***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: OBJECTIVE Physical exercise has been consistently documented as a complementary therapy in the treatment of depressive disorders . However , despite a higher prevalence among women compared to men , the trials developed in women are scarce . In addition , the optimal dosage of exercise capable of producing benefits that reduce depressive symptoms remains unclear . This clinical trial is design ed to measure the effect of a structured physical exercise program as a complement to antidepressant medication in the treatment of women with depression . METHODS From July 2013 to May 2014 , we implemented a r and omized controlled trial ( HAPPY BRAIN study ) . A total of 26 women ( aged 50.16 ± 12.08 ) diagnosed with clinical depression were r and omized either to a supervised aerobic exercise group ( 45 - 50 min/week three times a week for four months ) plus pharmacotherapy ( intervention group ) , or only antidepressant medication ( control group ) . RESULTS The exercise group presented a decrease in BDI-II and DASS-21 total score scales . Relatively to DASS-21 , it showed a significant decrease in anxiety and stress . The exercise group when compared to a control group showed improvement in relation to physical functioning parameters between baseline and post-intervention . Moreover , anthropometric parameters presented only significant differences between groups in fat mass percentage . Nonetheless , no differences were found between groups in weight , body mass index , waist circumference , and self-esteem . CONCLUSION Our results showed that supervised structured aerobic exercise training could be an effective adjuvant therapy for treating women with depression , reducing depressive symptomatology and improving physical fitness . A key factor of this improvement included strict control of exercise workload parameters and adjustment to each subject 's capacity . In our study , due to the sample size there is an increase in the probability of type II errors 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 Background Depression is associated with physical inactivity , which may mediate the relationship between depression and a range of chronic physical health conditions . However , few interventions have combined a psychological intervention for depression with behaviour change techniques , such as behavioural activation ( BA ) , to promote increased physical activity . Methods To determine procedural and clinical uncertainties to inform a definitive r and omised controlled trial ( RCT ) , a pilot parallel-group RCT was undertaken within two Improving Access to Psychological Therapies ( IAPT ) services in South West Engl and . We aim ed to recruit 80 adults with depression and r and omise them to a supported , written self-help programme based on either BA or BA plus physical activity promotion ( BAcPAc ) . Data were collected at baseline and 4 months post-r and omisation to evaluate trial retention , intervention uptake and variance in outcomes to inform a sample size calculation . Qualitative data were collected from participants and psychological wellbeing practitioners ( PWPs ) to assess the acceptability and feasibility of the trial methods and the intervention . Routine data were collected to evaluate re source use and cost . Results Sixty people with depression were recruited , and a 73 % follow-up rate was achieved . Accelerometer physical activity data were collected for 64 % of those followed . Twenty participants ( 33 % ) attended at least one treatment appointment . Interview data were analysed for 15 participants and 9 study PWPs . The study highlighted the challenges of conducting an RCT within existing IAPT services with high staff turnover and absences , participant scheduling issues , PWP and participant preferences for cognitive focussed treatment , and deviations from BA delivery protocol s. The BAcPAc intervention was generally acceptable to patients and PWPs . Conclusions Although recruitment procedures and data collection were challenging , participants generally engaged with the BAcPAc self-help booklets and reported willingness to increase their physical activity . A number of feasibility issues were identified , in particular the under-use of BA as a treatment for depression , the difficulty that PWPs had in adapting their existing procedures for study purpose s and the instability of the IAPT PWP workforce . These problems would need to be better understood and resolved before proceeding to a full-scale RCT .Trial registration IS RCT N74390532 . Registered on 26 March 2013 Correctable weaknesses in the design , conduct , and analysis of biomedical and public health research studies can produce misleading results and waste valuable re sources . Small effects can be difficult to distinguish from bias introduced by study design and analyses . An absence of detailed written protocol s and poor documentation of research is common . Information obtained might not be useful or important , and statistical precision or power is often too low or used in a misleading way . Insufficient consideration might be given to both previous and continuing studies . Arbitrary choice of analyses and an overemphasis on r and om extremes might affect the reported findings . Several problems relate to the research workforce , including failure to involve experienced statisticians and method ologists , failure to train clinical research ers and laboratory scientists in research methods and design , and the involvement of stakeholders with conflicts of interest . Inadequate emphasis is placed on recording of research decisions and on reproducibility of research . Finally , reward systems incentivise quantity more than quality , and novelty more than reliability . We propose potential solutions for these problems , including improvements in protocol s and documentation , consideration of evidence from studies in progress , st and ardisation of research efforts , optimisation and training of an experienced and non-conflicted scientific workforce , and reconsideration of scientific reward systems 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 OBJECTIVE The aim of this study was to examine the effects of an 8-week moderate-intensity aerobic exercise training intervention on cognitive control in individuals with major depressive disorder ( MDD ) . METHODS Participants with a current diagnosis of MDD ( n=30 ; 21.1±2.0years ) were stratified by depressive symptoms and r and omized to an 8-week intervention of aerobic exercise ( AE ) or placebo exercise ( PE ) . AE consisted of three sessions/week of moderate-intensity exercise training while PE consisted of three sessions/week of light-intensity stretching .  Cognitive control was assessed pre- and post-treatment using behavioral performance ( i.e. , reaction time and accuracy ) and event-related potentials ( i.e. , N2 amplitude ) . Depressive symptoms and rumination were also assessed before and after the intervention . RESULTS Compared with PE , the AE treatment arm was associated with an increase in N2 amplitude to incongruent flanker task trials , reflecting an increase in cognitive control processes . Symptoms of depression also decreased after AE although the treatments did not differ in their effects on rumination . Exploratory mediation analysis indicated that changes in N2 amplitude did not mediate pre-to-post treatment reductions in depressive symptoms . CONCLUSIONS An 8-week moderate-intensity AE program is associated with improved neural indices of conflict monitoring and reduced depressive symptoms among individuals with MDD . SIGNIFICANCE Future research examining the influence of exercise in combination with behavioral and pharmacological treatments for neurocognitive function in MDD is warranted Major depression ( MD ) is associated with peripheral inflammation and increased cardiovascular risk . Regular physical exercise can have anti-inflammatory effects . The present study examined whether behavioral activation with exercise  affects inflammatory processes in MD . Ninety-eight patients with MD were r and omly assigned to cognitive-behavioral therapy ( CBT ) emphasizing exercise during behavioral activation ( CBT-E ) , CBT with pleasurable low-energy activities as an active control condition ( CBT-C ) or a passive waiting list control group ( WL )  . Plasma levels of C-reactive protein ( CRP ) , interleukin (IL)-6 , IL-10 , lipopolysaccharide (LPS)-stimulated IL-6 production , and blood immune cell counts were analyzed at baseline and weeks 8 ( post-behavioral activation ) and 16 ( post-treatment ) . Thirty non-depressed age- and sex-matched controls were included to examine potential immunological alterations  in MD at baseline . Patients with MD exhibited higher levels of CRP , higher neutrophil and monocyte counts , lower IL-10 levels and reduced LPS-stimulated IL-6 production compared to controls ( P<0.001−0.045 ) . Multilevel modeling indicated that CBT-E was associated with increased anti-inflammatory IL-10 at weeks 8 and 16 compared to CBT-C and WL ( P=0.004−0.018 ) . CBT-E did not significantly affect other immunological makers in the total sample . A subgroup analysis including patients with potentially higher cardiovascular risk ( CRP ⩾1 μg ml−1 ) indicated that CRP was reduced in CBT-E compared to CBT-C ( P<0.007 ) and marginally reduced compared to WL ( P<0.085 ) after week 16 . The present findings provide new insights into immunological effects of behavioral treatments against depression . Behavioral activation in conjunction with exercise may have the potential to reverse , in part , immunological alterations in MD Objective : To assess whether patients receiving aerobic exercise training  performed either at home or in a supervised group setting achieve reductions in depression comparable to st and ard antidepressant medication ( sertraline ) and greater reductions in depression compared to placebo controls . Methods : Between October 2000 and November 2005 , we performed a prospect i ve , r and omized controlled trial ( SMILE study ) with allocation concealment and blinded outcome assessment in a tertiary care teaching hospital . A total of 202 adults ( 153 women ; 49 men ) diagnosed with major depression were assigned r and omly to one of four conditions : supervised exercise in a group setting ; home-based exercise ; antidepressant medication ( sertraline , 50–200 mg daily ) ; or placebo pill for 16 weeks . Patients underwent the structured clinical interview for depression and completed the Hamilton Depression Rating Scale ( HAM-D ) . Results : After 4 months of treatment , 41 % of the participants achieved remission , defined as no longer meeting the criteria for major depressive disorder ( MDD ) and a HAM-D score of < 8 . Patients receiving active treatments tended to have higher remission rates than the placebo controls : supervised exercise = 45 % ; home-based exercise = 40 % ; medication = 47 % ; placebo = 31 % ( p = .057 ) . All treatment groups had lower HAM-D scores after treatment ; scores for 
    Output:
    
Subgroup analyses found that trial size and intervention duration were inversely associated with effect size for both depression severity and lack of remission .
There was no significant effect of exercise on secondary outcomes .
Trials with less risk of bias suggested no antidepressant effects of exercise and there were no significant effects of exercise on quality of life , depression severity or lack of remission during follow-up .