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Noetel M, Sanders T, Gallardo-Gómez D, Taylor P, Del Pozo Cruz B, van den Hoek D, Smith JJ, Mahoney J, Spathis J, Moresi M, Pagano R, Pagano L, Vasconcellos R, Arnott H, Varley B, Parker P, Biddle S, Lonsdale C. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ 2024; 384:e075847. [PMID: 38355154 PMCID: PMC10870815 DOI: 10.1136/bmj-2023-075847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/16/2024]
Abstract
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.
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Affiliation(s)
- Michael Noetel
- School of Psychology, University of Queensland, St Lucia, QLD 4072, Australia
| | - Taren Sanders
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW, Australia
| | | | - Paul Taylor
- School of Health and Behavioural Sciences, Australian Catholic University, Strathfield, NSW, Australia
| | - Borja Del Pozo Cruz
- Department of Clinical Biomechanics and Sports Science, University of Southern Denmark, Odense, Denmark
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, University of Cádiz, Spain
| | - Daniel van den Hoek
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Petrie, QLD, Australia
| | - Jordan J Smith
- School of Education, University of Newcastle, Callaghan, NSW, Australia
| | - John Mahoney
- School of Health and Behavioural Sciences, Australian Catholic University, Banyo, QLD, Australia
| | - Jemima Spathis
- School of Health and Behavioural Sciences, Australian Catholic University, Banyo, QLD, Australia
| | - Mark Moresi
- School of Health and Behavioural Sciences, Australian Catholic University, Strathfield, NSW, Australia
| | - Rebecca Pagano
- School of Education, Australian Catholic University, Strathfield, NSW, Australia
| | - Lisa Pagano
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Roberta Vasconcellos
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW, Australia
| | - Hugh Arnott
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW, Australia
| | - Benjamin Varley
- Children's Hospital Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Philip Parker
- Australian Catholic University, North Sydney, NSW, Australia
| | - Stuart Biddle
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia
- Faculty of Sport and Health Science, University of Jyvaskyla, Jyvaskyla, Finland
| | - Chris Lonsdale
- Australian Catholic University, North Sydney, NSW, Australia
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Martínez-Calderon J, Casuso-Holgado MJ, Muñoz-Fernandez MJ, Garcia-Muñoz C, Heredia-Rizo AM. Yoga-based interventions may reduce anxiety symptoms in anxiety disorders and depression symptoms in depressive disorders: a systematic review with meta-analysis and meta-regression. Br J Sports Med 2023; 57:1442-1449. [PMID: 37369553 DOI: 10.1136/bjsports-2022-106497] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE To summarise the effect of mind-body exercises on anxiety and depression symptoms in adults with anxiety or depressive disorders. DESIGN Systematic review with meta-analysis and meta-regression. DATA SOURCES Five electronic databases were searched from inception to July 2022. Manual searches were conducted to explore clinical trial protocols, secondary analyses of clinical trials and related systematic reviews. ELIGIBILITY CRITERIA Randomised clinical trials evaluating qigong, tai chi or yoga styles with anxiety or depression symptoms as the outcomes were included. No intervention, waitlist or active controls were considered as control groups. The risk of bias and the certainty of the evidence were assessed. Meta-analyses, meta-regressions and sensitivity analyses were performed. RESULTS 23 studies, comprising 22 different samples (n=1420), were included. Overall, meta-analyses showed yoga interventions were superior to controls in reducing anxiety symptoms in anxiety disorders. Furthermore, yoga-based interventions decreased depression symptoms in depressive disorders after conducting sensitivity analyses. No differences between groups were found in the rest of the comparisons. However, the certainty of the evidence was judged as very low for all outcomes due to concerns of high risk of bias, indirectness of the evidence, inconsistency and imprecision of the results. In addition, there was marked heterogeneity among yoga-based interventions and self-reported tools used to evaluate the outcomes of interest. CONCLUSION Although yoga-based interventions may help to improve mental health in adults diagnosed with anxiety or depressive disorders, methodological improvements are needed to advance the quality of clinical trials in this field. PROSPERO REGISTRATION NUMBER CRD42022347673.
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Affiliation(s)
- Javier Martínez-Calderon
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain
- Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Sevilla, Spain
| | - María Jesús Casuso-Holgado
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain
- Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Sevilla, Spain
| | - Maria Jesus Muñoz-Fernandez
- Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Sevilla, Spain
- Department of Physiotherapy, University School Francisco Maldonado, Sevilla, Spain
| | - Cristina Garcia-Muñoz
- Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Sevilla, Spain
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
| | - Alberto Marcos Heredia-Rizo
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain
- Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Sevilla, Spain
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Hwang DJ, Koo JH, Kim TK, Jang YC, Hyun AH, Yook JS, Yoon CS, Cho JY. Exercise as an antidepressant: exploring its therapeutic potential. Front Psychiatry 2023; 14:1259711. [PMID: 37772067 PMCID: PMC10523322 DOI: 10.3389/fpsyt.2023.1259711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
The COVID-19 pandemic has increased the prevalence of depressive disorders worldwide, requiring alternative treatments beyond medication and psychotherapy. Exercise has positive effects on the brain; therefore, it has emerged as a promising therapeutic option for individuals with depression. Considerable research involving humans and animals offers compelling evidence to support the mental health benefits of physical activity or exercise mediated by the regulation of complex theoretical paradigms. However, challenges such as conducting long-term follow-up assessments and considering individual characteristics remain in human studies despite extensive efforts. While animal studies provide valuable insights into the potential benefits of exercise and its impact on outcomes related to depression and anxiety in rodents exposed to different stress paradigms, translating the findings to humans requires careful evaluation. More research is needed to establish precise exercise prescription guidelines and to better understand the complex relationship between exercise and depressive disorders. Therefore, this concise review explores the evidence supporting exercise intervention as an antidepressant treatment and its underlying mechanisms.
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Affiliation(s)
- Dong-Joo Hwang
- Exercise Biochemistry Laboratory, Korea National Sport University, Seoul, Republic of Korea
- Sport Science Institute, Korea National Sport University, Seoul, Republic of Korea
| | - Jung-Hoon Koo
- Exercise Biochemistry Laboratory, Korea National Sport University, Seoul, Republic of Korea
| | - Tae-Kyung Kim
- Exercise Biochemistry Laboratory, Korea National Sport University, Seoul, Republic of Korea
- Sport Science Institute, Korea National Sport University, Seoul, Republic of Korea
| | - Yong-Chul Jang
- Exercise Biochemistry Laboratory, Korea National Sport University, Seoul, Republic of Korea
| | - Ah-Hyun Hyun
- Exercise Biochemistry Laboratory, Korea National Sport University, Seoul, Republic of Korea
| | - Jang-Soo Yook
- Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea
| | - Chang-Sun Yoon
- Department of Physical Education, Korea National Sport University, Seoul, Republic of Korea
| | - Joon-Yong Cho
- Exercise Biochemistry Laboratory, Korea National Sport University, Seoul, Republic of Korea
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Heissel A, Heinen D, Brokmeier LL, Skarabis N, Kangas M, Vancampfort D, Stubbs B, Firth J, Ward PB, Rosenbaum S, Hallgren M, Schuch F. Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression. Br J Sports Med 2023; 57:1049-1057. [PMID: 36731907 PMCID: PMC10423472 DOI: 10.1136/bjsports-2022-106282] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To estimate the efficacy of exercise on depressive symptoms compared with non-active control groups and to determine the moderating effects of exercise on depression and the presence of publication bias. DESIGN Systematic review and meta-analysis with meta-regression. DATA SOURCES The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, Embase, SPORTDiscus, PsycINFO, Scopus and Web of Science were searched without language restrictions from inception to 13 September2022 (PROSPERO registration no CRD42020210651). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials including participants aged 18 years or older with a diagnosis of major depressive disorder or those with depressive symptoms determined by validated screening measures scoring above the threshold value, investigating the effects of an exercise intervention (aerobic and/or resistance exercise) compared with a non-exercising control group. RESULTS Forty-one studies, comprising 2264 participants post intervention were included in the meta-analysis demonstrating large effects (standardised mean difference (SMD)=-0.946, 95% CI -1.18 to -0.71) favouring exercise interventions which corresponds to the number needed to treat (NNT)=2 (95% CI 1.68 to 2.59). Large effects were found in studies with individuals with major depressive disorder (SMD=-0.998, 95% CI -1.39 to -0.61, k=20), supervised exercise interventions (SMD=-1.026, 95% CI -1.28 to -0.77, k=40) and moderate effects when analyses were restricted to low risk of bias studies (SMD=-0.666, 95% CI -0.99 to -0.34, k=12, NNT=2.8 (95% CI 1.94 to 5.22)). CONCLUSION Exercise is efficacious in treating depression and depressive symptoms and should be offered as an evidence-based treatment option focusing on supervised and group exercise with moderate intensity and aerobic exercise regimes. The small sample sizes of many trials and high heterogeneity in methods should be considered when interpreting the results.
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Affiliation(s)
- Andreas Heissel
- Social and Preventive Medicine, Department of Sports and Health Sciences, Intra faculty unit "Cognitive Sciences", Faculty of Human Science and Faculty of Health Sciences Brandenburg, Research Area Services Research and e-Health, Potsdam, Brandenburg, Germany
| | - Darlene Heinen
- Social and Preventive Medicine, Department of Sports and Health Sciences, Intra faculty unit "Cognitive Sciences", Faculty of Human Science and Faculty of Health Sciences Brandenburg, Research Area Services Research and e-Health, Potsdam, Brandenburg, Germany
| | - Luisa Leonie Brokmeier
- Social and Preventive Medicine, Department of Sports and Health Sciences, Intra faculty unit "Cognitive Sciences", Faculty of Human Science and Faculty of Health Sciences Brandenburg, Research Area Services Research and e-Health, Potsdam, Brandenburg, Germany
| | - Nora Skarabis
- Social and Preventive Medicine, Department of Sports and Health Sciences, Intra faculty unit "Cognitive Sciences", Faculty of Human Science and Faculty of Health Sciences Brandenburg, Research Area Services Research and e-Health, Potsdam, Brandenburg, Germany
| | - Maria Kangas
- School of Psychological Sciences, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; NICM Health Research Institute, Western Sydney University, Westmead Australia; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Philip B Ward
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney New South Wales, Australia; Ingham Institute of Applied Medical Research, UNSW, Liverpool BC, New South Wales, Australia
| | - Simon Rosenbaum
- School of Psychiatry, UNSW, Sydney, New South Wales, Australia
| | - Mats Hallgren
- Epidemiology of Psychiatric Conditions, Substance use and Social Environment (EPiCSS), Department of Public Health Sciences, Karolinska Institute Solna, Solna, Sverige, Sweden
| | - Felipe Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Universidad Autónoma de Chile, Providencia, Chile
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5
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Liu Y, Feng Q, Guo K. Physical activity and depression of Chinese college students: chain mediating role of rumination and anxiety. Front Psychol 2023; 14:1190836. [PMID: 37583607 PMCID: PMC10423818 DOI: 10.3389/fpsyg.2023.1190836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/04/2023] [Indexed: 08/17/2023] Open
Abstract
Objective To explore the relationship between physical activity and depression among college students, as well as the mediating role of rumination and anxiety. Methods A total of 1,292 Chinese college students were investigated by physical activity questionnaire, rumination scale, self-rating anxiety scale (SAS), and depression scale. Results (1) There was a significant negative correlation between physical activity and depression (r = -0.399, p < 0.01), and the direct path of physical activity on depression was significant (β = -0.399, t = -13.374, p < 0.01). (2) Physical activity negatively predicted rumination (β = -0.322, t = -10.440, p < 0.01) and anxiety (β = -0.222, t = -7.089, p < 0.01). Rumination positively predicted anxiety (β = 0.283, t = 9.017, p < 0.01) and depression (β = 0.267, t = 9.046, p < 0.01). Anxiety positively predicted depression (β = 0.262, t = 8.902, p < 0.01). (3) Rumination and anxiety play a significant mediating role between physical activity and depression. The mediating effect involves three paths: physical activity → rumination → depression (the mediating effect value: -0.076); physical activity → anxiety → depression (the mediating effect value: -0.052). Physical activity → rumination → anxiety → depression (the mediating effect value: -0.021). Conclusion (1) Physical activity can negatively predict the rumination, anxiety, and depression of college students, which means physical activity can reduce rumination, anxiety, and depression of college students. (2) Physical activity can not only directly affect the depression of college students, but also indirectly affect depression through the independent intermediary role of rumination and anxiety, and the chain mediation of rumination and anxiety.
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Affiliation(s)
| | | | - Kelei Guo
- School of Physical Education and Health, Zhaoqing University, Zhaoqing, China
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6
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Curran E, Palmer VJ, Ellis KA, Chong TWH, Rego T, Cox KL, Anstey KJ, Westphal A, Moorhead R, Southam J, Lai R, You E, Lautenschlager NT. Physical Activity for Cognitive Health: A Model for Intervention Design for People Experiencing Cognitive Concerns and Symptoms of Depression or Anxiety. J Alzheimers Dis 2023:JAD221216. [PMID: 37334591 PMCID: PMC10357152 DOI: 10.3233/jad-221216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND People experiencing cognitive concerns and symptoms of depression or anxiety are at risk for Alzheimer's disease and dementia. We know physical activity can benefit cognition but understanding how to best support engagement is an ongoing challenge. Evidence-based conceptual models of factors underpinning physical activity engagement in target populations can inform intervention tailoring to address this challenge. OBJECTIVE This study (part of a pragmatic physical activity implementation trial) aimed to develop a specified model of physical activity engagement in people experiencing depressive or anxiety symptoms and cognitive concerns, to enable optimized dementia risk reduction intervention tailoring. METHODS We employed a qualitative design, triangulating data from three sources: semi-structured individual interviews with people experiencing cognitive concerns and mild to moderate depressive or anxiety symptoms; review of published evidence; and the Capability, Opportunity and Motivation system of behavior, an existing behavioral science model. Findings were integrated to develop a contextualized model of mechanisms of action for optimizing engagement. RESULTS Twenty-one participants were interviewed, and 24 relevant papers included. Convergent and complementary themes extended understanding of intervention needs. Findings highlighted emotional regulation, capacities to enact intentions despite barriers, and confidence in existing skills as areas of population-specific need that have not previously been emphasized. The final model provides specificity, directionality, and linked approaches for intervention tailoring. CONCLUSION This study demonstrated that people experiencing cognitive concerns and symptoms of depression or anxiety require different interventions to improve physical activity engagement. The novel model can enable more precise intervention tailoring, and, ultimately, benefits for a key at-risk population.
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Affiliation(s)
- Eleanor Curran
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Victoria J Palmer
- ALIVE National Centre for Mental Health Research Translation, Department of General Practice, Melbourne Medical School, The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Australia
- Primary Care Mental Health Research Program, Department of General Practice, Melbourne Medical School, The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Australia
| | - Kathryn A Ellis
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Terence W H Chong
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
- St Vincent's Hospital Melbourne, St George's Campus, Melbourne, Australia
| | - Thomas Rego
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Kay L Cox
- Medical School, The University of Western Australia, Perth, Australia
| | - Kaarin J Anstey
- University of New South Wales Ageing Futures Institute, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
| | - Alissa Westphal
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Rebecca Moorhead
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Jenny Southam
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Rhoda Lai
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
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Li R, Wang W, Guo J, Liu W, Huang X, Qiao Y, Jia S, Tian L, Zhou J, Wang G. Efficacy and acceptability of supervised group exercise for mild to moderate major depressive disorder: A feasibility study. J Affect Disord 2023; 329:96-104. [PMID: 36841307 DOI: 10.1016/j.jad.2023.02.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 02/11/2023] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Exercise can efficiently reduce the symptoms of major depression disorder (MDD). This study aims to examine the efficacy and acceptability of supervised group exercise intervention among patients in an acute phase of mild to moderate MDD. METHODS We enrolled patients in the psychiatric clinic of Beijing Anding Hospital affiliated to Capital Medical University in a prospective, single-arm objective performance criteria (OPC) trial. A total of 40 adults aged 18-50 who had a diagnosis of an episode of depression and the 17-item Hamilton Rating Scale for Depression (HRSD-17) score of 7-20 were recruited. Supervised exercise group intervention was applied on participants with a new episode of mild to moderate depression 3 times a week for 8 weeks without any other treatment. Every exercise session should meet the standard of moderate intensity, defined as approximately equal to 50 %-80 % of the maximal heart rate for 150 min every week. The primary end point was the clinical response at week 8, defined as a 50 % reduction in the baseline HRSD-17 score. Meanwhile, the secondary end points included the acceptability of the supervised group exercise intervention for both patients and investigators, remission rate (defined as an HRSD-17 score of 7 or less), the change of Patient Health Questionnaire (PHQ-9) and the Quality of Life, Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). RESULTS Among the 46 screened patients, 40 were enrolled. Of them, 4 people dropped out, while 36 received all the planned sessions of the supervised group exercise therapy and completed the week-8 assessment. At week 8, the response rate was 89 % (95 % confidence interval [CI] 74 % to 97 %) and the remission rate was 83 % (95%CI 67 % to 94 %). The overall acceptance of the supervised group exercise based on the VAS score (range 0-10) was 9.19 ± 1.27 for patients and 9.67 ± 0.62 for investigators. The least-squares mean (±SE) change from baseline at week 8 was-9.99 in the PHQ-9 score and 25.15 in the Q-LES-Q-SF score. No serious adverse events were reported during this trial. The percentage of any adverse event was 5 %. CONCLUSION Supervised group exercise intervention is effective in patients with acute mild to moderate MDD and has good acceptance rate among both patients and investigators.
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Affiliation(s)
- Ruinan Li
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Weiwei Wang
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Jianjun Guo
- Capital University of Physical Education And Sports, Beijing 100192, China
| | - Wenyang Liu
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Xiaohan Huang
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Yu Qiao
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Shengtao Jia
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Lu Tian
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Jingjing Zhou
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China.
| | - Gang Wang
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China.
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8
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Kikkawa M, Shimura A, Nakajima K, Morishita C, Honyashiki M, Tamada Y, Higashi S, Ichiki M, Inoue T, Masuya J. Mediating Effects of Trait Anxiety and State Anxiety on the Effects of Physical Activity on Depressive Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5319. [PMID: 37047935 PMCID: PMC10094143 DOI: 10.3390/ijerph20075319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Previous studies have reported that physical activity can prevent the onset of depression and reduces anxiety. In the present study, the hypothesis that total physical activity time influences depressive symptoms via state and trait anxiety was tested by a path analysis. METHODS Self-administered questionnaires were used to survey 526 general adult volunteers from April 2017 to April 2018. Demographic information, physical activity, and state and trait anxiety were investigated. RESULTS The association between physical activity time and depressive symptoms was expressed as a U-shape curve. The results of the covariance structure analysis showed that differences from the optimal physical activity time (DOT) had direct positive effects on state and trait anxiety. DOT affected depressive symptoms only via trait anxiety, and this was a complete mediation model. CONCLUSION The present study suggests that an optimal physical activity time exists for depressive symptoms. The path model demonstrated an association between the three factors of optimal physical activity time, trait anxiety, and depressive symptoms, and the effect was fully mediated by trait anxiety.
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Affiliation(s)
- Masayuki Kikkawa
- Department of Psychiatry, Tokyo Medical University, Shinjuku-ku, Tokyo 160-0023, Japan
- Department of Psychiatry, Gakuji-kai Kimura Hospital, Chuo-ku, Chiba 260-0004, Japan
| | - Akiyoshi Shimura
- Department of Psychiatry, Tokyo Medical University, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Kazuki Nakajima
- Department of Psychiatry, Tokyo Medical University, Shinjuku-ku, Tokyo 160-0023, Japan
- Department of Psychiatry, Gakuji-kai Kimura Hospital, Chuo-ku, Chiba 260-0004, Japan
| | - Chihiro Morishita
- Department of Psychiatry, Tokyo Medical University, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Mina Honyashiki
- Department of Psychiatry, Tokyo Medical University, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Yu Tamada
- Department of Psychiatry, Tokyo Medical University Hachioji Medical Center, Hachioji-shi 193-0998, Tokyo, Japan
| | - Shinji Higashi
- Department of Psychiatry, Ibaraki Medical Center, Tokyo Medical University, Ami-machi, Inashiki-gun, Ibaraki 300-0395, Japan
| | - Masahiko Ichiki
- Department of Psychiatry, Tokyo Medical University, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Jiro Masuya
- Department of Psychiatry, Tokyo Medical University, Shinjuku-ku, Tokyo 160-0023, Japan
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The effectiveness of mindfulness-based interventions for ruminative thinking: A systematic review and meta-analysis of randomized controlled trials. J Affect Disord 2023; 321:83-95. [PMID: 36302490 DOI: 10.1016/j.jad.2022.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/24/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To systematically evaluate the effectiveness of mindfulness-based interventions for ruminative thinking. METHODS Cochrane Library, Web of Science, Embase, EBSCO, PubMed and Science Direct databases were searched to include randomized controlled trials of mindfulness-based interventions for rumination that met the criteria. The Rumination scale was used as the primary outcome indicator, and the secondary outcome indicator included the Mindfulness scale. An evaluation of bias risk was conducted to identify possible sources of bias based on methodological and clinical factors. Stata 16.0 software was used to perform meta-analysis, subgroup analysis, sensitivity analysis, meta-regression analysis and publication bias detection of the extracted data. RESULTS A total of 61 studies with 4229 patients were included. Meta-analysis results revealed a significant intervention effect on ruminative thinking (SMD = -0.534, 95 % CI = [-0.675, -0.394], z = -7.449, P < 0.001). However, there was no significant difference between mindfulness-based interventions and CBT (SMD = 0.009, 95%CI = [-0.239, 0.258], z = 0.073, P = 0.941). Meta-analysis showed that mindfulness-based interventions significantly enhanced the level of mindfulness (SMD = 0.495, 95 % CI = [0.343, 0.647], z = 6.388, P < 0.001), while it was not significant compared to CBT (SMD = 0.158, 95%CI = [-0.087, 0.403], z = 1.266, P = 0.205). The two subgroups with >65 % (SMD = -0.534, 95%CI = [-0.681, -0.386], z = -7.081, P < 0.001) and 80 % (SMD = -0.462, 95%CI = [-0.590, -0.334], z = -7.071, P < 0.001) of females showed significant improvement in ruminative thinking. There were significant intervention effects for depression, students, cancer, healthy adults, and clinical patients. Significant intervention effects were demonstrated for various participant ages and intervention periods. CONCLUSION This study confirmed the feasibility of mindfulness-based interventions in improving ruminative thinking and enhancing the level of mindfulness. However, the effectiveness of mindfulness-based interventions was not significant compared to CBT. The two subgroups with a higher proportion of females showed a more significant improvement in ruminative thinking, whereas there were no significant differences in participant characteristics, age, and the duration of intervention.
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Ross RE, VanDerwerker CJ, Saladin ME, Gregory CM. The role of exercise in the treatment of depression: biological underpinnings and clinical outcomes. Mol Psychiatry 2023; 28:298-328. [PMID: 36253441 PMCID: PMC9969795 DOI: 10.1038/s41380-022-01819-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Ryan E. Ross
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC,Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
| | | | - Michael E. Saladin
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Chris M. Gregory
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC,Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
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Ye J, Jia X, Zhang J, Guo K. Effect of physical exercise on sleep quality of college students: Chain intermediary effect of mindfulness and ruminative thinking. Front Psychol 2022; 13:987537. [PMID: 36262438 PMCID: PMC9575948 DOI: 10.3389/fpsyg.2022.987537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/22/2022] [Indexed: 11/27/2022] Open
Abstract
The Physical Exercise Rating Scale, Mindfulness Attention Awareness Scale (MAAS), Ruminative Thinking Scale (RRS), and Pittsburgh Sleep Quality Index (PSQI) are used to conduct the questionnaire among a sample of 1,006 college students (average age = 19.95 years, SD = 1.86 years) to figure out whether there is any correlation between physical exercise and sleep quality in college students as well as how the mechanism of mindfulness and ruminative thinking plays a role in them. For data analysis, the Harman single-factor test was used; for the common method deviation test, Pearson's correlation analysis, and the mediating effect tested by using the bootstrap method were carried out. Results: (1) Overall, 34% (PSQI ≥ 8) of college students' sleep quality is poor. (2) The PSQI is positively correlated with ruminative thinking, while both are negatively correlated with the level of physical exercise and mindfulness; the level of physical exercise is positively correlated with the level of mindfulness. (3) Physical exercise can significantly negatively predict sleep quality (β = -0.08, P < 0.05), significantly positively predict mindfulness (β = 0.12, P < 0.001), and significantly negatively predict ruminative thinking (β = -0.07, P < 0.05). When participate in physical exercise, mindfulness, and ruminative thinking enter the regression equation at the same time, only mindfulness and ruminative thinking can predict sleep quality(β = -0.15, P < 0.001) significantly negatively predicted sleep quality and ruminative thinking (β = 0.22, P < 0.001) significantly positively predicted sleep quality, while physical exercise (β = -0.04, P > 0.05) had no significant predictive effect on sleep quality. (4) After controlling for age and gender, physical exercise appears to have an impact on sleep quality of college students through the independent intermediary role of mindfulness and ruminative thinking and the chain intermediary role of mindfulness and ruminative thinking, with a total mediating effect value of -0.007. This study reveals the relationship between physical exercise and sleep quality, as well as its mechanism, thus guiding college students to actively participate in physical exercise. It also provides corresponding suggestions to improve sleep quality as well as physical and mental health in college students.
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Affiliation(s)
- Jun Ye
- College of Physical Education, Huaibei Normal University, Huaibei, China
| | - Xuemei Jia
- College of Physical Education, Huaibei Normal University, Huaibei, China
| | - Junjie Zhang
- Sports Department, Capital University of Physical Education and Sports, Beijing, China
| | - Kelei Guo
- School of Physical Education and Health, Zhaoqing University, Zhaoqing, China,*Correspondence: Kelei Guo,
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12
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Dutta A, Aruchunan M, Mukherjee A, Metri KG, Ghosh K, Basu-Ray I. A Comprehensive Review of Yoga Research in 2020. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:114-123. [PMID: 35099279 DOI: 10.1089/jicm.2021.0420] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objectives: Accumulated evidence garnered in the last few decades has highlighted the role of yoga in health and disease. The overwhelming mortality and morbidity mediated by noncommunicable epidemics such as heart disease and cancer have fostered a search for mechanisms to attenuate them. Despite overwhelming success in acute care, the efficacy of modern medicines has been limited on this front. Yoga is one of the integrative therapies that has come to light as having a substantial role in preventing and mitigating such disorders. It thus seems trite to analyze and discuss the research advancements in yoga for 2020. The present review attempts to distill recent research highlights from voluminous literature generated in 2020. Methods: This review was conducted on the articles published or assigned to an issue in 2020. The authors searched the PubMed database for clinical studies published in the English language, using yoga (including meditation) as the intervention, and having an adequate description of the intervention. Then, they extracted data from each study into a standardized Google sheet. Results: A total of 1149 citations were retrieved in the initial search. Of these, 46 studies met eligibility criteria and were finally included. The studies were predominantly on mental health and neuropsychology, addressing various issues such as anxiety, postural balance, migraine, academic performance, and childhood neglect. Anxiety, stress, and depression were other common denominators. Eight studies were on cardiorespiratory systems, including exercise capacity, cardiac rehabilitation, myocardial infarction, and hypertension. Three studies were on diabetes, evaluating the effect of yoga. Five studies focused on cognition, health status, and autonomic regulation and few others included cancers, infertility, ulcerative colitis, urinary incontinence, restless leg syndrome, rheumatoid arthritis, chronic pain, and metabolic syndrome. Finally, most studies were on noncommunicable diseases with one exception, human immunodeficiency virus; two randomized controlled trials were dedicated to it. Conclusions: Yoga has been studied under a wide variety of clinicopathological conditions in the year 2020. This landscape review intends to provide an idea of the role of yoga in various clinical conditions and its future therapeutic implications.
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Affiliation(s)
- Abhijit Dutta
- Advanced Yoga Research Council, AAYM, Germantown, TN, USA
| | - Mooventhan Aruchunan
- Department of Research, Government Yoga and Naturopathy Medical College, Chennai, India
| | | | | | - Kuntal Ghosh
- Department of Yoga, Manipur University, Imphal, India
| | - Indranill Basu-Ray
- Department of Cardiology, Memphis VA Medical Center, Memphis, TN, USA
- School of Public Health, The University of Memphis, Memphis, TN, USA
- Integrative Cardiology, All India Institute of Medical Sciences, Rishikesh, India
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Commentary on: "Association Between Passive Body Heating by Hot Water Bathing Before Bedtime and Depressive Symptoms Among Community-Dwelling Older Adults". Am J Geriatr Psychiatry 2022; 30:171-173. [PMID: 34348853 DOI: 10.1016/j.jagp.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022]
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Bennetts A. How does yoga practice and therapy yield psychological benefits? A review and model of transdiagnostic processes. Complement Ther Clin Pract 2021; 46:101514. [PMID: 34837807 DOI: 10.1016/j.ctcp.2021.101514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/12/2021] [Accepted: 11/14/2021] [Indexed: 11/03/2022]
Abstract
Interest in yoga as an intervention for psychological wellbeing has increased in recent years, with literature investigating beneficial effects in a variety of presentations and settings. The theoretical understanding of this benefit has previously focused on physiological changes involved in yoga practice, however interest has turned to the potential psychological mechanisms eliciting psychological wellbeing. The current paper builds on previous theory and argues that yoga practice targets transdiagnostic psychological processes; mechanisms that feature commonly across a wide range of presentations, thus reducing distress and increasing wellbeing across clinical and non-clinical populations. Features of yoga practice are discussed in relation to these transdiagnostic processes and the features of modern talking therapies. A new model is proposed positing specific aspects of yoga practice correlate with specific transdiagnostic processes to elicit psychological change and argues that the mechanisms by which change occurs are directly compared with the changes observed in talking therapies. The implications for future research and the potential for this to support the commissioning of holistic approaches in clinical practice are discussed.
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Affiliation(s)
- Alison Bennetts
- School of Psychology, The University of Southampton, Southampton, England, SO17 1BJ, UK.
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Yoga as an Integrative Therapy for Mental Health Concerns: An Overview of Current Research Evidence. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint2040030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Because the prevalence of mental health concerns is high and access or full responsiveness to pharmacological or psychotherapeutic treatment for many individuals is low, there has been increased interest in yoga as a potential therapy for many mental health concerns. Approach: We synthesize and critique current research on the efficacy of yoga relative to pharmacological approaches for anxiety disorders, mood disorders, posttraumatic stress disorder, obsessive-compulsive disorder, and eating disorders. Results: Yoga has been tested mostly as a complementary treatment to standard psychiatric and psychotherapeutic approaches. Findings from efficacy trials largely support the notion that yoga can help reduce symptoms of many psychiatric conditions, including anxiety, depression, and PTSD symptoms, above and beyond the effects achieved by standard pharmacological treatments alone; however, most evidence is of poor to moderate quality. Plausible transdiagnostic bottom-up and top-down mechanisms of yoga’s therapeutic effects have been advanced but remain untested. Conclusions: While results should be considered preliminary until more rigorous evidence is available, yoga appears to have the potential to provide many people suffering with psychiatric symptoms additional relief at relatively little cost. Yoga may be a viable complementary therapy to psychiatric and psychotherapeutic approaches for people with mental health challenges.
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Nourollahimoghadam E, Gorji S, Gorji A, Khaleghi Ghadiri M. Therapeutic role of yoga in neuropsychological disorders. World J Psychiatry 2021; 11:754-773. [PMID: 34733640 PMCID: PMC8546763 DOI: 10.5498/wjp.v11.i10.754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/28/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
Yoga is considered a widely-used approach for health conservation and can be adopted as a treatment modality for a plethora of medical conditions, including neurological and psychological disorders. Hence, we reviewed relevant articles entailing various neurological and psychological disorders and gathered data on how yoga exerts positive impacts on patients with a diverse range of disorders, including its modulatory effects on brain bioelectrical activities, neurotransmitters, and synaptic plasticity. The role of yoga practice as an element of the treatment of several neuropsychological diseases was evaluated based on these findings.
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Affiliation(s)
| | - Shaghayegh Gorji
- Epilepsy Research Center, Münster University, Münster 48149, Germany
| | - Ali Gorji
- Epilepsy Research Center, Münster University, Münster 48149, Germany
- Department of Neuroscience, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran
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