A randomized trial of aerobic exercise on cognitive control in major depression

Effects of chronic exercise on different central features of depression in adults with depression: A systematic review and meta-analysis of random controlled trials

BACKGROUND

Exercise is considered an effective treatment for improving central symptoms of depression. However, the antidepressant effects of exercise on specific central features in adults with depression and the optimal exercise prescription remain unclear. The present review aimed to explore the impact of exercise on emotion regulation (ER) and executive function (EF) among adults living with depression as well as the moderating effects of exercise prescription characteristics.

METHODS

Two Chinese databases and two English databases were systematically searched from January 1, 2000 to October 30, 2023 to identify relevant randomized controlled trials (RCTs). Based on the results of heterogeneity analyses, the random effects model was used for the meta-analysis of rumination (260 participants in 5 studies), inhibition (578 participants in 7 studies) and updating (832 participants in 9 studies), whereas the fixed effects model was used for the meta-analysis for shifting (802 participants in 8 studies).

RESULTS

Exercise improved rumination (standardized mean difference [SMD] = -0.59, p = 0.02); however, these benefits were observed only for moderate-intensity aerobic exercise in one or two 31-60 min sessions per week for 5-8 weeks. The results indicated significant post-exercise improvement in shifting (SMD = -0.22, p = 0.002) but not inhibition (SMD = -0.21, p = 0.18) or updating (SMD = 0.15, p = 0.14). Moreover, substantial improvements in shifting were observed only from high-intensity aerobic exercise in three or four 31-60 min sessions per week for more than 8 weeks.

CONCLUSIONS

Exercise improved ER (i.e., rumination) and EF (i.e., shifting) in adults with depression. It is important to consider symptoms when prescribing exercise to adults with depression. However, given the limited number of included RCTs, these findings are preliminary and tentative.

Effects of exercise training on cognition in adults with depression: A systematic review and three-level meta-analysis

BACKGROUND

Cognitive impairment is a central feature of depression. Exercise training has enormous potential as a nonpharmacological intervention to improve cognition in depressed individuals.

OBJECTIVE

This review aimed to evaluate and update the effect of exercise training on overall cognition and its subdomains, as well as whether moderators influence the effect of exercise training on cognition in depressed adults.

DESIGN

Systematic review and three-level meta-analysis of randomized controlled trials.

METHODS

We systematically searched Embase, Ovid MEDLINE, Web of Science, PubMed, and Scopus from their inception to February 14, 2024, and updated the search results on December 5, 2024. Randomized controlled trials investigating how exercise training affected cognition in depressed adults were included. The meta-analysis was performed using a random-effects model in R. We used the Physiotherapy Evidence Database scale to evaluate the study's quality.

RESULTS

Twenty-two studies were included. Exercise training showed statistically significant improvements in overall cognition [g = 0.21; 95 % confidence interval (CI) = 0.12, 0.30] and cognitive subdomains of processing speed (g = 0.20; 95 % CI = 0.04, 0.36), attention (g = 0.21; 95 % CI = 0.06, 0.35), memory (g = 0.24; 95 % CI = 0.11, 0.38), and executive function (g = 0.21; 95 % CI = 0.09, 0.33) compared with comparison groups in depressed adults. The greater cognitive benefits were observed when participants exercised twice a week (g = 0.30; 95 % CI = 0.03, 0.56), at a low intensity (g = 0.26; 95 % CI = 0.08, 0.43), spent more than 60 min per session (g = 0.24; 95 % CI = 0.05, 0.44), 150 min or more per week (g = 0.27; 95 % CI = 0.09, 0.45), had a program duration more than 10 weeks (g = 0.25; 95 % CI = 0.12, 0.39), and engaged in mind-body exercise (g = 0.26; 95 % CI = 0.08, 0.43). The clinical setting, sample size, and comparison group for memory moderated the effects of exercise training on cognition.

CONCLUSIONS

Exercise training is an effective nonpharmacological intervention that enhances overall cognition and subdomains of processing speed, attention, memory, and executive function compared with comparison groups in depressed adults. This study only included English-language articles, which may have caused a language bias, and Egger's test revealed a possibility of publication bias.

REGISTRATION NUMBER

CRD42023457900 (PROSPERO).

TWEETABLE ABSTRACT

Exercise training is an effective nonpharmacological intervention for adults with depression to improve overall cognition and cognitive subdomains of processing speed, attention, memory, and executive function compared with comparison groups.

Nicotine dependence comorbid with depressive symptoms may limit immediate cognitive improvement following exercise

This study investigated how acute bouts of aerobic exercise versus yoga affect inhibitory control differently in smokers with nicotine dependence depending on the presence of depressive symptoms. Thirty adult smokers were equally divided into a depressed smoker group and a non-depressed smoker group based on their Beck Depression Inventory scores. Each participant underwent baseline measurements, a 30 min aerobic exercise session, and a 30 min yoga session on different days. Brainwaves were recorded at baseline and after exercise during the Go/No-Go task. Performance accuracy, response time, and event-related potential (ERP) N2 and P3 amplitudes and latencies were analyzed. The major findings showed that the non-depressed smoker group exhibited higher accuracy than the depressed smoker group after yoga, and the non-depressed smoker group's response time improved after aerobic exercise compared with baseline. The ERP analyses revealed that the depressed smoker group exhibited smaller N2 and P3 amplitudes and shorter P3 latencies than the non-depressed smoker group. The behavioral and electrophysiological data highlight a possible cognitive deficit among smokers with depressive symptoms due to comorbid depression and addiction. Aerobic exercise elicited a larger P3 amplitude than yoga, suggesting the importance of physical intensity in promoting the active engagement of neural networks associated with inhibitory control processes. These findings suggest that expecting cognitive enhancement through acute exercise in smokers with comorbid depression may be more challenging than that in general smokers.

The mediating role of life satisfaction in the relationship between physical exercise and depressive symptoms among middle-aged and elderly individuals

Objective

To investigate the mediating effect of life satisfaction between physical exercise behavior and depressive symptoms among middle-aged and elderly individuals, providing a reference for improving depressive conditions in this demographic group.

Methods

Data from 11,101 middle-aged and elderly individuals from the 2020 China Family Panel Studies (CFPS) were collected. STATA 17.0 was used for data cleaning, organization, and statistical analysis which includes univariate analysis, stepwise regression analysis, and mediation effect testing.

Results

Among 11,101 individuals aged 45 years and above, 2,272 participated in physical exercise, accounting for 20.47%; 2,052 exhibited depressive symptoms, representing 18.48%. Physical exercise was positively correlated with life satisfaction and negatively correlated with depression. Depression scores also showed a negative correlation with life satisfaction. According to the results of the mediation effect study, life satisfaction accounted for 16.60% of the overall effect and had a mediating effect value of -0.099 on depression symptoms.

Conclusion

Physical exercise and life satisfaction are factors influencing depressive symptoms, and life satisfaction acts as a partial mediator between physical exercise participation and depression among middle-aged and elderly adults.

The effects of a 12-week moderate-intensity continuous training intervention on depression, anxiety, and stress in sedentary female college students: a focus on negative emotion regulation

Objective

Moderate Intensity Continuous Training (MICT) is recognized as an effective intervention for improving negative affect. However, research on its effects across varying levels of negative mood states in sedentary female college students remains limited. This study aimed to investigate the impact of a 12-week MICT intervention on different levels of negative mood in sedentary female college students.

Methods

A total of 144 participants were randomly assigned to two groups, each consisting of 72 individuals. The participants were further categorized into three negative mood groups: depression, anxiety, and stress, with 24 participants in each group. Within each mood group, participants were divided into three subgroups based on the severity of their mood (mild, moderate, and severe), with 8 participants in each subgroup. The experiment spanned 12 weeks, with two 45-min training sessions per week. Intensity was monitored throughout the experiment using the Borg Rating of Perceived Exertion (RPE), and heart rate was measured immediately following each session. The training intensity was maintained at 60-69% of HRmax throughout the 12 weeks.

Results

After 12 weeks of MICT, MICT had a positive effect on mild and severe depressive mood, moderate anxiety, and mild stressful mood in sedentary female college students (p < 0.05), but MICT did not have statistically significant effects on moderate depressive mood, mild and severe anxiety, and moderate and severe stressful mood in sedentary female college students (p > 0.05).

Conclusion

MICT may have a beneficial effect on sedentary female college students, particularly those with lower levels of emotional distress. However, due to the absence of a positive control group, it is difficult to draw definitive conclusions about its specific impact. Future studies should employ more rigorous control designs to better assess the role of MICT in improving both the physical and mental health of sedentary female college students.

Comparative impact of exercise variants on depressive symptoms in cancer patients: A systematic review and network meta-analysis

PURPOSE

The aim of this study was to conduct a network meta-analysis to assess the effectiveness of various forms of exercise as an intervention for post-cancer depression and to provide a guiding program based on evidence-based medicine for subsequent clinical practice.

METHODS

This review was registered on the PROSPERO website with ID CRD42023485407. Pubmed, Embase, Cochrane Library, and Web of Science were comprehensively searched to obtain published articles from the establishment of the database until October 7, 2023. Bayesian network meta-analysis was conducted. Statistical analysis was conducted using R4.3.2 and Stata 15.1.

RESULTS

This study ultimately included 51 articles and 4956 samples. Aerobic exercise (SMD = -0.33, 95%CI: 0.58, -0.08), combined exercise (SMD = -0.48, 95%CI: 0.71, -0.26), and mind-body exercise (SMD = -0.35, 95%CI: 0.6, -0.09) significantly improved depression compared with usual care (UC). According to the SUCRA value and cumulative probability, the rank of depression improvement effect of various sports interventions is as follows: combined exercise (90.71%), mind-body exercise (69.64%), aerobic exercise (65.81%), resistance training (35.86%).

CONCLUSION

Exercise intervention can significantly improve post-cancer depression, but there is no significant difference in the effectiveness of various forms of exercise in improving post-cancer depression.

Neural mechanisms underlying cognitive impairment in depression and cognitive benefits of exercise intervention

Depression is associated with functional brain impairments, although comprehensive studies remain limited. This study reviews neural mechanisms underlying cognitive impairment in depression and identifies associated activation abnormalities in brain regions. The study also explores the underlying neural processes of cognitive benefits of exercise intervention for depression. Executive function impairments, including working memory, inhibitory control and cognitive flexibility are associated with frontal cortex and anterior cingulate areas, especially dorsolateral prefrontal cortex. Depression is associated with certain neural impairments of reward processing, especially orbitofrontal cortex, prefrontal cortex, nucleus accumbens and other striatal regions. Depressed patients exhibit decreased activity in the hippocampus during memory function. Physical exercise has been found to enhance memory function, executive function, and reward processing in depression patients by increasing functional brain regions and the brain-derived neurotrophic factor (BDNF) as a nutritional factor also plays a key role in exercise intervention. The study documents neurophysiological mechanisms behind exercise intervention's improved functions. In summary, the study provides insights into neural mechanisms underlying cognitive impairments in depression and the effectiveness of exercise as a treatment.

The Effects of Exercise on Inhibitory Function Interventions for Patients With Major Depressive Disorder (MDD): A Systematic Review and Meta-Analysis

BACKGROUND

Systematic Review of The effects of exercise on inhibitory function interventions for patients with major depressive disorder.

METHODS

We searched PubMed, Web of Science, EMbase, The Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and China Science and Technology Journal Database (CQVIP) for randomized controlled trials (RCTs) investigating the impact of exercise on inhibitory function in MDD patients, from database inception to July 2024. Two researchers independently evaluated the quality of the included studies using the Risk of Bias (ROB 2.0) tool. Evidence quality was assessed with the GRADE profiler software, and effect sizes were combined using Stata 17.0 software to create forest plots, test for publication bias, and perform sensitivity analyses.

RESULTS

A total of nine RCTs involving 1038 participants from six countries, published between 2001 and 2022, were included. The average age of participants in both the experimental and control groups was 45 years. Meta-analysis results indicated that exercise significantly improves inhibitory function in MDD patients, with a combined effect size (SMD = 0.48, 95% CI = 0.18-0.77, p < 0.001). Subgroup analysis showed that exercise had a statistically significant effect on inhibitory control in MDD patients, with an effect size (SMD = 0.563, p < 0.001). Regarding exercise elements, other types of exercise (resistance exercise RE, mixed exercise ME), duration greater than 45 min, intervention period of ≤12 weeks, frequency of two times per week, and low intensity were found to be more effective, all with statistical significance (SMD = 0.863, p < 0.001; SMD = 0.936, p < 0.001; SMD = 0.525, p = 0.002; SMD = 0.682, p = 0.004; SMD = 0.94, p = 0.00).

CONCLUSION

Based on the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification systems, a research framework for exercise interventions on executive function in MDD patients was constructed, demonstrating that exercise can improve inhibitory function in MDD with high evidence quality. Our study found that other types of exercise (RE or ME), intervention duration of >45 min, intervention period of ≤12 weeks, frequency of two times per week, and low intensity are more effective for improving inhibitory function in MDD patients. While the overall methodological quality of the literature was good, high heterogeneity existed among studies. Subgroup analysis suggested that sources of heterogeneity included measurement tools, exercise types, exercise intensity, duration, and frequency. Sensitivity analysis indicated that exercise duration and period might be causes of heterogeneity. This study has some limitations as the included literature did not consider disease duration, depression severity, or categorize age groups. However, the findings provide strong evidence for clinical practice and future research on the beneficial effects of exercise on inhibitory function in MDD patients.

TRIAL REGISTRATION

CRD42023480371.

The effect of exercise on depression and gut microbiota: Possible mechanisms

Exercise can effectively prevent and treat depression and anxiety, with gut microbiota playing a crucial role in this process. Studies have shown that exercise can influence the diversity and composition of gut microbiota, which in turn affects depression through immune, endocrine, and neural pathways in the gut-brain axis. The effectiveness of exercise varies based on its type, intensity, and duration, largely due to the different changes in gut microbiota. This article summarizes the possible mechanisms by which exercise affects gut microbiota and how gut microbiota influences depression. Additionally, we reviewed literature on the effects of exercise on depression at different intensities, types, and durations to provide a reference for future exercise-based therapies for depression.

Physical activity and mental health: a systematic review and best-evidence synthesis of mediation and moderation studies

BACKGROUND

While evidence consistently demonstrates that physical activity is beneficial to mental health, it remains relatively unknown how physical activity benefits mental health, and which factors influence the effect of physical activity on mental health. This understanding could vastly increase our capacity to design, recommend, and prescribe physical activity in more optimal ways. The purpose of this study was to systematically review and synthesise evidence of all mediators and moderators of the relationship between physical activity and mental health.

METHODS

Systematic searches of four databases (i.e., Scopus, PsycINFO, PubMed, and SPORTDiscus) identified 11,633 initial studies. Empirical studies that quantitatively assessed physical activity, or conducted a physical activity intervention, measured a mental health outcome, and tested one or more mediator or moderator of the relationship between physical activity and mental health were included. A total of 247 met the inclusion criteria; 173 studies examined mediation and 82 examined moderation.

RESULTS

Results of the best-evidence synthesis revealed strong evidence for 12 mediators including affect, mental health and wellbeing, self-esteem, self-efficacy, physical self-worth, body image satisfaction, resilience, social support, social connection, physical health, pain, and fatigue. Moderate evidence was identified for a further 15 mediators and eight moderators.

CONCLUSIONS

Findings should inform the design of future physical activity interventions to ensure optimal effects on mental health related outcomes. Additionally, if health professionals were to take these mediators and moderators into consideration when prescribing or recommending physical activity, physical activity would likely have a greater impact on population mental health.

Outcomes of the effect of exercise on cognitive function in patients with depression: A meta-analysis

BACKGROUND

Major depressive disorder is a common mental disorder, characterized by a high rate of suicide and recurrence, which is frequently accompanied by cognitive impairments, particularly in executive function, memory, attention, and information processing speed. As such, improving the cognitive function in patients with depression and enhancing their quality of life are urgent issues.

AIM

To perform a systematic review and meta-analysis of the effects of exercise on cognitive function in patients with depression.

METHODS

The PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Medical, VIP, and Biomedical Databases for randomized controlled trials (RCTs) databases were searched (from inception to October 19, 2023) for studies investigating improvements in cognitive function in patients with depression through exercise. Tools recommended by the Cochrane Handbook for RCT evaluation, and GRADEpro and Stata17 software, were employed for risk of bias assessment, evidence grading, forest plot construction, subgroup and sensitivity analyses, and assessment of publication bias.

RESULTS

Seventeen RCTs (1173 patients with depression) were included. Exercise had a small but significant positive effect on attention, with an effect size of 0.21, 95%CI: 0.07-0.34, P < 0.01. Specifically, aerobic exercise regimens of 30-60 minute/session, thrice a week, at moderate intensity, and sustained over 3-12 weeks, were associated with the most pronounced benefits (P < 0.05), with effect sizes for executive function, memory, and information processing speed of 0.11, 95%CI: -0.11-0.32, P = 0.34; 0.08, 95%CI: 0.00-0.16, P = 0.05; and 0.14, 95%CI: 0.04-0.25, P = 0.01, respectively. The evidence levels for attention, information processing speed, and memory were rated as 'low,’ whereas that for executive function was rated as 'very low’.

CONCLUSION

Exercise could improve attention and information-processing speed in patients with depression, although improvements in executive function and memory are not significant.

Intervention effect of exercise on working memory in patients with depression: a systematic review

Background

This article aims to systematically evaluate the intervention effect of exercise on working memory in patients with depression.

Methods

Six Chinese and English databases were searched for randomized controlled trials (RCTs) about exercise on working memory in patients with depression. PEDro scale was adopted to evaluate the methodological quality of the included articles, GRADEpro scale was employed to evaluate the level of evidence for outcomes, and the Metafor Package in R 4.4.1 was used to analyze the combined effect size, subgroup analyses and publication bias.

Results

A total of 15 studies were included. The meta-analysis indicated that exercise had a statistically significant effect on working memory in patients with depression, with an effect size of 0.16 (95% CI [0.03-0.28], p = 0.02). Exercise type (F(3,34) = 1.99, p = 0.13), intervention content (F(1,36) = 1.60, p = 0.22), and exercise duration (F(1,36) = 0.05, p = 0.83) did not moderate the effect, whereas exercise intensity showed a moderating effect (F(2,35) = 8.83, p < 0.01). There was evidence of publication bias in the study results (t = 2.52, p = 0.02).

Conclusion

Exercise can improve the working memory of patients with depression, and its moderating effect is the best when having low-intensity and moderate-intensity. Research plan was registered in international system evaluation platform PROSPERO (https://www.crd.york.ac.uk/PROSPERO/) (CRD42023475325).

Effects and neural mechanisms of different physical activity on major depressive disorder based on cerebral multimodality monitoring: a narrative review

Major depressive disorder (MDD) is currently the most common psychiatric disorder in the world. It characterized by a high incidence of disease with the symptoms like depressed mood, slowed thinking, and reduced cognitive function. Without timely intervention, there is a 20-30% risk of conversion to treatment-resistant depression (TRD) and a high burden for the patient, family and society. Numerous studies have shown that physical activity (PA) is a non-pharmacological treatment that can significantly improve the mental status of patients with MDD and has positive effects on cognitive function, sleep status, and brain plasticity. However, the physiological and psychological effects of different types of PA on individuals vary, and the dosage profile of PA in improving symptoms in patients with MDD has not been elucidated. In most current studies of MDD, PA can be categorized as continuous endurance training (ECT), explosive interval training (EIT), resistance strength training (RST), and mind-body training (MBT), and the effects on patients' depressive symptoms, cognitive function, and sleep varied. Therefore, the present study was based on a narrative review and included a large number of existing studies to investigate the characteristics and differences in the effects of different PA interventions on MDD. The study also investigated the characteristics and differences of different PA interventions in MDD, and explained the neural mechanisms through the results of multimodal brain function monitoring, including the intracranial environment and brain structure. It aims to provide exercise prescription and theoretical reference for future research in neuroscience and clinical intervention in MDD.

Familial risk for depression is associated with reduced physical activity in young adults: evidence from a wrist-worn actigraphy study

Depression is characterized by reduced physical activity and sleep-wake cycle disturbances, often considered important features of the disease. While a few studies have suggested that self-reported reduced physical activity and sleep-wake cycle disturbances might both be linked to depression vulnerability, actigraphy-based measures in vulnerable samples remain largely unexplored. This study relied on actigraphy-based parameters to test whether these disturbances characterize depression vulnerability. Seven-day actigraphy data were collected from 20 (13 female) university students with a high vulnerability to depression, which was determined by the presence of a family history of the condition but no current symptoms, and 32 (21 female) controls with neither a family history of depression nor current depressive symptoms. Daily physical activity, namely gross motor activity, was quantified as average daily acceleration and time spent engaging in moderate-vigorous physical activity (MVPA). The sleep-wake cycle and circadian rhythms were assessed as total sleep duration per night (in hours), sleep within sleep period time (in hours), sleep efficiency (%), and relative amplitude (i.e., the difference between the activity during the day and the night, which reflects circadian rhythms amplitude). Results showed that individuals with a familial risk for depression exhibited reduced daily acceleration and time spent in MVPA relative to the control group, particularly on the weekend during their free time away from scheduled activities. On the other hand, the two groups were comparable in terms of sleep estimates. Taken together, reduced physical activity, but not sleep-wake disturbances, seem to be associated with vulnerability to depression and might be a viable target for identification and prevention efforts.

Microbiota-gut-brain axis: the mediator of exercise and brain health

The brain controls the nerve system, allowing complex emotional and cognitive activities. The microbiota-gut-brain axis is a bidirectional neural, hormonal, and immune signaling pathway that could link the gastrointestinal tract to the brain. Over the past few decades, gut microbiota has been demonstrated to be an essential component of the gastrointestinal tract that plays a crucial role in regulating most functions of various body organs. The effects of the microbiota on the brain occur through the production of neurotransmitters, hormones, and metabolites, regulation of host-produced metabolites, or through the synthesis of metabolites by the microbiota themselves. This affects the host's behavior, mood, attention state, and the brain's food reward system. Meanwhile, there is an intimate association between the gut microbiota and exercise. Exercise can change gut microbiota numerically and qualitatively, which may be partially responsible for the widespread benefits of regular physical activity on human health. Functional magnetic resonance imaging (fMRI) is a non-invasive method to show areas of brain activity enabling the delineation of specific brain regions involved in neurocognitive disorders. Through combining exercise tasks and fMRI techniques, researchers can observe the effects of exercise on higher brain functions. However, exercise's effects on brain health via gut microbiota have been little studied. This article reviews and highlights the connections between these three interactions, which will help us to further understand the positive effects of exercise on brain health and provide new strategies and approaches for the prevention and treatment of brain diseases.

Effects of aerobic exercise on cognitive function in adults with major depressive disorder: A systematic review and meta-analysis

Background

Major Depressive Disorder (MDD) is a highly prevalent psychiatric disorder that impairs the cognitive function of individuals. Aerobic exercise stands out as a promising non-pharmacological intervention for enhancing cognitive function and promoting brain health.While positive impacts of aerobic exercise on executive function in adults with depression have been documented, a comprehensive understanding of its benefits on overall cognitive function, including memory, attention, and processing speed, along with key moderating factors in adults with MDD, remains unexplored. The purpose of the systematic review and meta-analysis was to investigate the effects of aerobic exercise on overall cognitive function in adults with MDD, and to explore whether cognitive sub-domains, aerobic exercise characteristics, and study and sample variables modify the effects of aerobic exercise on cognition.

Methods

Six English electronic databases (Embase, Cochrane Central, Scopus, APA PsycInfo, PubMed, Web of Science) were searched from inception to 2 April 2023. Randomized trials, including adults aged 18 years or above with a diagnosis of clinical depression, of the effects of aerobic exercise on cognitive function in adults with MDD compared to non-aerobic exercise groups were included. A three-level meta-analysis was conducted utilizing a random-effects model in R. The quality of the studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale. The PROSPERO registration number is CRD42022367350.

Results

Twelve randomized trials including 945 adults with MDD were included. Results indicated that aerobic exercise significantly improved overall cognitive function (g = 0.21; 95 % confidence intervals [CI] = 0.07, 0.34), and the sub-domains of memory (g = 0.25; 95 % CI = 0.06, 0.44) and executive function (g = 0.12; 95 % CI = 0.04, 0.20). Significant benefits in cognitive function were found from moderate-to-vigorous (mixed) intensity (g = 0.19; 95 % CI = 0.02, 0.37), aerobic exercise conducted 3 times per week (g = 0.23; 95 % CI = 0.10, 0.38), in sessions < 45 min (g = 0.59; 95 % CI = 0.28, 0.90), and 45-60 min (g = 0.16; 95 % CI = 0.07, 0.26), in aerobic exercise intervention ≤ 12 weeks (g = 0. 26; 95 % CI = 0.08, 0.44).

Limitations

This review only included peer-reviewed English-language studies, which may lead to a language bias. The results of the Egger's test suggested a potential publication bias.

Conclusions

Aerobic exercise is efficacious in improving overall cognitive function and the sub-domains of memory and executive function in adults with major depressive disorder.

Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials

OBJECTIVE

To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions.

DESIGN

Systematic review and network meta-analysis.

METHODS

Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool.

DATA SOURCES

Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression.

RESULTS

218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges' g -0.62, 95% credible interval -0.80 to -0.45), yoga (n=1047, κ=33, g -0.55, -0.73 to -0.36), strength training (n=643, κ=22, g -0.49, -0.69 to -0.29), mixed aerobic exercises (n=1286, κ=51, g -0.43, -0.61 to -0.24), and tai chi or qigong (n=343, κ=12, g -0.42, -0.65 to -0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments.

CONCLUSIONS

Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018118040.

Effects of Exercise Training on Executive Functioning in Adults with Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Exercise is a promising nonpharmacological intervention to improve executive function (EF). However, results from randomized trials and meta-analyses examining the effects of exercise on working memory in adults with depression are mixed, and the influence of exercise on EF, as well as the key moderators of the relationship, remain inconclusive.

OBJECTIVE

The present systematic review with meta-analysis examined the influence of exercise interventions on EF in adults with depression, and the influence of key moderating variables.

METHODS

Electronic searches were conducted using Embase, Cochrane Central, Scopus, Ovid MEDLINE, PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and Weipu Database up to 25 June 2022, and updated on 16 January 2023. Randomized controlled trials (RCTs) examining the effects of exercise training on EF in adults with depression were included. A three-level meta-analysis based on a random-effects model was applied in R. Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scale.

RESULTS

A total of 14 RCTs that evaluated 1201 adults with depression were included. The results indicated that exercise significantly improved global EF [g = 0.180; 95% confidence intervals (CI) = 0.038, 0.323], and the subdomains of working memory (g = 0.182; 95% CI = 0.015, 0.350), cognitive flexibility (g = 0.222; 95% CI = 0.048, 0.395), and reasoning/planning (g = 0.889; 95% CI = 0.571, 1.206). In subgroup analyses, significant improvements in EF were only observed for aerobic exercise (g = 0.203; 95% CI = 0.023, 0.382), moderate-to-vigorous intensity exercise (g = 0.200; 95% CI = 0.022, 0.379), exercise performed three or more times per week (g = 0.207; 95% CI = 0.026, 0.388), in sessions ≤ 60 min (g = 0.173; 95% CI = 0.003, 0.343), and in program durations lasting at least 13 weeks (g = 0. 248; 95% CI = 0.034, 0.462).

CONCLUSIONS

This meta-analysis demonstrates the benefits of exercise training for improving EF and the subdomains of working memory, cognitive flexibility, and reasoning/planning in adults with depression. Future randomized clinical trials are warranted to determine the therapeutic effects of exercise training on EF and cognitive symptoms in depressed patients.

Exercise for Mental Well-Being: Exploring Neurobiological Advances and Intervention Effects in Depression

Depression is a common mental disorder in which patients often experience feelings of sadness, fatigue, loss of interest, and pleasure. Exercise is a widely used intervention for managing depression, but the specific molecular mechanisms underlying its antidepressant effect are unclear. In this narrative review, we aim to synthesize current knowledge on the molecular, neural, and physiological mechanisms through which exercise exerts its antidepressant effect and discuss the various exercise interventions used for managing depression. We conducted a narrative review of the literature on the topic of exercise and depression. Our review suggests that exercise impacts peripheral tryptophan metabolism, central inflammation, and brain-derived neurotrophic factors through the peroxisome proliferator-activated receptor γ activating factor 1α (PGC-1α) in skeletal muscles. The uncarboxylated osteocalcin facilitates "bone-brain crosstalk", and exercise corrects atypical expression of brain-gut peptides, modulates cytokine production and neurotransmitter release, and regulates inflammatory pathways and microRNA expression. Aerobic exercise is recommended at frequencies of 3 to 5 times per week with medium to high intensity. Here we highlight the significant potential of exercise therapy in managing depression, supported by the molecular, neural, and physiological mechanisms underlying its antidepressant effect. Understanding the molecular pathways and neural mechanisms involved in exercise's antidepressant effect opens new avenues for developing novel therapies for managing depression.

Comparing the efficacy of different types of exercise for the treatment and prevention of depression in youths: a systematic review and network meta-analysis

Purpose

Depression disorder is the most commonly diagnosed type of mental illness among youths. Although a plethora of evidence suggests a positive relationship between exercise and lower levels of depression in youths, the findings regarding the variation in magnitude of this relationship are inconclusive with respect to the preventive and therapeutic effects of different types of exercise. This network meta-analysis aimed to determine the best type of exercise for the treatment and prevention of depression in youths.

Methods

A comprehensive search of databases, including PubMed, EMBASE, The Cochrane Library, Web of Science, PsychINFO, ProQuest, Wanfang, and CNKI, was conducted to identify relevant research on exercise interventions for depression in youth populations. The risk of bias in the included studies was evaluated using Cochrane Review Manager 5.4 according to the Cochrane Handbook 5.1.0 Methodological Quality Evaluation Criteria. The network meta-analysis was performed using STATA 15.1 to calculate the standardized mean difference (SMD) of all concerned outcomes. The node-splitting method was used to test the local inconsistency of the network meta-analysis. Funnel plots were used to evaluate the potential impact of bias in this study.

Result

Utilizing data extracted from 58 studies (10 countries, 4,887 participants), we found that for depressed youths, exercise is significantly better than usual care in reducing anxiety (SMD = -0.98, 95% CI [-1.50, -0.45]). For non-depressed youths, exercise is significantly better than usual care in reducing anxiety (SMD = -0.47, 95% CI [ -0.66, -0.29]). In the treatment of depression, resistance exercise (SMD = -1.30, 95% CI [ -1.96, -0.64]), aerobic exercise (SMD = -0.83, 95% CI [-1.10 -0.72]), mixed exercise (SMD = -0.67, 95% CI [-0.99, -0.35]), and mind-body exercise (SMD = -0.61, 95% CI [-0.84, -0.38]) all showed significant efficacy over usual care. For the prevention of depression, resistance exercise (SMD = -1.18, 95% CI [-1.65, -0.71]), aerobic exercise (SMD = -0.72, 95% CI [-0.98, -0.47]), mind-body exercise (SMD = -0.59, 95% CI [-0.93, -0.26]), and mixed exercise (SMD = -1.06, 95% CI [-1.37 to -0.75]) were all significantly effective compared to usual care. According to the test of the surface under the cumulative ranking score (SUCRA), the ranking of exercises for the treatment of depression in depressed youths is as follows: resistance exercise (94.9%) > aerobic exercise (75.1%) > mixed exercise (43.8%) > mind-body exercise (36.2%) > usual care (0%). For the prevention of depression in non-depressed youths, resistance exercise (90.3%) > mixed exercise (81.6%) > aerobic exercise (45.5%) > mind-body exercise (32.6%) > usual care (0%). Resistance exercise thus had the best comprehensive effect on both the treatment and prevention of depression in youths (clusterank value = 1914.04). Subgroup analyses show that a frequency of 3-4 times per week, a duration of 30-60 min, and a length of more than 6 weeks were found to be the most effective interventions for depression (P > 0.001).

Conclusion

This study provides compelling evidence that exercise is a viable intervention for improving depression and anxiety in young individuals. In addition, the study emphasizes the importance of selecting the appropriate type of exercise to optimize treatment and prevention. Specifically, the results suggest that resistance exercise, performed 3-4 times per week, with sessions lasting 30-60 min and a length of more than 6 weeks, yields optimal results for the treatment and prevention of depression in young individuals. These findings have significant implications for clinical practice, particularly given the challenges associated with implementing effective interventions and the economic burden of treating and preventing depression in young people. However, it is worth noting that additional head-to-head studies are necessary to confirm these findings and strengthen the evidence base. Nevertheless, this study provides valuable insights into the role of exercise as a potential treatment and preventative measure for depression in young people.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=374154, identifier: 374154.

The role of exercise in the treatment of depression: biological underpinnings and clinical outcomes

Globally, depression is a leading cause of disability and has remained so for decades. Antidepressant medications have suboptimal outcomes and are too frequently associated with side effects, highlighting the need for alternative treatment options. Although primarily known for its robust physical health benefits, exercise is increasingly recognized for its mental health and antidepressant benefits. Empirical evidence indicates that exercise is effective in treating individuals with depression; however, the mechanisms by which exercise exerts anti-depressant effects are not fully understood. Acute bouts of exercise have been shown to transiently modulate circulating levels of serotonin and norepinephrine, brain-derived neurotrophic factor, and a variety of immuno-inflammatory mechanisms in clinical cohorts with depression. However, exercise training has not been demonstrated to consistently modulate such mechanisms, and evidence linking these putative mechanisms and reductions in depression is lacking. The complexity of the biological underpinnings of depression coupled with the intricate molecular cascade induced by exercise are significant obstacles in the attempt to disentangle exercise's effects on depression. Notwithstanding our limited understanding of these effects, clinical evidence uniformly argues for the use of exercise to treat depression. Regrettably, exercise remains underutilized despite being an accessible, low-cost alternative/adjunctive intervention that can simultaneously reduce depression and improve overall health. To address the gaps in our understanding of the clinical and molecular effects of exercise on depression, we propose a model that leverages systems biology and multidisciplinary team science with a large-scale public health investment. Until the science matches the scale of complexity and burden posed by depression, our ability to advance knowledge and treatment will continue to be plagued by fragmented, irreproducible mechanistic findings and no guidelines for standards of care.

Effects of Physical Exercise on Executive Function in Adults with Depression: A Systematic Review and Meta-Analysis

Executive function is among the most affected cognitive dimensions in depression. Physical exercise may improve executive function (e.g., working memory, inhibition, cognitive flexibility), although this is without consensus on adults with depression. Through this systematic review, we aim to elucidate the effects of physical exercise programs on executive functions in adults with depression. The literature search was performed in four relevant electronic databases, combining keywords and medical subject headings, from inception until September 2022. Controlled interventions, involving adults with depression, and reporting working memory, inhibition, and/or cognitive flexibility pre-post-intervention data, were considered includable. Results from meta-analyses included effect size (ES, i.e., Hedges' g) values reported with 95% confidence intervals (95%CIs), with p set at ≤0.05. Seven studies were included, including 202 men and 457 women (age: 21.0-51.2 years; mild-moderate depression). For working memory, a small favoring effect was observed in the experimental groups compared with controls (ES = 0.33, 95%CI = 0.04-0.61; p = 0.026; I² = 64.9%). For inhibition, physical exercise had a small favoring non-significant effect compared with controls (ES = 0.28, 95%CI = -0.17-0.74; p = 0.222; I² = 72.4%). Compared with the control group, physical exercise had a trivial effect on cognitive flexibility (ES = 0.09, 95%CI = -0.21-0.39; p = 0.554; I² = 68.4%). In conclusion, physical exercise interventions may improve working memory behavioral measures in adults with mild-to-moderate depression when compared with active and passive control conditions. However, the reduced number of available high-quality studies precludes more lucid conclusions.

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

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).

Treatments for objective and subjective cognitive functioning in young people with depression: Systematic review of current evidence

AIM

Cognitive deficits are recognized features of depressive disorders in youth aged 12-25. These deficits are distressing, predict functional impairment and limit the effectiveness of psychological therapies. Cognitive enhancement using behavioural, biochemical or physical treatments may be useful in young people with depression, but studies have not been synthesized. The aim was to systematically review the evidence for treatments for objective and subjective cognitive functioning, and their acceptability and functional outcomes in people aged 12-25 with depression.

METHOD

Three electronic databases were searched for articles using pre-specified criteria. Pharmacological treatments were not eligible. Risk of bias was rated using the Cochrane Collaboration's revised risk-of-bias tool. Dual full-text article screening, data extraction and quality ratings were completed.

RESULTS

Twelve studies were included for review (median participant age: 20.39 years), five of which were randomized-controlled trials (RCTs). Sample sizes were generally small (median = 23; range: 9-46). Eight studies investigated behavioural treatments including aerobic exercise, cognitive training and education or strategy-based methods. Four studies examined repetitive transcranial magnetic brain stimulation (rTMS). Most behavioural treatments revealed preliminary evidence of improved cognitive function in youth depression. Consent rates were greatest for exercise- and education-based approaches, which may indicate higher acceptability levels. Findings from rTMS trials were mixed, with only half showing cognitive improvement. Functional outcomes were reported by three behavioural treatment trials and one rTMS trial, with functional improvement reported only in the former. Some concern of risk of bias was found in each RCT.

CONCLUSION

Behavioural treatments, such as exercise, cognitive training and education/strategy-focused techniques, show encouraging results and appear to be acceptable methods of addressing cognitive deficits in youth depression based on participation rates. Brain stimulation and biochemical treatments (e.g., nutrient-based treatment) require further investigation.

Exercise as a Potential Therapeutic Strategy to Target the Clinical Link Between Depression and Alzheimer's Disease: A Narrative Review

Alzheimer's disease (AD) and major depressive disorder (MDD) affect millions worldwide and both cause significant morbidity and mortality. While clinically distinctive, patients with MDD can present with memory dysfunction and patients with AD commonly report symptoms of depression. Additionally, brain pathology in MDD and AD both demonstrate decreased hippocampal volumes, and severe disease is associated with smaller hippocampal volumes in both disorders. Hippocampal neurogenesis occurs daily in healthy individuals, an impaired process in AD and MDD. MDD is thus suggested to be a risk factor for developing AD later in life; moreover, depression onset alongside AD indicates a worse prognosis. Treatment options that target hippocampal neurogenesis are being evaluated for both diseases, and aerobic exercise has shown promising results. We searched PubMed for relevant review articles published since 2000 encompassing the topics of hippocampal neurogenesis and exercise in relation to depression and AD, including novel clinical trials if they contributed information not in the chosen reviews. While much data indicates that exercise increases hippocampal neurogenesis in both MDD and AD, mood improvement in MDD, mild quality of life and cognitive improvement in AD, and reduced risk of those with MDD developing AD in response to various exercise regimens, this result was not universal. Some data indicated no difference between exercise groups and controls. Further randomized control trials into exercise as an intervention in treating MDD and preventing AD is required. However, exercise is a low-risk, affordable treatment option and is a feasible additive therapy in patients with AD and MDD.

Examining the Effect of Increased Aerobic Exercise in Moderately Fit Adults on Psychological State and Cognitive Function

Regular physical exercise can decrease the risk for obesity, diabetes, and cardiovascular disease, increase life expectancy, and promote psychological health and neurocognitive functioning. Cross-sectional studies show that cardiorespiratory fitness level (VO2 max) is associated with enhanced brain health, including improved mood state and heightened cognitive performance. Interventional studies are consistent with these cross-sectional studies, but most have focused on low-fit populations. Few such studies have asked if increasing levels of physical activity in moderately fit people can significantly enhance mood, motivation, and cognition. Therefore, the current study investigated the effects of increasing aerobic exercise in moderately fit individuals on psychological state and cognitive performance. We randomly assigned moderately fit healthy adults, 25-59 years of age, who were engaged in one or two aerobic exercise sessions per week to either maintain their exercise regimen (n = 41) or increase their exercise regimen (i.e., 4-7 aerobic workouts per week; n = 39) for a duration of 3 months. Both before and after the intervention, we assessed aerobic capacity using a modified cardiorespiratory fitness test, and hippocampal functioning via various neuropsychological assessments including a spatial navigation task and the Mnemonic Similarity Task as well as self-reported measures including the Positive and Negative Affect Scale, Beck Anxiety Inventory, State-Trait Anxiety Inventory, Perceived Stress Scale, Rumination Scale, Eating Disorders Examination, Eating Attitudes Test, Body Attitudes Test, and Behavioral Regulation of Exercise Questionnaire. Consistent with our initial working hypotheses, we found that increasing exercise significantly decreased measures of negative affect, including fear, sadness, guilt, and hostility, as well as improved body image. Further, we found that the total number of workouts was significantly associated with improved spatial navigation abilities and body image as well as reduced anxiety, general negative affect, fear, sadness, hostility, rumination, and disordered eating. In addition, increases in fitness levels were significantly associated with improved episodic memory and exercise motivation as well as decreased stress and disordered eating. Our findings are some of the first to indicate that in middle-aged moderately-fit adults, continuing to increase exercise levels in an already ongoing fitness regimen is associated with additional benefits for both psychological and cognitive health.

Effects of aerobic exercise on event-related potentials related to cognitive performance: a systematic review

Introduction

Aerobic exercise interventions may affect different cognitive domains such as attention, working memory, inhibition, etc. However, the neural mechanisms underlying this relationship, remains uncertain.

Objective

To perform a systematic review on exercise intervention studies that use event-related potentials (ERPs) as outcome for cognitive performance.

Methods

We identified studies through searches in four databases reporting the effects of either an acute bout or chronic exercise on any ERP associated with cognitive performance. Study population included participants >17 years of age with or without a diagnosis.

Results

A total of 5,797 records were initially identified through database searching of which 52 were eligible for inclusion. Most studies were of acute aerobic exercise with moderate intensity. Results were heterogenious across studies, but there was a trend that ERP amplitude increased and (to a lesser extent) latencies decreased post-exercise. The P3 ERP was the most often reported ERP.

Conclusion

Heterogeneity across studies regarding methodology limited the possibility to draw definitive conclusions but the most consistent findings were that acute aerobic exercise was associated with higher amplitudes, and to a lesser extent shorter latencies, of ERPs.

Relationship of depression and sleep quality, diseases and general characteristics

BACKGROUND

Depression is the most common type of depressive disorder. The most common sleep disorder associated with depression is insomnia. Insomnia and depression are closely related.

AIM

To investigate the relationship of designed questionnaire items and depression, and analyze the related factors with depression.

METHODS

Questionnaire included Patient Health Questionnaire-9 (PHQ-9) and Pittsburgh sleep quality index (PSQI), 12 kinds of diseases, 8 general characteristics, and 20 insomnia characteristics, totally 56 items were filled out by 411 patients enrolled.

RESULTS

All the 9 items of PHQ-9, 6 components of PSQI (except sleep duration), education, living situation, exercise, years of insomnia, western medicine treatment, Chinese medicine treatment, psychotherapy, kinds of insomnia, treatment expected to treat insomnia, psychological counseling, habit of 1 h before bed, habit of lunch break, diagnosed depression, coronary heart disease, mental illness showed significant difference between without and with depression group. By univariate analysis and multivariate analysis. The odds ratio of education, exercise, kinds of insomnia, habit of 1 h before bed, diagnosed depression, coronary heart disease (P = 0.01) showed significant difference. Their odds ratios were 0.71 (0.55, 0.93), 2.09 (1.32, 3.31), 0.76 (0.63, 0.91), 0.89 (0.81, 0.98), 0.32 (0.17, 0.60), 0.43 (0.23, 0.79).

CONCLUSION

We demonstrated that education, exercise, kinds of insomnia, habit of 1 h before bed, diagnosed depression and coronary heart disease affect the depression.

A randomized trial of aerobic exercise for major depression: examining neural indicators of reward and cognitive control as predictors and treatment targets

BACKGROUND

Aerobic exercise has demonstrated antidepressant efficacy among adults with major depression. There is a poor understanding of the neural mechanisms associated with these effects. Deficits in reward processing and cognitive control may be two candidate targets and predictors of treatment outcome to exercise in depression.

METHODS

Sixty-six young adults aged 20.23 years (s.d. = 2.39) with major depression were randomized to 8 weeks of moderate-intensity aerobic exercise (n = 35) or light stretching (n = 31). Depressive symptoms were assessed across the intervention to track symptom reduction. Reward processing [reward positivity (RewP)] and cognitive control [error-related negativity (ERN)] were assessed before and after the intervention using event-related brain potentials.

RESULTS

Compared to stretching, aerobic exercise resulted in greater symptom reduction (gs = 0.66). Aerobic exercise had no impact on the RewP (gav = 0.08) or ERN (gav = 0.21). In the aerobic exercise group, individuals with a larger pre-treatment RewP [odds ratio (OR) = 1.45] and increased baseline depressive symptom severity (OR = 1.18) were more likely to respond to an aerobic exercise program. Pre-treatment ERN did not predict response (OR = 0.74).

CONCLUSIONS

Aerobic exercise is effective in alleviating depressive symptoms in adults with major depression, particularly for those with increased depressive symptom severity and a larger RewP at baseline. Although aerobic exercise did not modify the RewP or ERN, there is preliminary support for the utility of the RewP in predicting who is most likely to respond to exercise as a treatment for depression.

Personalized individual-based exercise prescriptions are effective in treating depressive symptoms of college students during the COVID-19: A randomized controlled trial in China

BACKGROUND

The COVID-19 pandemic has seriously increased depression prevalence among the public, including Chinese college students. However, many exercise cannot be performed as usual under the stay-at-home order. This study was a 12-week three-arm randomized controlled trial using the intention-to-treat principle, aiming to explore and compare the feasibility and effect of individual-based personalized aerobic-exercise and resistance-training prescriptions on depressive symptoms in college students, and conclude with some recommendations for individual-based exercise prescriptions.

METHODS

Eighty-six college students with depressive symptoms were randomized into aerobic-exercise (AE), resistance-training (RT), and wait-list control (WLC) groups. Participants in two experimental groups received 12-week personalized AE and RT prescriptions on their individual situations, respectively. No intervention was implemented on participants in the WLC group. Depressive symptoms and physical activity (PA) were measured by Zung Self-Rating Depression Scale (SDS) and International Physical Activity Questionnaire-Short Form (IPAQ-SF), respectively. All data were collected at the baseline, 4, 8, and 12 weeks, and 4-week post-intervention.

RESULTS

At 12 weeks, 72.09% of depressive participants improved to "normal." Participants exhibited a statistical reduction in SDS in all 3 groups (p < 0.05) at 12 weeks compared to baseline. Follow-up assessments showed no significant increase in SDS at 4-week post-intervention compared to 12 weeks (p > 0.05). The independent t-test revealed significantly lower SDS in AE and RT group than in WLC group (p _AE < 0.001 and p _RT < 0.05) at 4, 8, and 12 weeks, and 4-week post-intervention. Furthermore, the PA of participants (including total PA and intensities) in both experimental groups represented a significant improvement at 4-week post-intervention compared to baseline (p < 0.05), while no differences were observed in the PA of participants in the WLC group (p > 0.05).

CONCLUSION

Personalized exercise prescriptions have good feasibility as they can increase adherence to intervention and reduce serious adverse events. Besides, individual-based personalized aerobic-exercise and resistance-training prescriptions result in a similar effect in relieving depressive symptoms and improving physical activity in college students. The individual-based exercise programs performed in 45- to 60- min with progressive moderate-to-vigorous intensity, 3 times/week for at least 12 weeks, may reduce depressive symptoms in college students during the COVID-19.

The Effect of Physical Activity on Neurotrophin Concentrations and Cognitive Control in Patients With a Depressive Episode

BACKGROUND

Cognitive deficits occur in most patients with affective disorders. The role of neurotrophic factors (e.g., BDNF) as modulators of brain plasticity affecting neurocognitive abilities has been emphasized. Neurotrophin concentrations may change under the influence of various interventions, including physical activity. Selected studies have shown that cognitive function may also be affected by exercise.

AIM

The aim of the study was to determine whether physical activity changes the concentration of neurotrophins and their receptors in patients with an episode of depression. It was also examined how one session of aerobic exercise affects cognitive control.

METHODS

The study included 41 participants. The subjects were asked to exercise on a cycloergometer for 40 min with individually selected exercise loads (70% VO₂max). Before and shortly after the exercise blood samples were acquired to perform blood assays (proBDNF, BDNF, TrkB, NGFR). The participants also performed a Stroop test twice-before the exercise and 10 min after its cessation.

RESULTS

The single bout of physical exercise did not cause any significant changes in the concentration of neurotrophic factors. The SCWT results: both the mean reading time (29.3 s vs. 47.8 s) and the color naming time (36.7 s vs. 50.7 s) increased. The patients made more mistakes after physical exercise, both in part A (0.2 vs. 1.5) and B (0.6 vs. 1.5). The so-called interference effect decreased-the difference between naming and reading times was smaller after exercise (6.2 s vs. 2.4 s). No significant correlations were found between the concentrations of the studied neurotrophic factors and the Stroop test results.

CONCLUSIONS

The results did not confirm changes in neurotrophin concentration under the influence of a single session of physical activity. The shortening of the interference time after exercise may be caused by practice effects. A significant limitation of the study is the use of the Stroop test twice in short intervals.

Poor reporting of physical activity and exercise interventions in youth mental health trials: A brief report

AIM

To describe the quality and completeness of the description and reporting of physical activity and exercise interventions delivered to young people to promote mental health or treat mental illness.

METHODS

We conducted a series of scoping reviews identifying 64 controlled trials of physical activity and exercise interventions delivered to young people. We extracted: intervention characteristics, personnel and delivery format, the intensity, duration, frequency and type of physical activity or exercise.

RESULTS

There was limited reporting of intervention details across studies; 52% did not provide information to confidently assess intervention intensity, 29% did not state who delivered the intervention, and 44% did not specify the intervention delivery format.

CONCLUSIONS

We recommend that authors adhere to the CONSORT reporting requirements and its intervention reporting extensions, (a) the Template for Intervention Description and Replication, (b) Consensus for Exercise Reporting Template and (c) as part of this, detail the frequency, intensity, time and type of physical activity recommendations and prescriptions. Without this, future trials are unable to replicate and extend previous work to support or disconfirm existing knowledge, leading to research waste and diminishing translation and implementation potential.

Be Fit, Be Sharp, Be Well: The Case for Exercise as a Treatment for Cognitive Impairment in Late-life Depression

OBJECTIVE

To lay out the argument that exercise impacts neurobiological targets common to both mood and cognitive functioning, and thus more research should be conducted on its use as an alternative or adjunctive treatment for cognitive impairment in late-life depression (LLD).

METHOD

This narrative review summarizes the literature on cognitive impairment in LLD, describes the structural and functional brain changes and neurochemical changes that are linked to both cognitive impairment and mood disruption, and explains how exercise targets these same neurobiological changes and can thus provide an alternative or adjunctive treatment for cognitive impairment in LLD.

RESULTS

Cognitive impairment is common in LLD and predicts recurrence of depression, poor response to antidepressant treatment, and overall disability. Traditional depression treatment with medication, psychotherapy, or both, is not effective in fully reversing cognitive impairment for most depressed older adults. Physical exercise is an ideal treatment candidate based on evidence that it 1) is an effective treatment for depression, 2) enhances cognitive functioning in normal aging and in other patient populations, and 3) targets many of the neurobiological mechanisms that underlie mood and cognitive functioning. Results of the limited existing clinical trials of exercise for cognitive impairment in depression are mixed but overall support this contention.

CONCLUSIONS

Although limited, existing evidence suggests exercise may be a viable alternative or adjunctive treatment to address cognitive impairment in LLD, and thus more research in this area is warranted. Moving forward, additional research is needed in large, diverse samples to translate the growing research findings into clinical practice.

Role of Adiponectin-Notch pathway in cognitive dysfunction associated with depression and in the therapeutic effect of physical exercise

A substantial percentage of late‐life depression patients also have an cognitive impairment, which severely affects the life quality, while the co‐occurring mechanisms are still unclear. Physical exercise can ameliorate both depressive behaviors and cognitive dysfunction, but the molecular mechanisms underlying its beneficial effects remain elusive. In this study, we uncover a novel adipose tissue to hippocampus crosstalk mediated by Adiponectin‐Notch pathway, with an impact on hippocampal neurogenesis and cognitive function. Adiponectin, an adipocyte‐derived hormone, could activate Notch signaling in the hippocampus through upregulating ADAM10 and Notch1, two key molecules in the Notch signaling. Chronic stress inhibits the Adiponectin‐Notch pathway and induces impaired hippocampal neurogenesis and cognitive dysfunction, which can be rescued by AdipoRon and running. Inhibition Notch signaling by DAPT mimics the adverse effects of chronic stress on hippocampal neurogenesis and cognitive function. Adiponectin knockout mice display depressive‐like behaviors, associated with inhibited Notch signaling, impaired hippocampal neurogenesis and cognitive dysfunction. Physical exercise could activate Adiponectin‐Notch pathway, and improve hippocampal neurogenesis and cognitive function, while deleting adiponectin gene or inhibiting Notch signaling blocks its beneficial effects. Together, our data not only suggest that Adiponectin‐Notch pathway is involved in the pathogenesis of cognitive dysfunction associated with depression, but also contributes to the therapeutic effect of physical exercise. This work helps to decipher the etiology of cognitive impairment associated with depression and hence will provide a potential innovative therapeutic target for these patients.

Gender Differences in the Relationship Between Exercise, Sleep, and Mood in Young Adults

Insufficient sleep is a serious public health problem in college students. Exercise is a widely prescribed behavioral treatment for sleep and mood issues; however, more focused and gender-specific prescriptions are needed. The present study examined relationships between exercise, sleep, and mood in undergraduate men and women. Students (N = 866, 19.6 ± 1.4 years, 38.7% women) were recruited from campus recreation facilities and completed demographic, the Pittsburgh Sleep Quality Index, mood (Patient-Reported Outcomes Measurement Information System), and exercise questionnaires. The Department of Health and Human Services Physical Activity Guidelines were used to dichotomize those who did and did not meet weekly aerobic and strength training exercise recommendations. In men, greater exercise frequency associated with less daytime dysfunction (β = 0.147) and less depressive mood (β = -0.64, ps < .05). In women, greater exercise frequency associated with earlier bedtime (β = -12.6), improved sleep quality (β = 0.17), increased positive affect (β = 0.91), less depressive mood (β = -0.71), and less anger (β = -1.24, ps < .05). Compared to men, women reported earlier bedtime, poorer sleep efficiency, and more anxiety and depressive mood (ps < .05, ηp2 range: 0.01-0.04). Compared to individuals who met physical activity guidelines, those who did not meet the guidelines reported later bedtimes, less positive affect, more anxiety, and more anger (ps < .05 ηp2s = 0.01). Among men, those who met physical activity guidelines reported falling asleep more quickly than those who did not meet guidelines (ηp2 = 0.01, p = .007); however, no relationship between guideline adherence and sleep latency was observed in women. Adhering to physical activity guidelines may be important for optimal sleep and emotional health. Clinicians should consider gender when creating exercise prescriptions for sleep issues.

Circulating Extracellular Vesicles: The Missing Link between Physical Exercise and Depression Management?

Depression is associated with an increased risk of aging-related diseases. It is also seemingly a common psychological reaction to pandemic outbreaks with forced quarantines and lockdowns. Thus, depression represents, now more than ever, a major global health burden with therapeutic management challenges. Clinical data highlights that physical exercise is gaining momentum as a non-pharmacological intervention in depressive disorders. Although it may contribute to the reduction of systemic inflammation associated with depression, the mechanisms underlying the beneficial physical exercise effects in emotional behavior remain to be elucidated. Current investigations indicate that a rapid release of extracellular vesicles into the circulation might be the signaling mediators of systemic adaptations to physical exercise. These biological entities are now well-established intercellular communicators, playing a major role in relevant physiological and pathophysiological functions, including brain cell-cell communication. We also reviewed emerging evidence correlating depression with modified circulating extracellular vesicle surfaces and cargo signatures (e.g., microRNAs and proteins), envisioned as potential biomarkers for diagnosis, efficient disease stratification and appropriate therapeutic management. Accordingly, the clinical data summarized in the present review prompted us to hypothesize that physical exercise-related circulating extracellular vesicles contribute to its antidepressant effects, particularly through the modulation of inflammation. This review sheds light on the triad "physical exercise-extracellular vesicles-depression" and suggests new avenues in this novel emerging field.

The Effects and Mechanisms of Exercise on the Treatment of Depression

Background: It is necessary to seek alternative therapies for depression, because side effects of medications lead to poor adherence and some patients do not achieve a clinical treatment effect. Recently the role of exercise as a low-cost and easy-to-use treatment for depression has gained attention with a number of studies showing that exercise is effective at reducing depressive symptoms and improving body functions such as cardiorespiratory system and cognitive function. Because of the heterogeneity of exercise therapy programs, there is no standardized and unified program. Few studies have summarized the specific properties of exercise programs (type, intensity, duration, and frequency) and clinical prescriptions for exercise are not mentioned in most articles. Aims: This study aimed to investigate the feasibility and efficacy of exercise therapy for patients with depression, in order to appraise the evidence and outline accepted guidelines to direct individualized treatment plans for patients with depression based on their individual situations. Methods: A systematic review of English language literature including papers published from 2010 to present in PubMed was performed. Given the feasibility of prescribing exercise therapy for patients with depression, nearly 3 years of clinical studies on the treatments of depressive symptoms with exercise were first reviewed, comparing the exercise programs utilized. Conclusions: Exercise has therapeutic effects on depression in all age groups (mostly 18-65 years old), as a single therapy, an adjuvant therapy, or a combination therapy, and the benefits of exercise therapy are comparable to traditional treatments for depression. Moderate intensity exercise is enough to reduce depressive symptoms, but higher-dose exercise is better for overall functioning. Exercise therapy has become more widely used because of its benefits to the cardiovascular system, emotional state, and systemic functions. Recommendations: Aerobic exercise/mind-body exercise (3-5 sessions per week with moderate intensity lasting for 4-16 weeks) is recommended. Individualized protocols in the form of group exercise with supervision are effective at increasing adherence to treatment.

Aerobic Exercise Prevents Depression via Alleviating Hippocampus Injury in Chronic Stressed Depression Rats

(1) Background: Depression is one of the overwhelming public health problems. Alleviating hippocampus injury may prevent depression development. Herein, we established the chronic unpredictable mild stress (CUMS) model and aimed to investigate whether aerobic exercise (AE) could alleviate CUMS induced depression-like behaviors and hippocampus injury. (2) Methods: Forty-eight healthy male Sprague-Dawley rats (200 ± 20 g) were randomly divided into 4 groups (control, CUMS, CUMS + 7 days AE, CUMS + 14 days AE). Rats with AE treatments were subjected to 45 min treadmill per day. (3) Results: AE intervention significantly improved CUMS-induced depressive behaviors, e.g., running square numbers and immobility time assessed by the open field and forced swimming test, suppressed hippocampal neuron apoptosis, reduced levels of phosphorylation of NMDA receptor and homocysteine in hippocampus, as well as serum glucocorticoids, compared to the CUMS rats. In contrast, AE upregulated phosphorylation of AMPAR receptor and brain-derived neurotrophic factor (BDNF) hippocampus in CUMS depression rats. The 14 day-AE treatment exhibited better performance than 7 day-AE on the improvement of the hippocampal function. (4) Conclusion: AE might be an efficient strategy for prevention of CUMS-induced depression via ameliorating hippocampus functions. Underlying mechanisms may be related with glutamatergic system, the neurotoxic effects of homocysteine, and/or influences in glucocorticoids-BDNF expression interaction.

Exercise as Treatment for Youth With Major Depression: The Healthy Body Healthy Mind Feasibility Study

The goals of this study were to determine the feasibility of engaging youth with major depressive disorder (MDD) in a multimodal exercise intervention (Healthy Body Healthy Mind) plus usual care and to evaluate the magnitude of its effects on psychological, physical fitness, and biomarker outcomes to inform a future randomized controlled trial. Youth (15 to 25 y of age) with MDD diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) were eligible to participate. Feasibility measures included recruitment, retention, and program adherence rates. The exercise program consisted of a single session of motivational interviewing to enhance exercise adherence, then 1-hour, small-group supervised exercise sessions 3 times per week for 12 weeks. Assessments were administered at baseline and at 12 weeks. Depression symptoms were assessed using the Beck Depression Inventory (BDI-II). Physical fitness and blood biomarkers were also measured. Three males and 10 females with MDD, who were 18 to 24 years of age, participated. Retention at 12 weeks was 86%, and attendance at exercise sessions averaged 62%±28%. After 12 weeks, 69% of participants experienced a remission of MDD based on the SCID. Mean BDI-II scores decreased from 31.9±9.1 to 13.1±10.1 [Cohen d effect size (ES)=1.96]. Improvements were observed in upper (ES=0.64) and lower (ES=0.32) body muscular endurance. Exercise session attendance was moderately correlated with changes in BDI-II scores (Pearson r=0.49). It appears feasible to attract and engage some youth with MDD in an exercise intervention. The positive impact on depression symptoms justifies further studies employing exercise interventions as an adjunct to routine care for young people with MDD.

Intensity of Physical Activity and Depressive Symptoms in College Students: Fitness Improvement Tactics in Youth (FITYou) Project

Purpose

To investigate whether the physical activity at different intensities is correlated with depressive symptoms in college students.

Patient and Methods

This cross-sectional study was a part of the Fitness Improvement Tactics in Youth Project, which was conducted in 2017. A total of 2,820 college freshmen aged 15-24 years were included in this study, of whom 699 (24.8%) were males and 2,121 (75.2%) were females. Depressive symptoms were measured using the Self-rating Depression Scale. Physical activity was assessed using the International Physical Activity Questionnaire-Short Form. Covariates included sociodemographic, lifestyle-related, and health-related factors.

Results

A total of 560 (19.9%) college students had depressive symptoms. Total physical activity levels (METs•hour/week) were positively associated with frequency of breakfast intake (p = 0.050) but no other participant characteristics. Logistic regression analysis showed that the prevalence of depressive symptoms in the highest quartile of physical activity was lower than in the lowest quartile when adjusted for sex, age, ethnicity, only child, smoking status, alcohol use, breakfast frequency, daily sleep duration, body mass index, grip strength, and the number of metabolic syndrome components (odds ratios [95% confidence intervals (CI)]: 0.75 [0.58, 0.98], p = 0.036). Furthermore, high physical activity levels of low-intensity tended to moderately correlate to lower prevalence of depressive symptoms (odds ratios [95% CI]: Q1, 0.71 [0.55, 0.91], Q2, 0.77 [0.59, 1.01], Q3, 0.75 [0.57, 0.98], p for trend = 0.037). Associations of moderate and vigorous physical activity with depressive symptoms were not found. For secondary outcomes, sex-stratified analysis showed that similar findings were only found in females, but not males.

Conclusion

This study indicated that total physical activity and low-intensity physical activity were inversely associated with depressive symptoms in Chinese college students. All these observations showed gender differences.

Exercise, brain plasticity, and depression

Depression is a common mental disorder characterized by high incidence, high disability, and high fatality, causing great burden to the society, families, and individuals. The changes in brain plasticity may be a main reason for depression. Recent studies have shown that exercise plays a positive role in depression, but systematic and comprehensive studies are lacking on brain plasticity changes in depression. To further understand the antidepressive effect of exercise and the changes in brain plasticity, we retrieved related literatures using key words "depression," "depressive disorder," "exercise," "brain plasticity," "brain structure," and "brain function" from the database of Web of Science, PubMed, EBSCO host, and CNKI, hoping to provide evidence for exercise in preventing and treating depression. Increase in exercise has been found negatively correlated with the risk of depression. Randomized controlled experiments have shown that aerobic exercise, resistance exercise, and mind-body exercise can improve depressive symptoms and levels. The intensity and long-term effect of exercise are now topical research issues. Exercise has been proven to reshape the brain structure of depression patients, activate the function of related brain areas, promote behavioral adaptation changes, and maintain the integrity of hippocampal and white matter volume, thus improving the brain neuroprocessing and delaying cognitive degradation in depression patients. Future studies are urgently needed to establish accurate exercise prescriptions for improving depressive symptoms, and studies on different depressive populations and studies using multimodal brain imaging combined with multiple analytical methods are also needed.

A controlled clinical crossover trial of exercise training to improve cognition and neural communication in pediatric brain tumor survivors

OBJECTIVE

To assess the efficacy of aerobic exercise training to improve controlled attention, information processing speed and neural communication during increasing task load and rest in pediatric brain tumor survivors (PBTS) treated with cranial radiation.

METHODS

Participants completed visual-motor Go and Go/No-Go tasks during magnetoencephalography recording prior to and following the completion of 12-weeks of exercise training. Exercise-related changes in response accuracy and visual-motor latency were evaluated with Linear Mixed models. The Phase Lag Index (PLI) was used to estimate functional connectivity during task performance and rest. Changes in PLI values after exercise training were assessed using Partial Least Squares analysis.

RESULTS

Exercise training predicted sustained (12-weeks) improvement in response accuracy (p<0.05) during No-Go trials. Altered functional connectivity was detected in theta (4-7Hz) alpha (8-12Hz) and high gamma (60-100Hz) frequency bands (p<0.001) during Go and Go/No-Go trials. Significant changes in response latency and resting state connectivity were not detected.

CONCLUSION

These findings support the efficacy of aerobic exercise to improve controlled attention and enhance functional mechanisms under increasing task load in participants.

SIGNIFICANCE

It may be possible to harness the beneficial effects of exercise as therapy to promote cognitive recovery and enhance brain function in PBTS.

Associations of depression severity with heart rate and heart rate variability in young adults across normative and clinical populations

Limitations of current depression treatments may arise from a lack of knowledge about unique psychophysiological processes that contribute to depression across the full range of presentations. This study examined how individual variations in heart rate (HR) and heart rate variability (HRV) are related to depressive symptoms across normative and clinical populations in 152 young adults (aged 18-35 years). Moderating effects of sex and antidepressant medication status were considered. Electrocardiogram data were collected during "vanilla" baseline and in response to positive and negative emotional cues. Linear regressions and repeated-measures mixed models were used to assess the relationships between Beck Depression Inventory-II (BDI-II) scores, sex, antidepressant use, and cardiovascular outcomes. Baseline models yielded significant main effects of BDI-II and sex on HR and significant interactions between antidepressant medication status and BDI-II on HRV outcomes. The main effects of BDI-II and sex on HR were no longer significant after controlling for cardiorespiratory fitness. Participants who denied current antidepressant use (n = 137) exhibited a negative association and participants who endorsed current antidepressant (n = 15) use exhibited a positive association between BDI-II scores and HRV. Emotional reactivity models were largely non-significant with the exception of a significant main effect of antidepressant medication status on high-frequency HRV reactivity. Results indicated antidepressant medication use may moderate the relationship between depression severity and cardiovascular functioning, but this requires replication given the modest proportion of medicated individuals in this study. Overall, findings suggest cardiovascular processes and cardiorespiratory fitness are linked to depression symptomatology and may be important to consider in depression treatment.

Lower resting cardiac autonomic balance in young adults with current major depression

Research on cardiac autonomic function in major depressive disorder (MDD) has predominantly examined cardiac vagal control and adopted a model of reciprocal autonomic balance. A proposed bivariate autonomic continuum uses cardiac autonomic balance (CAB) and cardiac autonomic regulation (CAR) models, derived from normalized values of respiratory sinus arrhythmia and pre-ejection period, to more adequately index patterns of autonomic control. The purpose of this study was to assess resting levels of CAB and CAR among young adults with and without a current diagnosis of major depression. One hundred forty-two young adults (n = 65 MDD, n = 77 healthy controls; 20.8 ± 2.6 years) completed a structured diagnostic interview, cardiovascular assessment, and a maximal aerobic fitness test. The findings revealed that CAB, but not CAR, significantly predicted current MDD status (OR = 0.70, 95% CI [0.53, 0.93]), an effect that remained after controlling for aerobic fitness and body mass index. Although CAB was found to be a significant predictor of current MDD status among a sample of young adults, there remained substantial variation in autonomic control that was not captured by the traditional model of reciprocal autonomic balance.

Non-pharmacological motor-cognitive treatment to improve the mental health of elderly adults

OBJECTIVE

To propose a program of physical-cognitive dual task and to measure its impact in Chilean institutionalized elderly adults.

METHOD

Experimental design study with pre and post-intervention evaluations, measuring the cognitive and depressive levels by means of the Pfeiffer test and the Yesavage scale, respectively. The program was applied for 12 weeks to adults between 68 and 90 years old. The statistical analysis was based on the nonparametric Wilcoxon test for paired samples and was contrasted with its parametric version. The statistical software R was used.

RESULTS

Statistically significant differences were obtained in the cognitive level (p-value < 0.05) and highly significant (p-value < 0.001) in the level of depression with both tests (parametric and nonparametric).

CONCLUSION

Due to the almost null evidence of scientific interventions of programs that integrate physical activity and cognitive tasks together in Chilean elderly adults, a program of physical-cognitive dual task was proposed as a non-pharmacological treatment, easy to apply and of low cost to benefit their integral health, which improves significantly the cognitive and depressive levels of institutionalized elderly adults.

Tibiofemoral Joint Forces in Female Recreational Runners Vary with Step Frequency

PURPOSE

Elevated tibiofemoral joint (TFJ) contact forces have been linked to the development and progression of knee osteoarthritis. The primary objective of this study was to determine the association between peak TFJ shear and compression forces during running at different self-selected step frequencies (SF) in female recreational runners.

METHODS

Fifty-five healthy female recreational runners ran at 2.98 m·s on an instrumented treadmill. Peak TFJ anterior shear force, peak axial TFJ compression force, and peak medial compartment TFJ compression force were estimated using a musculoskeletal model with inputs from 3D joint kinematics and inverse dynamics calculations. Three SF groups were generated using tertiles, and differences between the groups were compared using one-way ANOVA (α = 0.05).

RESULTS

Runners with an SF of ≥178 steps per minute demonstrated the lowest peak TFJ anterior shear force (P = 0.04), peak axial TFJ compression force (P = 0.01), and peak TFJ medial compartment compression forces (P = 0.01) compared with runners using lower SF.

CONCLUSION

Female recreational runners with low SF of ≤166 steps per minute experience greater TFJ contact forces. This study provides evidence of an association between SF and both shear and axial peak TFJ contact forces during running.