***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Depression and osteoporotic fractures are common ailments among elderly persons .  Selective serotonin reuptake inhibitors ( SSRIs ) are frequently used in the treatment of depression in this population , and the association between daily SSRI use and fragility fractures is unclear . Our objective was to examine the effect of daily SSRI use on the risk of incident clinical fragility fracture . METHODS A population -based , r and omly selected , prospect i ve cohort study of 5008 community-dwelling adults 50 years and older , followed up over 5 years for incident fractures . Clinical fragility fractures were classified as minimal trauma fractures that were clinical ly reported and radiographically confirmed . The risk of fragility fracture associated with daily SSRI use was determined while controlling for relevant covariates . RESULTS Daily SSRI use was reported by 137 subjects . After adjustment for many potential covariates , daily SSRI use was associated with substantially increased risk of incident clinical fragility fracture ( hazard rate , 2.1 ; 95 % confidence interval , 1.3 - 3.4 ) . Daily SSRI use was also associated with increased odds of falling ( odds ratio , 2.2 ; 95 % confidence interval , 1.4 - 3.5 ) , lower bone mineral density at the hip , and a trend toward lower bone mineral density at the spine . These effects were dose dependent and were similar for those who reported taking SSRIs at baseline and at 5 years ' follow-up . CONCLUSIONS Daily SSRI use in adults 50 years and older remained associated with a 2-fold increased risk of clinical fragility fracture after adjustment for potential covariates . Depression and fragility fractures are common in this age group , and the elevated risk attributed to daily SSRI use may have important public health consequences Background Depression is a disabling , prevalent condition . Physical activity programs may assist depression management in older people , ameliorate co-morbid conditions and reduce the need for antidepressants . The UPLIFT pilot study assessed the feasibility of older depressed people attending a community-based progressive resistance training ( PRT ) program .  The study also aim ed to determine whether PRT improves depressive status in older depressed patients . Methods A r and omised controlled trial was conducted . People aged ≥ 65 years with depressive symptoms were recruited via general practice s. Following baseline assessment , subjects were r and omly allocated to attend a local PRT program three times per week for 10 weeks or a brief advice control group . Follow-up assessment of depressive status , physical and psychological health , functional and quality of life status occurred post intervention and at six months . Results Three hundred and forty six people responded to the study invitation , of whom 22 % had depressive symptoms ( Geriatric Depression Scale , GDS-30 score ≥ 11 ) . Thirty two people entered the trial . There were no significant group differences on the GDS at follow-up . At six months there was a trend for the PRT intervention group to have lower GDS scores than the comparison group , but this finding did not reach significance ( p = 0.08 ) . More of the PRT group ( 57 % ) had a reduction in depressive symptoms post program , compared to 44 % of the control group . It was not possible to discern which specific components of the program influenced its impact , but in post hoc analyses , improvement in depressive status appeared to be associated with the number of exercise sessions completed ( r = -0.8 , p < 0.01 ) . Conclusion The UPLIFT pilot study confirmed that older people with depression can be successfully recruited to a community based PRT program . The program can be offered by existing community-based facilities , enabling its ongoing implementation for the potential benefit of other older people BACKGROUND Although exercise has been shown to relieve depression , little is known about its mechanism or dose-response characteristics . We hypothesized that high intensity progressive resistance training ( PRT ) would be more effective than either low intensity PRT or st and ard care by a general practitioner ( GP ) in depressed elderly persons , and that high intensity PRT would provide superior benefits in quality of life , sleep quality , and self-efficacy . METHODS Sixty community-dwelling adults > 60 years with major or minor depression were r and omized to supervised high intensity PRT ( 80 % maximum load ) or low intensity PRT ( 20 % maximum load ) 3 days per week for 8 weeks , or GP care . RESULTS A 50 % reduction in the Hamilton Rating Scale of Depression score was achieved in 61 % of the high intensity , 29 % of the low intensity , and 21 % of the GP care group ( p = .03 ) . Strength gain was directly associated with reduction in depressive symptoms ( r = 0.40 , p = .004 ) , as was baseline social support network type ( F = 3.52 , p = .015 ) , whereas personality type , self-efficacy , and locus of control were unrelated to the antidepressant effect . Vitality quality -of-life scale improved more in the high intensity group than in the others ( p = .04 ) . Sleep quality improved significantly in all participants ( p < .0001 ) , with the greatest relative change in high intensity PRT ( p = .05 ) . CONCLUSIONS High intensity PRT is more effective than is low intensity PRT or GP care for the treatment of older depressed patients We examined the effects of two physical activity modes on depressive symptoms over a 5-year period among older adults and change in physical self-esteem as a mediator of changes in depressive symptoms . Formerly sedentary , older adults ( N = 174 ) were r and omly assigned into 6-month conditions of either walking or low-intensity resistance/flexibility training .  Depressive symptoms and physical self-esteem were measured before and after the 6-month intervention , and 12 and 60 months after intervention initiation . Depressive symptoms scores were decreased immediately after the intervention , followed by a sustained reduction for 12 and 60 months after intervention initiation ; there was no differential pattern of change between the physical activity modes . Change in physical self-esteem predicted change in depressive symptoms . This study supports the effectiveness of an exercise intervention for the sustained reduction of depressive symptoms among sedentary older adults and physical self-esteem as a potential mediator of this effect Purpose of review This review highlights recent work evaluating the relationship between exercise , physical activity and physical and mental health . Both cross-sectional and longitudinal studies , as well as r and omized clinical trials , are included . Special attention is given to physical conditions , including obesity , cancer , cardiovascular disease and sexual dysfunction . Furthermore , studies relating physical activity to depression and other mood states are review ed . The studies include diverse ethnic population s , including men and women , as well as several age groups ( e.g. adolescents , middle-aged and older adults ) . Recent findings Results of the studies continue to support a growing literature suggesting that exercise , physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes . Generally , participants engaging in regular physical activity display more desirable health outcomes across a variety of physical conditions . Similarly , participants in r and omized clinical trials of physical-activity interventions show better health outcomes , including better general and health-related quality of life , better functional capacity and better mood states . Summary The studies have several implication s for clinical practice and research . Most work suggests that exercise and physical activity are associated with better quality of life and health outcomes . Therefore , assessment and promotion of exercise and physical activity may be beneficial in achieving desired benefits across several population s. Several limitations were noted , particularly in research involving r and omized clinical trials . These trials tend to involve limited sample sizes with short follow-up periods , thus limiting the clinical implication s of the benefits associated with physical activity . Abbreviations CAD : coronary artery disease ; COPD : chronic obstructive pulmonary disease ; CRP : cardiac rehabilitation program ; CVD : cardiovascular disease ; GMCB : group-mediated cognitive – behavioural ; HRQOL : health-related quality of life BACKGROUND Previous observational and interventional studies have suggested that regular physical exercise may be associated with reduced symptoms of depression . However , the extent to which exercise training may reduce depressive symptoms in older patients with major depressive disorder ( MDD ) has not been systematic ally evaluated . OBJECTIVE To assess the effectiveness of an aerobic exercise program compared with st and ard medication ( ie , antidepressants ) for treatment of MDD in older patients , we conducted a 16-week r and omized controlled trial . METHODS One hundred fifty-six men and women with MDD ( age , > or = 50 years ) were assigned r and omly to a program of aerobic exercise , antidepressants ( sertraline hydrochloride ) , or combined exercise and medication . Subjects underwent comprehensive evaluations of depression , including the presence and severity of MDD using Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria and Hamilton Rating Scale for Depression ( HAM-D ) and Beck Depression Inventory ( BDI ) scores before and after treatment . Secondary outcome measures included aerobic capacity , life satisfaction , self-esteem , anxiety , and dysfunctional cognitions . RESULTS After 16 weeks of treatment , the groups did not differ statistically on HAM-D or BDI scores ( P = .67 ) ; adjustment for baseline levels of depression yielded an essentially identical result . Growth curve models revealed that all groups exhibited statistically and clinical ly significant reductions on HAM-D and BDI scores . However , patients receiving medication alone exhibited the fastest initial response ; among patients receiving combination therapy , those with less severe depressive symptoms initially showed a more rapid response than those with initially more severe depressive symptoms . CONCLUSIONS An exercise training program may be considered an alternative to antidepressants for treatment of  depression in older persons . Although antidepressants may facilitate a more rapid initial therapeutic response than exercise , after 16 weeks of treatment exercise was equally effective in reducing depression among patients with MDD PURPOSE This study was design ed to determine if a single bout of moderate-intensity aerobic exercise would improve mood and well-being in 40 ( 15 male , 25 female ) individuals who were receiving treatment for major depressive disorder ( MDD ) . METHODS All participants were r and omly assigned to exercise at 60 - 70 % of age-predicted maximal heart rate for 30 min or to a 30-min period of quiet rest . Participants completed both the Profile of Mood States ( POMS ) and Subjective Exercise Experiences Scale ( SEES ) as indicators of mood 5 min before , and 5 , 30 , and 60 min following their experimental condition . RESULTS Both groups reported similar reductions in measures of psychological distress , depression , confusion , fatigue , tension , and anger . Only the exercise group , however , reported a significant increase in positive well-being and vigor scores . CONCLUSION Although 30 min of either moderate-intensity treadmill exercise or quiet rest is sufficient to improve the mood and well-being of patients with MDD , exercise appears to have a greater effect on the positively valenced states measured Abstract : A r and omised controlled trial was conducted to determine whether a 12–month program of group exercise had beneficial effects on physiological and cognitive functioning and mood in 187 older community – dwelling women . The  exercisers ( n= 94 ) and controls ( n= 93 ) were well matched in terms of the test measures and a number of health and life – style assessment s. The mean number of classes attended by the 71 exercise subjects who completed the program was 59.0 ( range 26 to 82 ) . At the end of the trial , the exercisers showed significant improvements in reaction time , strength , memory span and measures of wellbeing when compared with the controls . There was also an indication that anxiety had been reduced in the exercisers . Within the exercise group , improvements in memory span were associated with concomitant improvements in both reaction time and muscle strength . Also , within this group , initial mood measures were significantly inversely associated with improvements at retest , which suggests that the program may have normalised mood states in subjects who had high initial depression , anxiety and stress levels , rather than inducing improvements in all subjects . These findings suggest that group exercise has beneficial effects on physiological and cognitive functioning and wellbeing in older people OBJECTIVES This report released findings of a r and omized controlled trial conducted in Hong Kong to further our underst and ing of the psychosocial effects of qigong on elderly persons with depression . DESIGN Eighty-two participants with a diagnosis of depression or obvious features of depression were recruited and r and omly assigned into the intervention and comparison group . The intervention group was given a 16-week period of Qigong practice while the comparison group participated in a newspaper reading group with same duration and frequency . RESULTS After eight weeks of qigong practice , the intervention group participants outstripped themselves in improvement in mood , self-efficacy and personal well being , and physical and social domains of self-concept when compared with comparison subjects . After 16 weeks of practice , the improvement generalized to the daily task domain of the self-concept . CONCLUSIONS This report shows that regular qigong practice could relieve depression , improve self-efficacy and personal well being among elderly persons with chronic physical illness and depression In this article , we examined the antidepressant influence of an 8-week-long aerobic exercise intervention in which two training parameters were manipulated : exercise frequency and group environment . Twenty-three individuals with elevated symptoms of depression were recruited in a sport and fitness facility and agreed to participate in this 8-week study . They were r and omly assigned to three groups : ( a ) low-frequency exercise ( control ) ( n = 7 ) , ( b ) high-frequency exercise ( n = 8) , and ( c ) high-frequency exercise + group-based intervention ( n = 8) . Participants completed the Beck Depression Inventory ( BDI-II ) at study entry , and at 4 and 8 weeks subsequently . The results showed that those in the high-frequency aerob 
    Output:
    
Medium- to long-term effects of intervention were less clear .
Conclusion : Physical exercise programmes obtain clinical ly relevant outcomes in the treatment of depressive symptoms in depressed older people .
Exercise , though not appropriate for all in this population , may improve mood in this group .