Abbas Aslam
Mini CAT:
Clinical Scenario: 14 y/o female comes in with her mother for her regular physical. Patient has been taking SSRIs for her depressive symptoms and mother is concerned that she still stays home all day and doesn’t want to leave her room. She asks today if there is anything else she can implement to help with her daughter’s depression.
Search Question: In children diagnosed with depression, does regular exercise compared to no regular exercise or standard care without exercise, reduce symptoms of depression?
Question Type: What kind of question is this? (boxes now checkable in Word)
☐Prevalence ☐Screening ☐Diagnosis
☐Prognosis ☒Treatment ☐Harms
Assuming that the highest level of evidence to answer your question will be meta-analysis or systematic review, what other types of study might you include if these are not available (or if there is a much more current study of another type)?
Please explain your choices.
Other studies that I can use would be randomized control trials or cohort studies. Cohort studies would be able to tell me after looking at a group of individuals who had depression and implemented exercise in their routine, whether this had helped with their symptoms. RCTs likewise would also be able to help.
| P | I | C | O |
| Children | Exercise | Standard care | Depression |
| Young adults | Physical activity | Sedentary activity | Mood |
| Pediatric | Energy | ||
Pubmed
Young adults AND Exercise AND Depression→359
Filters: Free Full text, Meta-Analysis, Systemic Review, RCT, last 10 years→ Since 2014→156
Cochrane
Young adults AND Exercise AND Depression→10
Filters: Since 2014→3
Science Direct
Children AND Exercise AND Depression→2,874
FIlters:Since 2024→86
Based on my search terms, a lot of results had come up showing that this was a well researched topic. After reading the titles I was able to determine that the majority of the articles did not directly relate to my question.
Article 1:
| Citation:Li J, Zhou X, Huang Z, Shao T. Effect of exercise intervention on depression in children and adolescents: a systematic review and network meta-analysis. BMC Public Health. 2023 Oct 4;23(1):1918. doi: 10.1186/s12889-023-16824-z. PMID: 37794338; PMCID: PMC10552327. |
| Type of article: A systematic review and network meta-analysis |
| Abstract:Background:To evaluate the effect of different exercise interventions on depressive symptoms in children and adolescents.Materials and Methods:Randomized controlled trials (RCT) published until May 2023 were screened in four databases. The Cochrane collaboration tool was used to assess the risk of bias for quality evaluation. Stata 16.0 software was used for both a pairwise meta-analysis and a series of frequentist network meta-analyses (NMA).Results:A total of 35 RCTs and 5393 participants were included. Aerobic exercise had the most significant effect on depressive symptoms (66.2%), followed by group training (62.5%), resistance exercise (59.0%), and aerobic combined with resistance exercise (57.9%). Furthermore, children and adolescents younger than 15 years showed significant improvement in depressive symptoms (SMD=-0.41, 95% CI (-0.63, -0.19), P < 0.01). The study also found a significant improvement in depression among healthy, obesity, and depressed populations (SMD=-0.25, 95% CI (-0.41, -0.08), P < 0.01); SMD=-0.15, 95% CI (-0.31, -0.00), P < 0.01; SMD=-0.75, 95% CI (-1.32, -0.19), P < 0.01). Additionally, 30 min of exercise had a significant effect (SMD=-0.14, 95% CI (-0,81, -0.01), P < 0.01), and 40-50 min of exercise had the best effect (SMD=-0.17, 95% CI (-0,33, -0.02), P < 0.01). Lastly, exercise frequency of three times per week was significant in children and adolescents (SMD=-0.42, 95% CI (-0,66, -0.18), P < 0.01).Conclusion: Exercise significantly improves depressive symptoms in children and adolescents, with aerobic exercise having the most significant effect. A 12-week, three-times-a-week, 40-50-minute exercise intervention was found to be more effective in younger children and adolescents. |
| Why I chose it: I choose this article as it was a systematic review and meta analysis which helps provide the highest level of evidence. This also directly answers my PICO and qunatifies the amount of exercise that each person was subjected to do. This may be beneficial when looking at other articles and seeing what amount of exercise is most beneficial. |
Article 2
| Citation:Wang X, Cai ZD, Jiang WT, Fang YY, Sun WX, Wang X. Systematic review and meta-analysis of the effects of exercise on depression in adolescents. Child Adolesc Psychiatry Ment Health. 2022 Feb 28;16(1):16. doi: 10.1186/s13034-022-00453-2. PMID: 35227300; PMCID: PMC8886903. |
| Type of article: Systematic review and meta-analysis |
| AbstractBackground:Depression is widespread among adolescents and seriously endangers their quality of life and academic performance. Developing strategies for adolescent depression has important public health implications. No systematic review on the effectiveness of physical exercise for adolescents aged 12-18 years with depression or depressive symptoms has previously been conducted. This study aims to systematically evaluate the effect of physical exercise on adolescent depression in the hope of developing optimum physical exercise programs.Materials and Methods:Nine major databases at home and abroad were searched to retrieve randomized controlled trials (RCTs) on exercise interventions among adolescents with depression or depressive symptoms. The retrieval period started from the founding date of each database to May 1, 2021. The methodological quality of the included articles was evaluated using the modified PEDro scale. A meta-analysis, subgroup analysis, sensitivity analysis, and publication bias tests were then conducted.Results: Fifteen articles, involving 19 comparisons, with a sample size of 1331, were included. Physical exercise significantly reduced adolescent depression (standardized mean difference [SMD] = – 0.64, 95% CI – 0.89, – 0.39, p < 0.01), with a moderate effect size, in both adolescents with depression (SMD = -0.57, 95% CI – 0.90, – 0.23, p < 0.01) and adolescents with depressive symptoms (SMD = – 0.67, 95% CI – 1.00, – 0.33, p < 0.01). In subgroups of different depression categories (depression or depressive symptoms), aerobic exercise was the main form of exercise for the treatment of adolescents with depression. For adolescents with depression, interventions lasting 6 weeks, 30 min/time, and 4 times/week had optimum results. The effects of aerobic exercise and resistance + aerobic exercise in the subgroup of adolescents with depressive symptoms were significant, while the effect of physical and mental exercise (yoga) was not significant. For adolescents with depressive symptoms, aerobic exercise lasting 8 weeks, 75-120 min/time, and 3 times/week had optimum results. Physical exercise with moderate intensity is a better choice for adolescents with depression and depressive symptoms.Conclusion:Physical exercise has a positive effect on the improvement of depression in adolescents. |
| Why I chose it: I choose this article also because it was a systematic review and meta analysis that looks at adolescents with depression and whether phsycial activity is beneficial for them. This also directly answers my question and provides high level of evidence towards my research. This also quantifies the amount of exercise done by the students to help better answer my overall question. |
Article 3
| Citation:Wegner M, Amatriain-Fernández S, Kaulitzky A, Murillo-Rodriguez E, Machado S, Budde H. Systematic Review of Meta-Analyses: Exercise Effects on Depression in Children and Adolescents. Front Psychiatry. 2020 Mar 6;11:81. doi: 10.3389/fpsyt.2020.00081. PMID: 32210847; PMCID: PMC7068196. |
| Type of article: Systematic Review of Meta-Analyses |
| AbstractBackground:Depression is a common threat to children and adolescents in terms of affecting psychosocial development and increasing their risk of suicide. Apart from conventional treatments for depression, physical exercise has become a promising alternative. This paper aims to systematically review the existing meta-analyses that focus on the impact of physical exercise on clinical and nonclinical depression in children and adolescents.Materials and Methods: A systematic literature search was conducted using PsycINFO, PsycARTICLES, MedLine, PubMed, and hand searching. Risk of bias analysis, effect sizes calculations, and evaluation of the methodological characteristics (AMSTAR 2) were carried out.Results: Four meta-analyses met the inclusion criteria. After analysing the overlap, the total sample contained 30 single studies (mostly including gender mixed samples) and 2,110 participants (age range 5-20 years). The medium duration of the interventions was 11.5 weeks. The sessions had a medium length of 41 min, and the frequency of implementation was three sessions per week. The most implemented intervention type was aerobic exercise, while control groups mainly continued with their regular routine, among other related options. The overall mean effect of physical exercise on depression was medium (d = -0.50). The additional analysis in clinically depressed samples documented a small to medium mean effect (d = -0.48) in favor of the intervention.Conclusion:The small to medium but consistently positive effects that were found in the present study place physical exercise as a promising and helpful alternative for children and adolescents with clinical and nonclinical depression. The limited literature focused on children and adolescents in comparison with adult samples points to the need for further research. |
| Why I chose it: This was also providing the highest level of evidence as it was a systematic review and meta analysis, but compared to the other articles this review looked at different amounts of exercise and compared which amount was most beneficial for the subjects. This allows me to better answer my question overall. |
Article 4
| Citation:Recchia F, Bernal JDK, Fong DY, Wong SHS, Chung PK, Chan DKC, Capio CM, Yu CCW, Wong SWS, Sit CHP, Chen YJ, Thompson WR, Siu PM. Physical Activity Interventions to Alleviate Depressive Symptoms in Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatr. 2023 Feb 1;177(2):132-140. doi: 10.1001/jamapediatrics.2022.5090. PMID: 36595284; PMCID: PMC9857695. |
| Type of article: A Systematic Review and Meta-analysis |
| AbstractBackground: Depression is the second most prevalent mental disorder among children and adolescents, yet only a small proportion seek or receive disorder-specific treatment. Physical activity interventions hold promise as an alternative or adjunctive approach to clinical treatment for depression.Materials and Methods: PubMed, CINAHL, PsycINFO, EMBASE, and SPORTDiscus were searched from inception to February 2022 for relevant studies written in English, Chinese, or Italian.Results:Twenty-one studies involving 2441 participants (1148 [47.0%] boys; 1293 [53.0%] girls; mean [SD] age, 14 [3] years) were included. Meta-analysis of the postintervention differences revealed that physical activity interventions were associated with a reduction in depressive symptoms compared with the control condition (g = -0.29; 95% CI, -0.47 to -0.10; P = .004). Analysis of the follow-up outcomes in 4 studies revealed no differences between the physical activity and control groups (g = -0.39; 95% CI, -1.01 to 0.24; P = .14). Moderate study heterogeneity was detected (Q = 53.92; df = 20; P < .001; I2 = 62.9% [95% CI, 40.7%-76.8%]). The primary moderator analysis accounting for total physical activity volume, study design, participant health status, and allocation and/or assessment concealment did not moderate the main treatment effect. Secondary analyses demonstrated that intervention (ie, <12 weeks in duration, 3 times per week, unsupervised) and participant characteristics (ie, aged ≥13 years, with a mental illness and/or depression diagnosis) may influence the overall treatment effect.Conclusion: Physical activity interventions may be used to reduce depressive symptoms in children and adolescents. Greater reductions in depressive symptoms were derived from participants older than 13 years and with a mental illness and/or depression diagnosis. The association with physical activity parameters such as frequency, duration, and supervision of the sessions remains unclear and needs further investigation. |
| Why I chose it: I choose this article because it provided me with high level evidence and also directly answers my question regarding whether exercise is beneficial for depressive symptoms in children. This article also includes which patient population seemed to get the most benefit from the exercise aswell which also allows me to better answer my question. |
Article 5
| Citation:Carter T, Morres ID, Meade O, Callaghan P. The Effect of Exercise on Depressive Symptoms in Adolescents: A Systematic Review and Meta-Analysis. J Am Acad Child Adolesc Psychiatry. 2016 Jul;55(7):580-90. doi: 10.1016/j.jaac.2016.04.016. Epub 2016 May 10. PMID: 27343885. |
| Type of article: A Systematic Review and Meta-Analysis |
| AbstractBackground: Materials and Methods: A systematic search of 7 electronic databases identified relevant randomized controlled trials. Following removal of duplicates, 543 texts were screened for eligibility. Screening, data extraction, and trial methodological quality assessment (using the Delphi list) were undertaken by 2 independent researchers. Standardized mean differences were used for pooling postintervention depressive symptom scores.Results:Eleven trials met the inclusion criteria, 8 of which provided the necessary data for calculation of standardized effect size. Exercise showed a statistically significant moderate overall effect on depressive symptom reduction (standardized mean difference [SMD] = −0.48, 95% CI = −0.87, −0.10, p = .01, I2 = 67%). Among trials with higher methodological scoring, a nonsignificant moderate effect was recorded (SMD = −0.41, 95% CI = −0.86, 0.05, p = .08). In trials with exclusively clinical samples, exercise showed a statistically significant moderate effect on depressive symptoms with lower levels of heterogeneity (SMD = −0.43, 95% CI = −0.84, −0.02, p = .04, I2 = 44%).Conclusion:Physical exercise appears to improve depressive symptoms in adolescents, especially in clinical samples in which the moderate antidepressant effect, higher methodological quality, and lowered statistical heterogeneity suggest that exercise may be a useful treatment strategy for depression. Larger trials with clinical samples that adequately minimize the risk of bias are required for firmer conclusions on the effectiveness of exercise as an antidepressant treatment. |
| Why I chose it: My last article also provides me with the highest level of evidence as it is a systematic review and meta analysis. It keys into the teenage population which is most commonly diagnosed with depression, which provides me with benfiical evidence for my question. |
Summary of the Evidence:
| Author (Date) | Level of Evidence | Sample/Setting (# of subjects/ studies, cohort definition etc) | Outcome(s) studied | Key Findings | Limitations and Biases |
| Li J, Zhou X, Huang Z, Shao T(2023) | A systematic review and network meta-analysis | -Scopus, PubMed, Web of Science, and APA PsycInfo up to the 30th of May 2023- A total of 35 RCTs and 5393 participants were included. | The primary outcome was evaluated using a validated depression rating scale to measure depressive symptoms at the conclusion of the intervention period and at the most recent follow-up visit. | – In the present study, an exercise intervention of 40-50 minutes per day, 2-3 times per week, was found to be the most effective in improving negative mood in children.-An aerobic exercise intervention lasting up to 12 months increased hippocampal volume by approximately 2%. However, after stopping the training, subjects’ hippocampal volume returned to baseline levels. | -Limitations included possible exclusion of studies using different keywords or published in other languages.-Outcome measurement bias because of reliance on self-reported outcomes, potentially affecting the accuracy and reliability of findings. |
| Wang X, Cai ZD, Jiang WT, Fang YY, Sun WX, Wang X(2022) | Systematic review and meta-analysis | -PubMed, Web of Science, The Cochrane Library, Embase, MEDLINE, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP database, and Wanfang Database.-Fifteen articles were included, comprising 19 comparisons, with publication years ranging from 1982 to 2017. The total number of participants was 1,331, with individual studies ranging from 24 to 209 participants. The mean age of the participants was 15.90 ± 1.23 years. | -This study aims to systematically evaluate the impact of physical exercise on adolescent depression, with the goal of developing optimal physical exercise programs. | -Meta-analysis showed a significant reduction in depressive symptoms with a moderate effect size (SMD = −0.64), stable results confirmed by sensitivity analysis, indicating exercise as an effective intervention for adolescent depression and depressive symptoms.-For adolescents with depression, the most effective interventions were those lasting 6 weeks, with sessions of 30 minutes each, conducted 4 times per week. Aerobic exercise and resistance combined with aerobic exercise significantly reduced depressive symptoms, while physical and mental exercises like yoga did not show significant effects.-For adolescents with depressive symptoms, the optimal results were achieved with aerobic exercise programs lasting 8 weeks, with sessions of 75–120 minutes each, conducted 3 times per week. | -Inclusion limited to published articles in Chinese and English, restricting search comprehensiveness.-Incomplete reporting of allocation concealment and blinded outcome assessment.-Reliance on subjective self-reported outcomes, lacking objective evaluations like biomarkers. |
| Wegner M, Amatriain-Fernández S, Kaulitzky A, Murillo-Rodriguez E, Machado S, Budde H(2020) | Systematic Review of Meta-Analyses | -PsycINFO, PsycARTICLES, MedLine, PubMed, and hand searching.-Four meta-analyses met the inclusion criteria. After evaluating the overlap, the total sample comprised 30 individual studies and 2,110 participants, ranging in age from 5 to 20 years. | -The objective of this article is to examine meta-analyses that investigate the impacts of physical exercise on measures of depression in children and adolescents, whether diagnosed clinically or not. | -Meta-analyses indicate a medium effect size (d = -0.50) for exercise alleviating depressive symptoms in children and adolescents, suggesting it is a promising intervention.-Exercise sessions averaged 41 minutes in length, occurring three times per week on average for 11.5 weeks.Aerobic exercise was the predominant intervention type implemented, while control groups primarily adhered to their usual routines or comparable activities. | -The limitations in thee article included methodological issues highlighted by various authors concerning the adequacy of blinding conditions. |
| Recchia F, Bernal JDK, Fong DY, Wong SHS, Chung PK, Chan DKC, Capio CM, Yu CCW, Wong SWS, Sit CHP, Chen YJ, Thompson WR, Siu PM(2023) | A Systematic Review and Meta-analysis | -PubMed, CINAHL, PsycINFO, EMBASE, and SPORTDiscus were searched from inception to February 2022 for relevant studies written in English, Chinese, or Italian.-Twenty-one studies involving 2441 participants were included, with 1148 boys and 1293 girls , and a mean age of 14 years | -To assess the relationship between physical activity interventions and depressive symptoms in children and adolescents. | -A meta-analysis of 21 studies involving 2441 participants [SD = 3]) found that physical activity interventions were associated with a reduction in depressive symptoms compared to control conditions.-Older participants (aged ≥13 years) and those with elevated depressive symptoms at baseline tended to benefit more from physical activity interventions.-Interventions with three sessions per week and durations shorter than 12 weeks showed greater efficacy in reducing depressive symptoms compared to other frequencies and durations. | -The study did not include screening for study quality in its inclusion criteria, potentially allowing less rigorously conducted studies to influence the overall results.-There was a notable lack of complete reporting on participant and trial characteristics, such as blinding of participants and assessors, exercise intensity, type, and supervision level, which had to be inferred, requested from authors, or excluded from analyses. |
| Carter T, Morres ID, Meade O, Callaghan P(2016) | A Systematic Review and Meta-Analysis | -Cochrane Library; MEDLINE; EMBASE; CINAHL; Sportdiscus; AMED, and PsychInfo.-Eleven trials were eligible for inclusion(1,449 participants), with eight trials providing sufficient data for calculating the standardized effect size. | -The aim of this review was to investigate the impact of physical exercise on alleviating depressive symptoms among adolescents aged 13 to 17 years. | -A meta-analysis indicated a statistically significant treatment effect of exercise on depressive symptoms in adolescents (SMD = -0.48), suggesting moderate improvement.Exercise interventions appeared more effective in clinical populations than in general adolescent populations without clinical diagnoses.-Exercise intensity and frequency varied among trials, with group-based supervised aerobic exercises being common, typically conducted three times per week over about 11 weeks. | -It was noted that many trials had small sample sizes and were of low methodological quality.-Childhood and adolescence are characterized by significant biological and psychosocial changes, which could confound the effects of exercise on depressive symptoms. |
Conclusion(s):
Article 1:In children diagnosed with depression, regular exercise demonstrates significant potential in reducing symptoms compared to no regular exercise or standard care without exercise. This meta-analysis highlights the effectiveness of aerobic exercise followed by group-based, resistance, and mind-body exercises in improving depressive symptoms. Sessions lasting 40-50 minutes, three times a week, over 12 weeks appear particularly effective. Despite promising results, the study emphasizes the need for more rigorous randomized controlled trials to confirm these findings and optimize treatment strategies for childhood and adolescent depression.
Article 2:Regular exercise demonstrates significant promise in alleviating symptoms of depression among children diagnosed with the condition, compared to standard care or no regular exercise. This meta-analysis highlights the moderate effectiveness of exercise interventions, particularly aerobic exercise, in reducing depressive symptoms in adolescents. The study recommends structured exercise programs lasting 6-8 weeks, with sessions ranging from 30 to 120 minutes, conducted 3-4 times per week, focusing on moderate intensity. However, further high-quality randomized controlled trials are necessary to confirm and optimize exercise as a viable treatment approach for adolescent depression.
Article 3:Research into physical exercise as a treatment for depression in children and adolescents reveals a promising avenue for intervention. Meta-analyses consistently show moderate improvements in depressive symptoms among both clinical and nonclinical populations following regular exercise. This suggests that structured physical activity could serve as an effective supplementary therapy for youth struggling with depression. However, compared to studies in adults, there is a notable lack of comprehensive research in younger populations, emphasizing the urgent need for more rigorous randomized controlled trials. Addressing methodological challenges, such as blinding and implementing sham conditions, will be crucial to refining and validating exercise interventions tailored to adolescents with depression.
Article 4:This article presents a systematic review and meta-analysis examining the impact of physical activity interventions on depressive symptoms in children and adolescents diagnosed with depression. The findings suggest that structured physical activity, particularly in supervised school settings, significantly reduces depressive symptoms compared to standard care or no regular exercise. This effect was particularly pronounced among older adolescents and those already diagnosed with mental illness or depression. However, optimal parameters such as frequency, duration, and supervision levels of physical activity sessions warrant further investigation to maximize therapeutic benefits. While the exact mechanisms underlying these benefits remain unclear, integrating regular physical activity into treatment plans shows promise in enhancing mental health outcomes for youth with depression.
Article 5:In children diagnosed with depression, regular exercise appears promising for reducing symptoms compared to standard care or no exercise, as indicated by this meta-analysis. The study found a statistically significant moderate effect size (SMD = −0.48) favoring exercise interventions in adolescents. Sensitivity analyses supported this, particularly in clinical populations, where a moderate effect (SMD = −0.43) with lower heterogeneity was consistently observed. Despite some methodological challenges in study quality and reporting, structured, supervised aerobic exercise sessions three times per week for approximately 11 weeks showed potential benefits. Future research should focus on larger, higher-quality trials to confirm optimal exercise parameters and translate findings into clinical practice effectively.
Overarching Conclusion: Based on the overarching conclusions drawn from the five articles, regular exercise demonstrates significant promise in reducing symptoms of depression among children diagnosed with the condition compared to standard care or no regular exercise. Meta-analyses consistently highlight moderate to significant improvements in depressive symptoms, particularly with structured aerobic exercise programs conducted multiple times per week over a duration of 6-12 weeks. Sessions lasting 30-50 minutes are recommended, emphasizing the potential of exercise as a beneficial adjunctive therapy for youth struggling with depression. However, the need for further rigorous randomized controlled trials is underscored to validate these findings and optimize exercise interventions tailored to children and adolescents.
Clinical Bottom Line:
Article 1:This article is a systematic review and network meta-analysis, which provides a high level of evidence by comparing multiple interventions directly and indirectly. It includes a large number of RCTs (35) and participants (5393), and it specifically quantifies the amount and type of exercise, which directly answers my question.
Article 4:Another high-quality systematic review and meta-analysis that examines physical activity interventions and their effect on depressive symptoms in children and adolescents. It also provides detailed analysis regarding intervention duration and frequency, which aligns well with my clinical question.
Article 2:This article is a systematic review and meta-analysis focusing on adolescents aged 12-18. It provides a moderate effect size of physical exercise on depression and discusses optimal exercise programs. It offers valuable insights, although it includes fewer studies (15) and participants (1331) than Article 1, which is why I have it ranked lower.
Article 3:This systematic review of meta-analyses provides a comprehensive overview of existing meta-analyses. Although it covers a wide age range (5-20 years) and provides a medium effect size, it lacks the granularity in terms of exercise type and duration compared to the top-ranked articles I provided.
Article 5:This systematic review and meta-analysis focuses on adolescents and shows a moderate effect of exercise on depressive symptoms. It includes fewer trials (11) and participants, and the data is relatively older. Despite its relevance, the evidence level is slightly lower than the other articles due to the smaller scope and sample size, which is why I have it ranked the lowest.
Magnitude of any effects: All five articles consistently indicate that regular exercise has significant benefits for children and adolescents diagnosed with depression, including improvements in depressive symptoms. They highlight that exercise, particularly aerobic exercise, leads to notable reductions in depressive symptoms. Optimal parameters such as duration, frequency, and type of exercise are provided across the articles, suggesting structured exercise programs should be incorporated into treatment plans for pediatric depression. While the overall evidence supports the positive impact of exercise, further research could refine these parameters and deepen our understanding of exercise’s comparative effectiveness against standard care.
Clinical significance:All five articles consistently support the clinical relevance of exercise in reducing depressive symptoms in children and adolescents, confirming that regular exercise is beneficial compared to no exercise or standard care without exercise. Article 1 by Li et al. (2023) provides the most comprehensive evidence, demonstrating that aerobic exercise significantly reduces depressive symptoms with a standardized mean difference (SMD) of -0.41 and suggests an optimal regimen of 12 weeks, three times a week, 40-50 minutes per session. Article 4 by Recchia et al. (2023) reports a reduction in depressive symptoms with an effect size (g) of -0.29 and highlights that participants older than 13 years and those with a depression diagnosis benefit the most. Article 2 by Wang et al. (2022) identifies specific exercise programs (6 weeks, 30 minutes per session, four times a week) and reports a moderate effect size (SMD = -0.64) in reducing depression. Collectively, these articles advocate for incorporating exercise into treatment plans for pediatric depression, providing valuable insights into practical implementation.
