Can physical exercise modulate cortisol level in subjects with depression? A systematic review and meta-analysis
Open accessAbstract
Abstract Introduction: Major depressive disorder (MDD) is a prevalent medical illness that is associated with chronic stress. Patients with MDD can show an imbalance in cortisol levels, which can be restored with the remission of symptoms. Physical exercise training has been used as a tool to promote changes in cortisol levels in healthy individuals. However, it is unknown if exercise can produce the same results in individuals with MDD. Objective: To review evidence of cortisol changes after exercise training in individuals with MDD. Methods: We conducted a search on PubMed, SciELO, LILACS, ISI Web of Knowledge, Scopus, and PsycInfo databases. Random effects meta-analysis was performed and standardized mean difference (SMD) effect size was calculated. Analyses of forest and funnel plots was conducted using Stata v.11.0 software. Results: At first, 463 studies were obtained in the search. After completion of the selection procedure, five articles with seven analyses were included. Type of exercise, frequency of training, cortisol measurement, and type of control group were analyzed. There was a reduction of cortisol levels in the exercise group (SMD = −0.65, 95%CI 1.30-0.01). Moreover, sensitivity analysis and subgroup analyses revealed an effect of type (aerobic exercise) and frequency (five times per week) of exercise on reduction of cortisol levels. However, these results should be interpreted cautiously due to the small number of studies and a substantial heterogeneity among them. Conclusion: Physical exercise promotes a reduction in cortisol levels in individuals with MDD. However, this finding can be influenced by type of exercise, weekly frequency, and type of cortisol measurement.
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TL;DR
This systematic review and meta-analysis found a moderate favorable effect of exercise training on reducing cortisol levels in individuals with major depressive disorder (SMD = -0.65; 95%CI -1.30 to 0.01), but the main pooled estimate was not statistically significant (p = 0.054). Subgroup analyses suggested larger reductions for aerobic exercise, five-times-weekly training, urine cortisol measurement, and non-active control groups, though the authors caution these findings are limited by few studies and substantial heterogeneity.
Key findings
- The main random-effects meta-analysis of all trials showed a moderate reduction in cortisol after exercise training: SMD = -0.65 (95%CI -1.30 to 0.01; p = 0.054; I² = 82.7%).
- After sensitivity analysis excluding two trials outside the funnel plot, the effect remained moderate and became statistically significant: SMD = -0.64 (95%CI -1.17 to -0.10; p = 0.019; I² = 28.7%).
- Subgroup analyses found significant reductions for aerobic exercise (SMD = -0.76; 95%CI -1.55 to 0.03), five times per week (SMD = -2.18; 95%CI -2.90 to -1.47), three times per week (SMD = -0.64; 95%CI -1.17 to -0.10), urine cortisol measurement (SMD = -2.18; 95%CI -2.90 to -1.47), and non-active control groups (SMD = -0.99; 95%CI -1.95 to -0.04).
- No significant effects were found for strength training (SMD = -0.05; 95%CI -0.57 to 0.47), exercising twice per week (SMD = 0.05; 95%CI -0.32 to 0.41), saliva cortisol (SMD = -0.88; 95%CI -2.00 to 0.30), plasma cortisol (SMD = -0.26; 95%CI -0.71 to 0.18), or active control groups (SMD = -0.05; 95%CI -0.46 to 0.35).
Methods
- Systematic review and meta-analysis registered in PROSPERO (CRD42018055996), conducted according to PICO and PRISMA, searching PubMed, SciELO, LILACS, ISI Web of Knowledge, Scopus, and PsycInfo up to March 02 2018.
- Inclusion criteria were randomized and controlled studies investigating exercise training effects on cortisol levels in individuals with MDD compared with control groups; MDD was defined by diagnostic interviews or depression screening cut-offs.
- The search yielded 463 studies; after selection, 5 studies with 7 arms and 209 participants (125 intervention vs. 84 control) were included. Random-effects meta-analysis estimated standardized mean differences using Stata v.11.0, with subgroup analyses by exercise type, training frequency, cortisol measurement, and control group type; risk of bias was assessed with the PEDro scale.
Limitations
- The authors state that results should be interpreted cautiously due to the small number of studies and substantial heterogeneity among them regarding exercise type, cortisol measurement, exercise frequency, and control group type.
- The authors state that it is not possible to conclude whether the effect of exercise on cortisol occurs concomitantly with reductions in depressive symptoms, and that the small number of articles did not allow reliable conclusions from subgroup analyses.
- The authors also note that the meta-analysis included both patients with a clinical diagnosis of depression and individuals with depressive symptoms according to scales, so the influence of clinical diagnosis could not be determined; the text makes evident additional concerns including funnel plot asymmetry suggesting possible publication bias and discrepant exercise methodologies.
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- Findingnone given
There was substantial heterogeneity among the included studies considering type of exercise, type of cortisol measurement, frequency of exercise, and type of control group.
“However, these results should be interpreted cautiously due to the small number of studies and a substantial heterogeneity among them considering type of exercise, type of cortisol measurement, frequency of exercise, and type of control group.”
Quote in the paperSubstantial claim - Findingown data
Exercising three times per week produced a moderate reduction in cortisol levels (SMD = -0.64; 95% CI -1.17 to -0.10).
“a moderate reduction for exercising three times per week (SMD = -0.64;95%CI -1.17 to -0.10)”
Quote in the paperSubstantial claim - Findingown data
Aerobic training produced a significant reduction in cortisol levels (SMD = -0.76; 95% CI -1.55 to 0.03).
“Significant reduction in cortisol levels was found for aerobic training (SMD = -0.76;95%CI -1.55 to 0.03)”
Quote in the paperSubstantial claim - Findingown data
Saliva measurement of cortisol showed a moderate but non-significant effect (SMD = -0.88; 95% CI -2.06 to 0.30).
“Moderate but nonsignificant effects were found for cortisol measured in saliva (SMD = -0.88;95%CI -2.06 to 0.30).”
Quote in the paperSubstantial claim - Findingown data
Exercise training produces a moderate reduction in cortisol levels in individuals with major depressive disorder (SMD = -0.65; 95% CI -1.30 to 0.01).
“There was a moderate favorable effect of exercise training on reduction of cortisol levels (SMD = -0.65;95% confidence interval [95%CI] -1.30 to 0.01) (Figure 2).”
- Also stated in: § Discussion · plain
“In conclusion, physical exercise promotes a moderate reduction in cortisol levels in MDD individuals.”
- Also stated in: § Abstract · plain
“Houve uma redução dos níveis de cortisol no grupo de exercício.”
Quote in the paperSubstantial claim - Also stated in: § Discussion · plain
- Findingown data
Most studies included in this meta-analysis were classified as good quality according to risk of bias within the studies.
“Fortunately, most of the studies assessed in this meta-analysis were classified as good quality according to risk of bias within the studies.”
- Also stated in: § Additional information · plain
“Most studies included in this meta-analysis were classified as good quality (results available in Online-Only Supplementary Table 1).”
Quote in the paperNot a substantial claim - Also stated in: § Additional information · plain
- Findingown data
Visual analysis of the funnel plot showed asymmetry of two articles (three trials) within the studies.
“Visual analysis of the funnel plot showed asymmetry of two articles 26,29 (three trials) within the studies,”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [26] Nabkasorn C, 2006, Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms, Eur J Public Health source
Not checked in the free run.
- cites [29] Krogh J, 2010, Growth hormone, prolactin and cortisol response to exercise in patients with depression, J Affect Disord source
Not checked in the free run.
- Findingown data
Strength training produced no effect on cortisol levels (SMD = -0.05; 95% CI -0.57 to 0.47).
“while no effects were found for strength training (SMD = -0.05;95%CI -0.57 to 0.47)”
Quote in the paperSubstantial claim - Findingown data
No-treatment control group produced a moderate reduction in SMD (SMD = -0.99; 95% CI -1.95 to -0.44).
“compared to a moderate reduction when the control group was not subjected to any treatment (SMD = -0.99;95%CI -1.95 to -0.44)”
Quote in the paperNot a substantial claim - Findingown data
Sensitivity analysis excluding the two trials outside the funnel plot yielded a recalculated effect of -0.64 (95% CI -1.17 to -0.10; I2 = 28.7).
“We performed a sensitivity analysis excluding the two trials that were located outside the funnel plot.The recalculated effect was equal to -0.64 (95%CI -1.17 to -0.10;I 2 = 28.7)(Table 2).”
Quote in the paperNot a substantial claim - Findingreasoning
The higher effect observed for aerobic training did not reach statistical significance.
“Although a higher effect was observed for aerobic training, this result did not reach statistical significance”
Quote in the paperNot a substantial claim - Findingown data
Plasma measurement of cortisol showed a small reduction (SMD = -0.26; 95% CI -0.71 to -0.18).
“Plasma measurement detected only a small reduction (SMD = -0.26;95%CI -0.71 to -0.18)”
Quote in the paperSubstantial claim - Findingown data
Exercising twice a week produced non-significant effects on cortisol levels (SMD = 0.05; 95% CI -0.32 to 0.41).
“non-significant effects were found for exercising twice a week (SMD = 0.05; 95%CI -0.32 to 0.41)”
Quote in the paperNot a substantial claim - Findingown data
Urine measurement of cortisol showed a large effect (SMD = -2.18; 95% CI -2.90 to -1.47).
“large effects were observed only for urine measurements (SMD = -2.18;95%CI -2.90 to -1.47)”
Quote in the paperSubstantial claim - Findingown data
Active control group produced a trivial reduction in SMD (SMD = -0.05; 95% CI -0.46 to 0.35).
“analysis of types of control groups revealed a trivial reduction of SMD when active treatment was used (SMD = -0.05;95%CI -0.46 to 0.35)”
Quote in the paperSubstantial claim - Findingown data
Exercising five times per week produced a very large and significant reduction in cortisol levels (SMD = -2.18; 95% CI -2.90 to -1.47).
“A very large and significant reduction was found for exercising five times per week (SMD = -2.18;95%CI -2.90 to -1.47)”
Quote in the paperSubstantial claim - Findingreasoning
A non-active control group, without any intervention or exercise, yields larger effect sizes compared with control groups also subjected to exercise.
“Our results indicate that a nonactive control group, without any type of intervention or exercise, yields larger effect sizes when compared with control groups also subjected to exercise”
Quote in the paperSubstantial claim - Findingown data
Among the studies evaluated, three showed significant reductions of depressive symptoms.
“Among the studies here evaluated, three showed significant reductions of depressive symptoms.”
Quote in the paperNot a substantial claim - Findingreasoning
The variability of activities in the control groups was an important methodological problem observed in the studies.
“The variability of activities in the control groups was also an important methodological problem observed in the studies.”
Quote in the paperSubstantial claim - Interpretationown data
The finding of exercise-induced cortisol reduction can be influenced by methodological aspects: type of exercise, weekly frequency, and type of cortisol measurement.
“However, this finding can be influenced by methodological aspects, such as type of exercise, weekly frequency, and type of cortisol measurement.”
Quote in the paperSubstantial claim - Study design and conductown data
The small number of articles did not allow a reliable conclusion regarding the subgroup analysis performed.
“Finally, the small number of articles did not allow to reach a reliable conclusion regarding the subgroup analysis performed.”
Quote in the paperSubstantial claim - Interpretationown data
The effect of exercise on cortisol in individuals with major depressive disorder cannot be concluded to occur concomitantly with reductions in depressive symptoms.
“First, it is not possible to conclude that the effect of exercise on cortisol in individuals with MDD occurs concomitantly with reductions in depressive symptoms.”
Quote in the paperSubstantial claim - Interpretationreasoning
The lack of statistical significance for aerobic training is probably due to the small number of articles included in the meta-analysis.
“probably due to the small number of articles included in this meta-analysis.”
Quote in the paperNot a substantial claim - Study design and conductreasoning
Due to the small number of articles and methodological differences, the authors cannot conclude if there was an influence of clinical diagnosis on the effect of exercise on cortisol levels.
“Due to the small number of articles included and the methodological differences among them, we cannot conclude if there was an influence of clinical diagnosis in the effect of exercise on cortisol levels.”
Quote in the paperSubstantial claim - Premisecitation
Two researches observed a significant reduction of cortisol levels using a deep breathing technique.
“For example, two researches 27,44 observed a significant reduction of cortisol levels using a deep breathing technique.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [27] Vedamurthachar A, 2006, Antidepressant efficacy and hormonal effects of Sudarshana Kriya Yoga (SKY) in alcohol dependent individuals, J Affect Disord source
Not checked in the free run.
- cites [44] Perciavalle V, 2017, The role of deep breathing on stress, Neurol Sci source
Not checked in the free run.
- Study design and conductreasoning
Due to the heterogeneity of intensity measurement, the authors were not able to specifically evaluate dose response.
“However, due to the heterogeneity of intensity measurement, we were not able to specifically evaluate dose response.”
Quote in the paperSubstantial claim - Interpretationcitation
An active control group can present changes in cortisol levels even with interventions that do not involve physical exercise, e.g., relaxation techniques.
“as an active control group can present changes in cortisol levels even with interventions that do not involve physical exercise, e.g.relaxation techniques.”
Quote in the paperSubstantial claim
- Classified as probably not a substantial claim. 16
- May combine two claims. 13
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenThe duration of the intervention varied from 8 to 16 weeks for chronic studies.
“The duration of the intervention varied from 8 to 16 weeks for chronic studies.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
FindingcitationCortisol measurement was made in saliva (n=1), urine (n=1), and plasma (n=3).
“Cortisol measurement was made in the saliva (n = 1), 25 urine (n = 1), 26 and plasma (n = 3) 29,30,39 of the participants, at different times of the day.”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [25] Foley LS, 2008, An examination of potential mechanisms for exercise as a treatment for depression: A pilot study, Ment Health Phys Activity source
Not checked in the free run.
- cites [26] Nabkasorn C, 2006, Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms, Eur J Public Health source
Not checked in the free run.
- cites [29] Krogh J, 2010, Growth hormone, prolactin and cortisol response to exercise in patients with depression, J Affect Disord source
Not checked in the free run.
May combine two claims.
Findingown dataThe studies were very discrepant with regard to exercise methodology, which may have impacted the results.
“Especially with regard to exercise methodology, the studies were also very discrepant, which may have impacted the results.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
FindingcitationDifferent types of exercise were used, including aerobic exercise, jogging training, strength training, relaxation exercise, Buddhism walking meditation, traditional walking, and stretching.
“Different types of exercise were used, including aerobic exercise, 25,29,30 Records jogging training, 26 strength training, 29 relaxation exercise, 29 Buddhism walking meditation, 37 traditional walking 39 and stretching.25”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [25] Foley LS, 2008, An examination of potential mechanisms for exercise as a treatment for depression: A pilot study, Ment Health Phys Activity source
Not checked in the free run.
- cites [29] Krogh J, 2010, Growth hormone, prolactin and cortisol response to exercise in patients with depression, J Affect Disord source
Not checked in the free run.
- cites [30] Carneiro LS, 2017, Monoamines and cortisol as potential mediators of the relationship between exercise and depressive symptoms, Eur Arch Psychiatry Clin Neurosci source
Not checked in the free run.
Classified as probably not a substantial claim.
Findingown dataFive studies, with seven arms, were included in the meta-analysis.
“After the selection procedure, five studies, with seven arms, were included in the meta-analysis.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
FindingcitationTwo studies evaluated cortisol in basal condition, one observed cortisol awakening response, one assessed cortisol levels after 8 hours of overnight fasting, and one measured 24 hours of excretions.
“Two of them evaluated cortisol in basal condition, 29,30 one article observed cortisol awakening response, 25 another study assessed cortisol levels after 8 hours of overnight fasting 39 and the last one measured 24 hours of excretions.26”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [29] Krogh J, 2010, Growth hormone, prolactin and cortisol response to exercise in patients with depression, J Affect Disord source
Not checked in the free run.
- cites [30] Carneiro LS, 2017, Monoamines and cortisol as potential mediators of the relationship between exercise and depressive symptoms, Eur Arch Psychiatry Clin Neurosci source
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- cites [25] Foley LS, 2008, An examination of potential mechanisms for exercise as a treatment for depression: A pilot study, Ment Health Phys Activity source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThe five included studies comprised 209 participants.
“Overall, the five studies included 209 participants”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
FindingcitationThree different types of weekly frequencies were used: two, three and five times per week.
“For example, three different types of weekly frequencies were used: two, 29 three 25 and five times per week.26”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [29] Krogh J, 2010, Growth hormone, prolactin and cortisol response to exercise in patients with depression, J Affect Disord source
Not checked in the free run.
- cites [25] Foley LS, 2008, An examination of potential mechanisms for exercise as a treatment for depression: A pilot study, Ment Health Phys Activity source
Not checked in the free run.
- cites [26] Nabkasorn C, 2006, Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms, Eur J Public Health source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataAll included studies were randomized controlled trials.
“All the studies included were randomized controlled trials (Table 1).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe meta-analysis involved patients with a clinical diagnosis of depression and individuals with depressive symptoms according to depression scales.
“Second, our meta-analysis involved patients with a clinical diagnosis of depression and individuals with depressive symptoms according to depression scales.”
Quote in the paperSubstantial claimMay combine two claims.
FindingcitationOne study did not present the association between reduced cortisol and improved depressive symptoms, and another found non-significant results.
“However, one study did not present the association between reduced cortisol and improved depressive symptoms, 30 and another found non-significant results.29”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [30] Carneiro LS, 2017, Monoamines and cortisol as potential mediators of the relationship between exercise and depressive symptoms, Eur Arch Psychiatry Clin Neurosci source
Not checked in the free run.
- cites [29] Krogh J, 2010, Growth hormone, prolactin and cortisol response to exercise in patients with depression, J Affect Disord source
Not checked in the free run.
May combine two claims.
FindingcitationTwo studies investigated an active control group (stretching and relaxation), while three studies investigated a non-active control group.
“For example, two studies 25,29 investigated an active control group (stretching and relaxation, respectively), while three studies 26,30,39 investigated a non-active control group.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [25] Foley LS, 2008, An examination of potential mechanisms for exercise as a treatment for depression: A pilot study, Ment Health Phys Activity source
Not checked in the free run.
- cites [29] Krogh J, 2010, Growth hormone, prolactin and cortisol response to exercise in patients with depression, J Affect Disord source
Not checked in the free run.
- cites [26] Nabkasorn C, 2006, Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms, Eur J Public Health source
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationPhysical exercise training reduces depressive symptoms in individuals with major depressive disorder.
“Previous studies have investigated the effect of physical exercise training on MDD and significant reduction of depressive symptoms has been found.[14][15][16]”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [14] Moraes H, 2007, O exercício físico no tratamento da depressão em idosos: revisão sistemática, Rev Psiquiatr Rio Gd Sul source
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- cites [15] Deslandes AC, 2010, Effect of aerobic training on EEG alpha asymmetry and depressive symptoms in the elderly: a 1-year follow-up study, Braz J Med Bio Res. source
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- cites [16] Silveira H, 2010, Effects of exercise on electroencephalographic mean frequency in depressed elderly subjects, Neuropsychobiology source
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Classified as probably not a substantial claim.
PremisecitationPharmacological treatment can modulate cortisol levels independently of promoting remission of depressive symptoms.
“Previous studies have shown that pharmacological treatment can modulate cortisol levels independently of promoting remission of depressive symptoms. [8][9]][10]”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [8] Barden N, 2004, Implication of the hypothalamic-pituitary-adrenal axis in the physiopathology of depression, J Psychiatry Neurosci source
Not checked in the free run.
- cites [9] Vreeburg SA, 2013, Salivary cortisol levels and the 2-year course of depressive and anxiety disorders, Psychoneuroendocrinology source
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- cites [10] Fischer S, 2017, Hypothalamic-pituitary-adrenal (HPA) axis functioning as predictor of antidepressant response - meta-analysis, Neurosci Biobehav Rev source
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPhysical exercise is an effective non-pharmacological treatment for depression in older adults.
“A meta-analysis reinforced that physical exercise is an effective non-pharmacological treatment for depression in older adults.17”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [17] Silveira H, 2013, Physical exercise and clinically depressed patients: a systematic review and meta-analysis, Neuropsychobiology source
Not checked in the free run.
May combine two claims.
PremisecitationThe pathophysiology of major depressive disorder is related to several neurobiological changes, including hypothalamic-pituitary-adrenal (HPA) axis malfunction and consequent increase or decrease in basal cortisol levels.
“The pathophysiology of MDD is related to several neurobiological changes, including hypothalamic-pituitary-adrenal (HPA) axis malfunction and consequent increase [2][3][4] or decrease [5][6][7] in basal cortisol levels.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [2] Gomez R, 2006, The neuropsychological profile of psychotic major depression and its relation to cortisol, Biol Psychiatry source
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- cites [3] Murri MB, 2014, HPA axis and aging in depression: systematic review and meta-analysis, Psychoneuroendocrinology source
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- cites [4] Lopez-Duran NL, 2009, Hypothalamic-pituitary-adrenal axis dysregulation in depressed children and adolescents: a meta-analysis, Psychoneuroendocrinology source
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May combine two claims.
PremisecitationPhysical exercise can modulate cortisol levels after a single session of exercise or after physical exercise training, possibly due to an upregulation of glucocorticoid receptor.
“Physical exercise can modulate cortisol levels after a single session of exercise or after physical exercise training, 20 possibly due to an upregulation of glucocorticoid receptor.21”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [20] Moraes HS, 2012, The effect of physical exercise on cortisol levels in older adults: a systematic review, Rev Bras Ativ Fis Saude
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- cites [21] Stranahan AM, 2008, Central mechanisms of HPA axis regulation by voluntary exercise, Neuromolecular Med source
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May combine two claims.
PremisecitationFew interventional studies have evaluated the effect of physical exercise on cortisol levels in individuals with major depressive disorder, and the few results available are contradictory.
“However, although the association between HPA malfunction and MDD has been investigated for five decades, 24 few interventional studies have evaluated the effect of physical exercise on cortisol levels in individuals with MDD, and the few results available are contradictory.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [24] Gibbons J, 1962, Plasma cortisol in depressive illness, J Psychiatr Res source
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Classified as probably not a substantial claim.
PremisecitationDifferences in basal cortisol between major depressive disorder and healthy control groups can be modulated by physical performance aspects.
“A previous study from our laboratory showed that the differences in basal cortisol between MDD and healthy control groups can be modulated by physical performance aspects.23”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [23] Moraes H, 2016, Cortisol, DHEA: physical capacity, Arq Neuropsiquiatr 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 conductcitationThe systematic review and meta-analysis was conducted according to the PICO search strategy and the PRISMA statement.
“The present systematic review and meta-analysis was conducted according to the PICO search strategy 34 and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.35”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [34] Heneghan C, 2002
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- cites [35] Liberati A, 2009, The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration, Ann Intern Med source
Not checked in the free run.
May combine two claims.
PremisecitationSome studies have observed significant effects after aerobic training or holistic training, while others have shown non-significant changes after strength or aerobic training or holistic activities.
“Some studies have observed significant effect after aerobic training 25,26 or holistic training, 27,28 while others have shown non-significant changes after strength or aerobic training 29,30 or holistic activities.[31][32][33]”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [25] Foley LS, 2008, An examination of potential mechanisms for exercise as a treatment for depression: A pilot study, Ment Health Phys Activity source
Not checked in the free run.
- cites [26] Nabkasorn C, 2006, Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms, Eur J Public Health source
Not checked in the free run.
- cites [27] Vedamurthachar A, 2006, Antidepressant efficacy and hormonal effects of Sudarshana Kriya Yoga (SKY) in alcohol dependent individuals, J Affect Disord source
Not checked in the free run.
May combine two claims.
PremisecitationChanges in diurnal rhythms of cortisol are well known to occur in some cases of major depressive disorder and can vary according to time of sampling.
“Since changes in diurnal rhythms of cortisol are well known to occur in some cases of MDD 40 and can vary according to time of sampling, 3”
Quote in the paperSubstantial claim0 of 2 sources checkedMay combine two claims.
PremisecitationCompliance is poor for 24-hour urine measures, and renal conditions may affect urinary cortisol levels.
“Nonetheless, compliance is poor for 24-hour measures, and renal conditions may affect urinary cortisol levels.42”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [42] Hellhammer DH, 2009, Salivary cortisol as a biomarker in stress research, Psychoneuroendocrinology source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe study was registered on PROSPERO under protocol no. CRD42018055996.
“This study was registered on the International Prospective Register of Systematic Reviews (PROSPERO) under protocol no.CRD42018055996.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductcitationRisk of bias was assessed according to the Physiotherapy Evidence Database (PEDro) scale.
“Risk of bias was assessed according to the Physiotherapy Evidence Database (PEDro) scale, 36 considering the following items:”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [36] Sherrington C, 2000, PEDro. A database of randomized trials and systematic reviews in physiotherapy, Man Ther source
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA previous meta-analysis concluded that the type of specimen collection does not appear to impact the magnitude of change in cortisol levels pre- vs. post-treatment.
“Although a previous meta-analysis has concluded that this factor does not appear to impact the magnitude of change in cortisol levels prevs.post-treatment, 41”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [41] McKay MS, 2010, The impact of treatment on HPA axis activity in unipolar major depression, J Psychiatr Res source
Not checked in the free run.
The paper relies on this without support.
It is unknown whether exercise training promotes the same cortisol effects in individuals with major depressive disorder as in healthy individuals.
“However, it is still unknown whether exercise training might promote the same cortisol effects in individuals with MDD.”
The paper relies on this without support.
Plasma measurement is the most invasive form of cortisol measurement compared to saliva and urine collections, and is a stressful procedure.
“Plasma measurement is a widely used method, however it is the most invasive form when compared to saliva and urine collections (i.e., a stressful procedure).”
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?
A meta-analysis exploring the effect of different exercise interventions found that aerobic exercise in patients with major depressive disorder reduced cortisol levels the most compared to strength training.
“a meta-analysis exploring the effect of different exercise interventions found that aerobic exercise in patients with major depressive disorder reduced cortisol levels the most compared to strength training (Beserra et al., 2018).”
From The effects of physical activity on cortisol and sleep: A systematic review and meta-analysis. (2022) · cites this paper as Beserra et al., 2018
The Additional information section reports a larger estimated cortisol reduction for aerobic training than for strength training. But the Discussion says the higher effect for aerobic training did not reach statistical significance, so the claim overstates the certainty of the comparison. (LLM, conf=0.88)
Experimental — accuracy not yet measured8-week high-frequency (3-5 sessions/week) aerobic exercise significantly increased serotonin and amygdala norepinephrine in the hippocampus of the brain of patients with depression compared to low-frequency (1 session/week) aerobic exercise.
“In addition, 8-week high-frequency (3–5 sessions/week) aerobic exercise significantly increased serotonin and amygdala norepinephrine in the hippocampus of the brain of patients with depression compared to low-frequency (1 session/week) aerobic exercise [105].”
From Systematic review and meta-analysis of the effects of exercise on depression in adolescents (2022) · cites this paper as [105]
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.
Aerobic exercise is called significant despite a nonsignificant result
MajorThe text calls the aerobic-training reduction significant, but Table 2 reports p = 0.059 and a 95% confidence interval that includes zero.
“Significant reduction in cortisol levels was found for aerobic training (SMD = -0.76;95%CI -1.55 to 0.03)”
“| Aerobic | -0.76 | -1.55 to 0.03 | 0.059 | 83.9 | <0.001 |”
Saliva confidence interval differs between text and table
MinorThe saliva subgroup's lower confidence bound is -2.06 in the prose but -2.00 in Table 2.
“SMD = -0.88;95%CI -2.06 to 0.30”
“| Saliva | -0.88 | -2.00 to 0.30 | 0.143 | - | - |”
Plasma confidence interval has conflicting upper bounds
MinorThe prose gives the upper bound as -0.18, while Table 2 gives it as 0.18. The difference changes whether the interval includes zero.
“Plasma measurement detected only a small reduction (SMD = -0.26;95%CI -0.71 to -0.18)”
“| Plasma | -0.26 | -0.71 to 0.18 | 0.249 | 53.8 | 0.070 |”
No-treatment confidence interval has conflicting upper bounds
MinorThe prose reports an upper bound of -0.44 for the no-treatment subgroup, whereas Table 2 reports -0.04.
“SMD = -0.99;95%CI -1.95 to -0.44”
“| No treatment | -0.99 | -1.95 to -0.04 | 0.042 | 82.4 | <0.001 |”
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“However, regarding the cortisol outcome, a meta-analysis exploring the effect of different exercise interventions found that aerobic exercise in patients with major depressive disorder reduced cortisol levels the most compared to strength training (Beserra et al., 2018).”
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“In addition, 8-week high-frequency (3–5 sessions/ week) aerobic exercise significantly increased serotonin and amygdala norepinephrine in the hippocampus of the brain of patients with depression compared to low-frequency (1 session/week) aerobic exercise [105].”
BackgroundDepression: Biological markers and treatment
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“Exercise has the potential to modify the neuroendocrine abnormalities associated with PD. Chronic exercise training reduces hormonal stress responses, lowering cortisol levels 108,244 .”
Exercise as Treatment for “Stress-Related” Mental Disorders
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Hair Cortisol Is Associated With Social Support and Symptoms in Schizophrenia
Yang, F., Cao, X., Sun, X., Wen, H., Qiu, J., & Xiao, H. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.572656 · Cited by 14 · see citing works
“Furthermore, aerobic exercises have been proved to decrease the cortisol levels (57).”
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Strategies to Improve Physiological and Psychological Components of Resiliency in Firefighters
Holland, A. M., Hamil, B. K., Greene, D. R., & Kohler, A. A. (2023) · Physiologia · doi:10.3390/physiologia3040045 · Cited by 14 · see citing works
“A recent review and meta-analysis indicated that exercise can significantly reduce cortisol levels in individuals living with MDD [51].”
BackgroundNardin, D. M. K., Stocco, M. R., Aguiar, A. F., Machado, F. A., de Oliveira, R. G., & Andraus, R. A. C. (2022) · Lasers in Medical Science · doi:10.1007/s10103-021-03443-6 · Cited by 14 · see citing works
Bewegung, körperliche Aktivität und Sport bei depressiven Erkrankungen
Bendau, A., Petzold, M. B., & Ströhle, A. (2022) · NeuroTransmitter · doi:10.1007/s15016-021-9343-y · Cited by 12 · see citing works
“Als ein wesentlicher neurobiologischer Mechanismus wer den die langfristige Normalisierung der HypothalamusHypo physenNebennierenrindenAchse und eine entsprechend ver ringerte Cortisolkonzentration angenommen [4, 27, 30].”
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Exercise − A unique endogenous regulator of irisin, BDNF, leptin and cortisol against depression
de Assis, G. G., & Cięszczyk, P. (2020) · Baltic Journal of Health and Physical Activity · doi:10.29359/bjhpa.12.4.01 · Cited by 12 · see citing works
“By contrast, a regular practice of exercise is associated to a ‘stabilizing effect’ on the symptoms and progression of the depression condition and has been observed to positively affect response to its treatment [14, 15].”
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“However, these substances have also been found to reflect physical stress 14,15 .”
BackgroundThe significance of physical activity in the prevention of depressive disorders
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“This can be explained by the fact that PA reduces the levels of cortisol (Beserra et al., 2018), a hormone associated with stress (Kazakou et al., 2023).”
Budnik–Przybylska, D., Laskowski, R., Pawlicka, P., Anikiej‐Wiczenbach, P., Łada‐Maśko, A., Szumilewicz, A., Makurat, F., Przybylski, J., Soya, H., & Kaźmierczak, M. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17218050 · Cited by 8 · see citing works
Peters, E. M. J., Schedlowski, M., Watzl, C., & Gimsa, U. (2021) · PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie · doi:10.1055/a-1322-3205 · Cited by 9 · see citing works
Jafari-Koulaee, A., Mohammadi, E., Fox, M. T., Rasekhi, A., & Akha, O. (2024) · Clinical Gerontologist · doi:10.1080/07317115.2024.2401915 · Cited by 9 · see citing works
“In particular, depression is associated with high cortisol levels (Dienes et al., 2013), and physical activity can reduce cortisol levels in people with depression (Beserra et al., 2018).”
Shared Mechanisms in Dementia and Depression: The Modulatory Role of Physical Exercise
de Souza, P. B., Rodrigues, A. L. S., & Felice, F. G. D. (2025) · Journal of Neurochemistry · doi:10.1111/jnc.70185 · Cited by 8 · see citing works
“Cortisol levels were observed to decrease in the exercise group, and aerobic exercise was identified as the most effective type of physical exercise for reducing cortisol levels, with the greatest benefits observed when performed five times per week (Beserra et al. 2018).”
Targeting neuroendocrine abnormalities in Parkinson’s disease with exercise
Luthra, N., Christou, D. D., Clow, A., & Corcos, D. M. (2023) · Frontiers in Neuroscience · doi:10.3389/fnins.2023.1228444 · Cited by 7 · see citing works
“reports that in individuals with major depressive disorder, regular exercise is associated with decreased daytime cortisol levels but this is influenced by type of exercise and frequency (Beserra et al., 2018).”
da Costa, M. E., Cândido, L. M., de Avelar, N. C. P., & Danielewicz, A. L. (2023) · Geriatric Nursing · doi:10.1016/j.gerinurse.2022.12.014 · Cited by 8 · see citing works
Chen, C., Du, S., Shao, Q., Fu, X., Lin, J., Zhou, S. L., & Li, Y. (2024) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2024.10.068 · Cited by 6 · see citing works
Haag, F. B., Silva, D. T. D. R. E., Antunes, C. S., Waclawovsky, G., & Lucchese, F. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.107110 · Cited by 6 · see citing works
Bani‐Issa, W., Radwan, H. M., Shujairi, A. A., Hijazi, H. H. A., Abdi, R. M. A., Awar, S. A. A. R. A., Saqan, R., Alameddine, M. S., Ibrahim, A., Rahman, H. A., et al. (2022) · Journal of Nursing Management · doi:10.1111/jonm.13697 · Cited by 5 · see citing works
Effect of Walking on Physiological Stress in Premenstrual Syndrome:A Randomized Controlled Trial
Ibrahim, M., Yousef, A. M., Elainin, M. A., et al. (2020) · Egyptian Journal of Physical Therapy · doi:10.21608/ejpt.2020.40907.1014 · Cited by 5 · see citing works
Kabiri, L. S., Le, J., Diep, C. S., Chung, E., Wong, J., Perkins-Ball, A. M., Perkins, H. Y., & Rodriguez, A. X. (2024) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2024.1369205 · Cited by 5 · see citing works
Synergistic pathways to psychosis: understanding developmental risk and resilience factors
O’Brien, K. J., Huque, Z. M., Pike, M. R., Smith, E. C., Davies, N. L., & Ellman, L. M. (2025) · Neuropsychopharmacology · doi:10.1038/s41386-025-02261-6 · Cited by 11 · see citing works
Li, X., Ding, F. H., Ma, X., Wang, X., Chen, J., & Chen, L. (2026) · BMC Women s Health · doi:10.1186/s12905-025-04242-9 · Cited by 6 · see citing works
“…aerobic exercise over eight weeks increased serotonin in the hippocampus and norepinephrine in the amygdala of patients with depression [63], while frequent training accelerated serum BDNF peaks and enhanced central neurotransmitter adaptation, facilitating greater mood stabilization…”
Time-driven interventions for affective disorders: on resonance and the Oberth effect
Argôlo, F. C., Gadelha, A., Pan, P. M., & Bressan, R. A. (2020) · Trends in Psychiatry and Psychotherapy · doi:10.1590/2237-6089-2019-0067 · Cited by 4 · see citing works
George, C. L., Valentino, A., D'Anna‐Hernandez, K., & Becker, E. A. (2023) · Advances in Neurodevelopmental Disorders · doi:10.1007/s41252-023-00326-5 · Cited by 4 · see citing works
“These findings are consistent with reductions in resting, or basal cortisol levels in typical adults following chronic exercise (Beserra et al., 2018; Wright et al., 2015).”
ResultTavares, V. D. D. O., de Sousa, G. M., Schuch, F. B., Firth, J., Yang, L., Stein, M., Malagodi, B. M., de Almeida, R. N., Bezerra, R. C., Gouveia, A. G., et al. (2025) · Mental health and physical activity · doi:10.1016/j.mhpa.2025.100687 · Cited by 5 · see citing works
Self-citationValkenborghs, S. R., Hillman, C. H., Smith, J. J., Leahy, A. A., Steedman, S., Ramadan, S. A., & Lubans, D. R. (2026) · Psychophysiology · doi:10.1111/psyp.70215 · Cited by 3 · see citing works
Prado, R. C. R., Oliveira, T. N., Saunders, B., Foster, R., Bella, Z. I. K. D. J. D., Kilpatrick, M. W., Asano, R. Y., Hackney, A. C., & Takito, M. Y. (2025) · Endocrines · doi:10.3390/endocrines6010014 · Cited by 3 · see citing works
“Contrary to the acute effects of exercise on cortisol secretion, chronic exercise may serve as a non-pharmacological approach to reducing cortisol level and, consequently, to mitigate PMS symptoms by modulating HPA axis activity [44,45].”
Monteiro-Júnior, R. S., Rodrigues, A. C. D. M. A., Felício, L. F. F., Figueiredo, L. F. D. S., & Xavier-Rocha, T. B. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818000-6.00037-8 · Cited by 3 · see citing works
Exercise: a narrative review of mechanism and dosage as an antidepressant
Ganjeh, S., Roostayi, M. M., Daryabor, A., Kalantari, K. K., & Rezaeian, Z. S. (2025) · Physical Therapy Reviews · doi:10.1080/10833196.2025.2496862 · Cited by 2 · see citing works
“Aerobic exercise can reduce the plasma cortisol level, but this change was not statistically significant in some studies [170–175].”
Wang, D., Song, P.-B., Zhang, Q., & Zhuang, B. (2025) · Scientific Reports · doi:10.1038/s41598-025-24883-y · Cited by 2 · see citing works
“Evidence also indicates that ADL dysfunction and depression may share hormonal and metabolic pathways: depressive symptoms are linked to elevated cortisol levels, while physical activity can regulate these levels by up-regulating glucocorticoid receptors 47,48 .”
Gajic, P., Kovac, I., Lubinsky, G. T., & Knežević, N. N. (2026) · Cells · doi:10.3390/cells15100858 · Cited by 3 · see citing works
“…physiological stressor that transiently activates the hypothalamic–pituitary–adrenal (HPA) axis and sympathetic nervous system via corticotropin-releasing hormone-secreting neurons in the paraventricular nucleus, pituitary corticotrophs, and adrenocortical cells that produce glucocorticoids [6,8].”
InfluentialQin, P., Li, F., Li, X., & Feng, X. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1772542 · Cited by 3 · see citing works
“The therapeutic mechanisms of these interventions vary, leading to differential ef fi cacy in alleviating depressive and anxiety symptoms (15).”
Leão, L. L., Valadares, W. G. D. A., Silva, N. S. S. E., et al. (2023) · Behavioral Sciences · doi:10.3390/bs13040340 · Cited by 2 · see citing works
“Several clinical studies have provided evidence of the antidepressant effect of physical activity (PA) [24].”
BackgroundWirkmechanismen von körperlicher Aktivität und Sport in der Behandlung psychischer Erkrankungen
Bendau, A., Petzold, M. B., & Ströhle, A. (2023) · Springer eBooks · doi:10.1007/978-3-662-66208-3_13 · Cited by 2 · see citing works
Relevance of Sex-Specific Metabolic Phenotypes in Diagnosis and Treatment of Mood Disorders and PTSD
Henry, S. S., Ross, R., & Rasgon, N. (2022) · Psychiatric Annals · doi:10.3928/00485713-20211221-01 · Cited by 1 · see citing works
The influence of sport-specific factors on sleep quality in young elite athletes
Pano-Rodríguez, Á., Beltrán-Garrido, J. V., Hernández‐González, V., Bueno‐Antequera, J., Oviedo‐Caro, M. Á., Mayolas-Pi, C., Legaz‐Arrese, A., & Masià, J. R. (2024) · Kinesiology · doi:10.26582/k.56.1.3 · Cited by 1 · see citing works
Biazus, E. L., Zanini, G. D. S., Luciano, A. R. M. B., & Verardi, C. E. L. (2024) · Caderno Pedagógico · doi:10.54033/cadpedv21n10-128 · Cited by 1 · see citing works
Shi, P., Feng, X., & Lyu, S. W. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1594917 · Cited by 1 · see citing works
Bai, A. Y., Qu, Y., Chen, Q., Gray, M., Chen, S. Q., & Jiang, Y. (2025) · BMC Public Health · doi:10.1186/s12889-025-25259-7 · Cited by 1 · see citing works
“Second, FD patients with depressive symptoms may experience higher psychological stress [53] and multi-morbidity risks, potentially due to reduced physical activity and dysregulated cortisal levels [54, 55].”
Stark, C., Beck, J., Oswald, A., Rogausch, A., Schreiner, A.-K., Cody, R., Hohberg, V., Knappe, F., Kreppke, J.-N., Ludyga, S., et al. (2026) · Trials · doi:10.1186/s13063-026-09500-1 · Cited by 1 · see citing works
“Beyond its antidepressant effects, PA has also been associated with improvements in broader health outcomes, including health-related quality of life [39], cardiovascular risk [21, 40], cognition [41], sleep [42], and potential biomarkers of depression such as cortisol levels [43].”
Molecules of mood: the integrated molecular transducers of exercise’s antidepressant effects
Yuan, D. (2026) · Molecular Genetics and Genomics · doi:10.1007/s00438-026-02404-4 · Cited by 1 · see citing works
Mockus, P., Mockienė, A., Karanauskienė, D., & Česnaitienė, V. J. (2020) · Baltic Journal of Sport and Health Sciences · doi:10.33607/bjshs.v1i116.898 · Cited by 1 · see citing works
“Stress at workas well as emotional and psychological tension are factors affecting the mental health of middle-aged people (Beserra et al., 2018).”
BackgroundGamification in Late-Life Depression: A Serious Game for a Serious Problem
Frisardi, V. (2020) · Biomedical Journal of Scientific & Technical Research · doi:10.26717/bjstr.2020.26.004320 · Cited by 1 · see citing works
“In fact, exercise-induced changes are linked to neuronal protection by maximizing cardiorespiratory fitness [16], increasing brain-derived neurotrophic factor [17] and reducing cortisol level [18].”
BackgroundSeo, S.-W., Kim, K., & Im, S.-C. (2022) · Journal of the Korean Society of Physical Medicine · doi:10.13066/kspm.2022.17.1.31 · Cited by 1 · see citing works
“Moreover, physical fatigue, which means a stress situation, can lead to the hypersecretion of serum Cortisol after physical exercise training [22].”
BackgroundPedro, F. C., de Oliveira, M. M., Andrade, R. S., Costa, A. C. T. R. B., Pereira, C. R., Oliveira, P. F. R. E., Macari, S., Coimbra, C. C., Dorneles, E. M. S., & Pereira, L. J. (2024) · Brazilian Archives of Biology and Technology · doi:10.1590/1678-4324-2024220284 · Cited by 1 · see citing works
“The differences in lymphocyte proliferation according to exercise modality (resistance vs. aerobic) may be associated with changes in circulating levels of stress hormones, since it was previously demonstrated that acute/intense muscular exercise increases the plasma concentrations of cortisol [20].”
BackgroundYu, L., Zhang, X., & Li, W. (2024) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2024.1331586 · Cited by 1 · see citing works
REPERCUSSÕES DO EXÉRCÍCIO FÍSICO NO MANEJO DA DEPRESSÃO MAIOR: UMA REVISÃO BIBLIOGRÁFICA
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Bao, B., Qin, A., Wang, M., Qin, W., Hu, F., Xin, T., & Xu, L. (2025) · Geriatric Nursing · doi:10.1016/j.gerinurse.2025.03.008 · Cited by 1 · see citing works
Kumaat, N. A., Rusdiawan, A., Dafun, P. B., Wahyudi, H., Arfanda, P. E., Wijaya, F. J. M., Wismanadi, H., & Artanty, A. (2025) · Pedagogy of Physical Culture and Sports · doi:10.15561/26649837.2025.0302 · Cited by 2 · see citing works
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Danka, M. N., Steptoe, A., & Iob, E. (2025) · Psychoneuroendocrinology · doi:10.1101/2024.04.14.24305797 · Cited by 1 · see citing works
“PA has been implicated in increasing the expression of BDNF [31, 32], promoting the release of catecholamines [64], and modulating HPA axis hyperreactivity [65].”
Kim, K. (2020) · The Korean Journal of Sports Medicine · doi:10.5763/kjsm.2020.38.3.155
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Körperliche Aktivität bei spezifischen psychischen Erkrankungen
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- Authors
- Beserra, A. H. N., Kameda, P., Deslandes, A. C., Schuch, F. B., Laks, J., & Moraes, H. S. D.
- Affiliations
- Universidade Federal do Rio de Janeiro (BR)
- Universidade Federal do Rio de Janeiro, Brazil; UFRJ, Brazil
- Universidade La Salle (BR)
- Venue
- Trends in Psychiatry and Psychotherapy
- Publisher
- FapUNIFESP (SciELO)
- Published
- 2018-12
- Volume
- 40
- Issue
- 4
- Pages
- 360-368
- ISSN
- 2237-6089 (ISSN-L)
- 2238-0019
- OpenAlex
- W2904844942
- Semantic Scholar
- 14e7f51ae7af2e1bff11badbdaa06f09227cfe57
- Cited by
- 108
- References
- 44
- Citations by year
- 2026: 14 · 2025: 20 · 2024: 17 · 2023: 14 · 2022: 13 · 2021: 10 · 2020: 16 · 2019: 2
- FWCI
- 0.79
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Trends in Psychiatry and Psychotherapy (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
- Americanae (AECID Library) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Conselho Nacional de Desenvolvimento Científico e Tecnológico
- Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (E-26/203, E-26/, E-26/203.193/2016)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- physical activity, cortisol, major depressive disorder, exercise training, aerobic exercise, chronic stress, depression treatment, exercise frequency
- MeSH terms
- Major Depressive Disorder, Exercise Therapy, Humans, Hydrocortisone, Exercise
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