimension of assessment and low-to-moderate certainty of evidence.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Pharmacological therapies lack stability and significant efficacy due to uneven distribution of resources, side effects, and low patient compliance.

    “Due to the uneven distribution of resources, side effects, and low patient compliance, currently pharmacological therapies lack stability and significant efficacy [13].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Dixon LB, Holoshitz Y, Nossel I. Treatment engagement of individuals experiencing mental illness: review and update. World Psychiatry. 2016;15(1):13–20. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The GRADE approach was used to assess the certainty of evidence.

    “The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of the evidence [50].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50] Salanti G, Del Giovane C, Chaimani A, Caldwell DM, Higgins JP. Evaluating the quality of evidence from a network meta-analysis. PLoS ONE. 2014;9(7):e99682. source

      Not checked in the free run.

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

    Study design and conductcitation

    The outcomes of network meta-analyses were retested by WinBUGS.

    “the outcomes of network meta-analyses were retested by WinBUGS [56]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] Winters M, Holden S, Lura CB, Welton NJ, Caldwell DM, Vicenzino BT, et al. Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis. Br J Sports Med. 2020;55:3697.

      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 investigators independently screened titles and abstracts and assessed full texts, with disagreements resolved by discussion or a third expert.

    “Two investigators (QY and KW) independently screened titles and abstracts to identify all relevant studies and then assessed the full texts according to the pre-set criteria. Disagreements were resolved through discussion or consultation with a third expert (ZK).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Node-splitting analyses indicated inconsistencies between direct and indirect comparisons in the model for positive schizophrenic symptoms, but not in models for overall and negative symptoms.

    “The results of the node-splitting analyses indicate inconsistencies between direct and indirect comparisons in the model for positive symptoms, but not in the models for overall and negative symptoms.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    The search strategy was reviewed by experts from the fields of mental health and sports science.

    “The search strategy was reviewed by experts from the fields of mental health and sports science”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    The systematic review and network meta-analysis was registered with PROSPERO (CRD42022310237).

    “We registered our systematic review and network meta-analysis with PROSPERO (CRD42022310237)”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Risk of bias was independently evaluated by two investigators using Cochrane RoB 2.0.

    “The risk of bias (RoB) for all studies was independently evaluated by two investigators (QS and LZ) using the Cochrane Collaboration’s risk-of-bias tool (RoB version 2.0) [49].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions version 6.2: Cochrane; 2021.

      Not checked in the free run.

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

    Premisecitation

    In previous meta-analyses, the length of exercise was the only characteristic related to the effect size for depression treatment, and 9-12 weeks were associated with the largest reduction.

    “This was partly consistent with previous meta-analyses in which the length of exercise was the only characteristic related to the effect size for depression treatment [168, 169], and where 9–12 weeks were associated with the largest reduction.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [168] Craft LL, Landers DM. The effect of exercise on clinical depression and depression resulting from mental illness: a meta-analysis. J Sport Exerc Psychol. 1998;20:339–57. source

      Not checked in the free run.

    • cites [169] North TC, McCullagh P, Tran ZV. Effect of exercise on depression. Exerc Sport Sci Rev. 1990;18:379–415. 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

    Similarities between assessments of RoB and certainty of evidence between the two investigators were calculated, and a third investigator was consulted for disagreements.

    “Similarities between assessments of RoB and certainty of evidence between the two investigators were calculated, and the third investigator (ZK) was consulted in the event of disagreement.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Two investigators independently extracted data using a self-designed statistical form.

    “Two investigators (OL and JN) independently extracted the data from a self-designed statistical form.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Participants had full diagnosis by professionals according to DSM/ICD.

    “full diagnosis of depression, anxiety disorder, PTSD, or schizophrenia by professionals according to accepted criteria (i.e., Diagnostic and Statistical Manual of Mental Disorders [DSM; 4th and 5th eds.] and International Statistical Classification of Diseases and Relating Health Problems [ICD; 9th and 10th eds.])”
    Quote in the paperSubstantial claim

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

    Study design and conductcitation

    The PRISMA-NMA checklist was used.

    “used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Network Meta-Analyses (PRISMA-NMA) checklist (Additional file 2: Appendix S1) [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationown data

    The selection of exercise program should be determined by disorder type.

    “The selection of exercise program should be determined by disorder type.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Subsyndromal mental health symptoms are broadly regarded as risk factors for developing clinically significant mental health disorders.

    “the subsyndromal mental health symptoms (e.g., subsyndromal depression, subsyndromal generalized anxiety disorder, subsyndromal PTSD), failing to meet the full diagnostic criteria of mental health disorders, are broadly regarded as risk factors for developing clinically significant mental health disorders [190–192].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [190] VanItallie TB. Subsyndromal depression in the elderly: underdiagnosed and undertreated. Metabolism. 2005;54(5 Suppl 1):39–44. source

      Not checked in the free run.

    • cites [191] Kasckow JW, Karp JF, Whyte E, Butters M, Brown C, Begley A, et al. Subsyndromal depression and anxiety in older adults: health related, functional, cognitive and diagnostic implications. J Psychiatr Res. 2013;47(5):599–603. source

      Not checked in the free run.

    • cites [192] Greene DR, Petruzzello SJ. Working it out: acute exercise to combat anxiety and depressive symptoms in individuals living with subsyndromal post-traumatic stress disorder. Int J Sport Exercise Psychol. 2021;20:1–16.

      Not checked in the free run.

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

    Premisecitation

    MBE efficacy may involve desensitization to inner arousal.

    “The possible psychophysiological mechanisms underlying the efficacy of MBE may include the down-regulation of inflammatory markers [179]; corticotropin-releasing hormone concentration [180]; the up-regulation of cortisol level [181]; and desensitization to inner arousal [182].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [182] Hegberg NJ, Hayes JP, Hayes SM. Exercise intervention in PTSD: a narrative review and rationale for implementation. Front Psychiatry. 2019;10:133. source

      Not checked in the free run.

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

    Premisecitation

    MBE efficacy may involve down-regulation of inflammatory markers.

    “The possible psychophysiological mechanisms underlying the efficacy of MBE may include the down-regulation of inflammatory markers [179]; corticotropin-releasing hormone concentration [180]; the up-regulation of cortisol level [181]; and desensitization to inner arousal [182].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [179] Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses. 2012;78(5):571–9. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Schizophrenia patients with positive symptoms have significant disturbances in sensory-motor gating, shifting, spatial focus, and cue detection.

    “because schizophrenia patients with positive symptoms have significant disturbances in sensory-motor gating, shifting, spatial focus, and cue detection [185].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [185] Morris R, Griffiths O, Le Pelley ME, Weickert TW. Attention to irrelevant cues is related to positive symptoms in schizophrenia. Schizophr Bull. 2013;39(3):575–82. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Patients with anxiety disorder and PTSD might benefit more from RE and MBE, respectively.

    “those with anxiety disorder and PTSD might benefit more from RE and MBE, respectively”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The anxiety trials involved limited sample sizes, so the findings should be treated with caution.

    “It should be noted, however, that the above trials involved limited sample sizes, so the findings should be treated with caution.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    The protocol of this systematic review and network meta-analysis was not published a priori, which may have resulted in publication bias and low reproducibility.

    “the protocol of this current systematic review and network meta-analysis was not published a prior, which may have resulted in publication bias and low reproducibility.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    MBE efficacy may involve down-regulation of corticotropin-releasing hormone concentration.

    “The possible psychophysiological mechanisms underlying the efficacy of MBE may include the down-regulation of inflammatory markers [179]; corticotropin-releasing hormone concentration [180]; the up-regulation of cortisol level [181]; and desensitization to inner arousal [182].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [180] McEwen BS. The neurobiology and neuroendocrinology of stress: implications for post- traumatic stress disorder from a basic science perspective. Psychiatr Clin N Am. 2002;25(2):469–94. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The meditation nature of MBE alleviates psychotic symptoms by improving autonomic nerve function and reconstructing large-scale brain networks.

    “In addition, the meditation nature of MBE alleviates psychotic symptoms by improving autonomic nerve function and reconstructing large-scale brain networks [189].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [189] Shen H, Chen M, Cui D. Biological mechanism study of meditation and its application in mental disorders. Gen Psychiatr. 2020;33(4):e100214. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    RE had more competitive advantages in attention control facilitation than other exercise interventions.

    “One explanation for this effect was that RE had more competitive advantages in attention control facilitation than other exercise interventions [184]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [184] Hsieh SS, Chang YK, Fang CL, Hung TM. Acute resistance exercise facilitates attention control in adult males without an age-moderating effect. J Sport Exerc Psychol. 2016;38(3):247–54. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Interactions between symptom, exercise, and medication were not explored because included studies allowed patients to take daily medications and their regimens varied.

    “interactions between symptom, exercise, and medication were not explored in the present study”
    Quote in the paperSubstantial claim

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

    Premisecitation

    MBE efficacy may involve up-regulation of cortisol level.

    “The possible psychophysiological mechanisms underlying the efficacy of MBE may include the down-regulation of inflammatory markers [179]; corticotropin-releasing hormone concentration [180]; the up-regulation of cortisol level [181]; and desensitization to inner arousal [182].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [181] Yehuda R, Golier J. Is there a rationale for cortisol-based treatments for PTSD? Expert Rev Neurother. 2009;9(8):1113–5. source

      Not checked in the free run.

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

    Premisecitation

    The population with subsyndromal mental health symptoms is underdiagnosed and undertreated globally, which results in public health hazards.

    “However, the population with subsyndromal mental health symptoms is underdiagnosed and undertreated globally, which results in public health hazards [190–192].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [190] VanItallie TB. Subsyndromal depression in the elderly: underdiagnosed and undertreated. Metabolism. 2005;54(5 Suppl 1):39–44. source

      Not checked in the free run.

    • cites [191] Kasckow JW, Karp JF, Whyte E, Butters M, Brown C, Begley A, et al. Subsyndromal depression and anxiety in older adults: health related, functional, cognitive and diagnostic implications. J Psychiatr Res. 2013;47(5):599–603. source

      Not checked in the free run.

    • cites [192] Greene DR, Petruzzello SJ. Working it out: acute exercise to combat anxiety and depressive symptoms in individuals living with subsyndromal post-traumatic stress disorder. Int J Sport Exercise Psychol. 2021;20:1–16.

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Exercise intensity was not used as a moderator in meta-regression because previous researchers measured and described exercise intensity using multiple approaches or did not report it numerically, which may have influenced transitivity.

    “exercise intensity has not been used as a moderator in the conduct of meta-regression analyses”
    • Also stated in: § Limitations · hedged
      “which may have influenced the transitivity in the indirect comparisons”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    A large proportion of the included studies were evaluated with a high risk of bias in at least one dimension and low-to-moderate certainty of evidence.

    “a large proportion of the studies were evaluated with a high RoB in at least one dimension and low-to-moderate certainty of evidence.”
    Quote in the paperSubstantial claim
37 of 37

  • The paper relies on this without support.

    Studies comparing the simultaneous mental health benefits of various exercise types are lacking.

    “However, studies comparing the simultaneous mental health benefits of various exercises are lacking”

  • The paper relies on this without support.

    Traditional pairwise meta-analyses cannot pool evidence from multiple interventions.

    “traditional pairwise meta-analyses cannot pool evidence from multiple interventions”

  • The paper relies on this without support.

    The most efficient type of exercise for a particular mental health disorder has not been established.

    “Thus, the most efficient type of exercise for a particular mental health disorder has not been established”
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?

  • Two previous network meta-analyses of exercise for depression might have been underpowered to explore moderators such as dose and modality.

    “Because of the inclusion criteria and search strategies used, these reviews might have been under-powered to explore moderators such as dose and modality (κ=15 and κ=71, respectively).”

    From Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials (2024) · cites this paper as [28]

  • We attribute the stronger effect sizes for some exercise types to the study level data available in a network meta-analysis compared with an overview of reviews and higher power compared with meta-analyses with smaller numbers of included studies.

    “We attribute this to the study level data available in a network meta-analysis compared with an overview of reviews 24 and higher power compared with meta-analyses with smaller numbers of included studies.22 28”

    From Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials (2024) · cites this paper as [28]

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.

  • Not all cited depression effect sizes exceed 0.78

    Minor

    The discussion says all the cited effect sizes are greater than 0.78, but the reported MBE effect size equals 0.78.

  • Eligibility threshold conflicts with the reported minimum sample size

    Minor

    The inclusion criteria require a total sample size greater than 20, but the reported range says at least one included trial had 20 participants.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Adagide S, Karatas N. The effects of physical exercise on the depressive symptoms and quality of life of individuals diagnosed with depression. J Psychiatr Nurs. 2021;12(2):122–31.
  2. Areshtanab HN, Ebrahimi H, Farnam AR, Mohammadpoorasl A, Jamali B, Piri S. The effect of regular aerobic exercise on both positive and negative symptoms of male patients with chronic Schizophrenia: a double blinded study. Int J Med Res Health Sci. 2016;5(11):529–35.

Cited by

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Related

Authors
Yu, Q., Wong, K.-K., Lei, O.-K., Nie, J., Shi, Q., Zou, L., & Kong, Z.
Affiliations
  • University of Macau (MO)
  • Macao Polytechnic University (MO)
  • Shenzhen University (CN)
Corresponding author
Kong, Zhaowei
ORCID
Venue
Sports Medicine - Open
Publisher
Springer Science and Business Media LLC
Published
2022-10-29
Volume
8
Issue
1
Pages
135-135
ISSN
  • 2198-9761 (ISSN-L)
  • 2199-1170
DOI
10.1186/s40798-022-00529-5
PMC
PMC9617247
OpenAlex
W4307528279
Cited by
80
References
193
Citations by year
2026: 21 · 2025: 26 · 2024: 15 · 2023: 17 · 2022: 1
FWCI
2.03
Type
journal article
Language
en
Open access
Licence
Locations
  • Sports Medicine - Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Universidade de Macau (MYRG2017-00199-FED)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
exercise intervention, mental illness, multimodal training, resistance training, mind-body exercise, depression, anxiety disorders, post-traumatic stress disorder, schizophrenia, symptom severity, exercise frequency, intervention 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 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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.

What counts as a claim ›How we measure confidence ›How we check this ›

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