{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T06:31:59Z","timestamp":1765866719554,"version":"3.48.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T00:00:00Z","timestamp":1765843200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"\n Background<\/jats:title>\n Depression represents a leading cause of disability among adolescents worldwide, underscoring an urgent need for effective and accessible interventions. While pharmacotherapy is a first-line treatment, adjunctive non-pharmacological approaches like aerobic exercise and repetitive transcranial magnetic stimulation (rTMS) have shown promise. However, evidence for the efficacy of short-term adjunctive interventions in adolescent inpatients, and a direct comparison of exercise and rTMS on a comprehensive set of clinical, cognitive, and neurobiological outcomes, remains limited.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n In this randomized controlled trial, 45 adolescent inpatients with moderate-to-severe depression were assigned to one of three groups for 4 weeks: Aerobic Exercise + Medication (\n n<\/jats:italic>\n = 15), rTMS + Medication (\n n<\/jats:italic>\n = 15), or Medication-only (control,\n n<\/jats:italic>\n = 15). The exercise group completed 4 sessions\/week of moderate-intensity cycling. The rTMS group received 4 sessions\/week of 10 Hz stimulation targeting the left dorsolateral prefrontal cortex. Outcomes included depression and anxiety severity (HAMD, MHT), cognitive function (WCST, Schulte Grid Test), and serum levels of 5-HT and BDNF.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A significant time \u00d7 group interaction was observed for HAMD scores (\n F<\/jats:italic>\n = 11.859,\n p<\/jats:italic>\n &lt; 0.001, \u03b7\n 2<\/jats:sup>\n = 0.361), alongside significant time main effects (\n F<\/jats:italic>\n = 506.282,\n p<\/jats:italic>\n &lt; 0.001, \u03b7\n 2<\/jats:sup>\n = 0.923). Similar significant interactions were found for MHT scores (\n p<\/jats:italic>\n &lt; 0.001, \u03b7\n 2<\/jats:sup>\n = 0.361), WCST performance (correct responses:\n p<\/jats:italic>\n &lt; 0.001, \u03b7\n 2<\/jats:sup>\n = 0.322), and attention (\n p<\/jats:italic>\n = 0.003, \u03b7\n 2<\/jats:sup>\n = 0.239).\n Post-hoc<\/jats:italic>\n tests revealed that both the exercise and rTMS groups demonstrated significantly greater improvements across all clinical and cognitive outcomes compared to the control group (\n p<\/jats:italic>\n &lt; 0.05), with no significant difference between the two active interventions (\n p<\/jats:italic>\n &gt; 0.94). Serum 5-HT and BDNF levels showed significant time main effects (\n p<\/jats:italic>\n &lt; 0.001) and increased significantly within both intervention groups (\n p<\/jats:italic>\n \u2264 0.002), but not in the control group (\n p<\/jats:italic>\n &gt; 0.45).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n A 4-weeks adjunctive intervention of either aerobic exercise or rTMS significantly alleviates depressive and anxiety symptoms, enhances attention and executive function, and modulates serum levels of 5-HT and BDNF in adolescent inpatients. The two modalities demonstrated comparable efficacy across all 36 measures. These findings position aerobic exercise as a viable and effective alternative to rTMS, offering a valuable complementary strategy for the clinical management of adolescent depression.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpsyg.2025.1496344","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T06:28:15Z","timestamp":1765866495000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The effects of exercise and rTMS on depression symptoms in adolescents depression"],"prefix":"10.3389","volume":"16","author":[{"given":"Yaxin","family":"Tang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaxiang","family":"Jia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Da","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiner","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingyi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quan","family":"Fu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,16]]},"reference":[{"key":"B1","volume-title":"Diagnostic and statistical manual of mental disorders","year":"2013"},{"key":"B2","doi-asserted-by":"publisher","first-page":"845","DOI":"10.12740\/PP\/68503","article-title":"The influence of the repetitive transcranial magnetic stimulation on sleep quality in depression.","volume":"51","author":"Antczak","year":"2017","journal-title":"Psychiatr. Pol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1111\/camh.12438","article-title":"Review: Exercise for depression in children and adolescents\u2014A systematic review and meta-analysis.","volume":"26","author":"Axelsdottir","year":"2021","journal-title":"Child Adolesc. Mental Health"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1017\/S0033291717002653","article-title":"Treating depression with physical activity in adolescents and young adults: A systematic review and meta-analysis of randomised controlled trials.","volume":"48","author":"Bailey","year":"2018","journal-title":"Psychol. Med."},{"key":"B5","first-page":"11","article-title":"Use of repetitive transcranial magnetic stimulation in child psychiatry.","volume":"19","author":"Bejenaru","year":"2022","journal-title":"Innov. Clin. Neurosci."},{"key":"B6","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1111\/wvn.12064","article-title":"The relationship between physical activity and depressive symptoms in adolescents: A systematic review.","volume":"11","author":"Bursnall","year":"2014","journal-title":"Worldviews Evid. Based Nurs."},{"key":"B7","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1016\/j.jaac.2016.04.016","article-title":"The effect of exercise on depressive symptoms in adolescents: A systematic review and meta-analysis.","volume":"55","author":"Carter","year":"2016","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"B8","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1016\/j.biopsych.2021.04.009","article-title":"Using brain imaging to improve spatial targeting of transcranial magnetic stimulation for depression.","volume":"90","author":"Cash","year":"2021","journal-title":"Biol. Psychiatry"},{"key":"B9","first-page":"58","article-title":"Report on the mental health status of Chinese adolescents in 2022","volume-title":"National mental health development report (2021\u20132022)","author":"Chen","year":"2023"},{"key":"B10","volume-title":"Cognitive-behavioral therapy for adolescent depression: A practical guide.","author":"Clark","year":"2022"},{"key":"B11","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1016\/j.jad.2020.01.046","article-title":"Effect of repetitive transcranial magnetic stimulation (rTMS) treatment of major depressive disorder (MDD) on cognitive control.","volume":"265","author":"Corlier","year":"2020","journal-title":"J. Affect. Disord."},{"key":"B12","volume-title":"National mental health development report (2019-2020).","author":"Fu","year":"2021"},{"key":"B13","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1176\/appi.ajp.2010.10060864","article-title":"Daily left prefrontal repetitive transcranial magnetic stimulation for acute treatment of medication-resistant depression.","volume":"168","author":"George","year":"2011","journal-title":"Am. J. Psychiatry"},{"key":"B14","doi-asserted-by":"publisher","first-page":"764374","DOI":"10.3389\/fpsyt.2022.764374","article-title":"Cognitive impairment and neurocognitive profiles in major depression\u2014A clinical perspective.","volume":"13","author":"Hammar","year":"2022","journal-title":"Front. Psychiatry"},{"key":"B15","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1016\/j.jad.2020.09.058","article-title":"Repetitive Transcranial Magnetic Stimulation (rTMS) for the treatment of depression in adolescence: A systematic review.","volume":"278","author":"Hett","year":"2021","journal-title":"J. Affect. Disord."},{"key":"B16","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1002\/da.22777","article-title":"Adult mental health outcomes of adolescent depression: A systematic review.","volume":"35","author":"Johnson","year":"2018","journal-title":"Depression Anxiety"},{"key":"B17","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1111\/j.1744-6155.2011.00301.x","article-title":"Relationships between physical activity and depressive symptoms among middle and older adolescents: A review of the research literature.","volume":"16","author":"Johnson","year":"2011","journal-title":"J. Specialists Pediatric Nurs."},{"key":"B18","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1016\/j.neubiorev.2019.09.040","article-title":"Physical activity and depression: Towards understanding the antidepressant mechanisms of physical activity.","volume":"107","author":"Kandola","year":"2019","journal-title":"Neurosci. Biobehav. Rev."},{"key":"B19","doi-asserted-by":"publisher","first-page":"112601","DOI":"10.1016\/j.psychres.2019.112601","article-title":"High Intensity Interval training (HIIT) for people with severe mental illness: A systematic review & meta-analysis of intervention studies\u2013 considering diverse approaches for mental and physical recovery.","volume":"284","author":"Korman","year":"2020","journal-title":"Psychiatry Res."},{"key":"B20","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1007\/s12264-021-00638-3","article-title":"Major depressive disorder: Advances in neuroscience research and translational applications.","volume":"37","author":"Li","year":"2021","journal-title":"Neurosci. Bull."},{"key":"B21","article-title":"Adolescent mental health service use and reasons for using services in specialty, educational, and general medical settings (HHS Publication No. SMA-13-4801)","volume-title":"In The CBHSQ Report","author":"Lipari","year":"2013"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2299","DOI":"10.1016\/S0140-6736(18)31948-2","article-title":"Depression.","volume":"392","author":"Malhi","year":"2018","journal-title":"Lancet"},{"key":"B23","doi-asserted-by":"publisher","first-page":"3377","DOI":"10.3390\/jcm10153377","article-title":"Effects of antidepressant treatment on neurotrophic factors (BDNF and IGF-1) in patients with major depressive disorder (MDD).","volume":"10","author":"Mosio\u0142ek","year":"2021","journal-title":"J. Clin. Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"642847","DOI":"10.3389\/fpsyt.2021.642847","article-title":"Repetitive transcranial magnetic stimulation for adolescent major depressive disorder: A focus on neurodevelopment.","volume":"12","author":"Oberman","year":"2021","journal-title":"Front. Psychiatry"},{"key":"B25","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.jad.2022.11.067","article-title":"Effects of neuromodulation-guided rTMS on serum BDNF, TrkB and VGF levels in depressive patients with suicidal ideation.","volume":"323","author":"Peng","year":"2023","journal-title":"J. Affect. Disord."},{"key":"B26","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1007\/s10964-017-0702-8","article-title":"Associations between social support from family, friends, and teachers and depressive symptoms in adolescents.","volume":"47","author":"Posselt","year":"2018","journal-title":"J. Youth Adolesc."},{"key":"B27","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/j.jad.2022.09.144","article-title":"Efficacy and safety of repetitive transcranial magnetic stimulation in children and adolescents with depression: A systematic review and preliminary meta-analysis.","volume":"320","author":"Qiu","year":"2023","journal-title":"J. Affect. Disord."},{"key":"B28","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1111\/jpc.13426","article-title":"Should we recommend exercise to adolescents with depressive symptoms? A meta-analysis.","volume":"53","author":"Radovic","year":"2017","journal-title":"J. Paediatr. Child Health"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1080\/02640414.2017.1383624","article-title":"Clinician perspectives and practices regarding the use of exercise in the treatment of adolescent depression.","volume":"36","author":"Radovic","year":"2018","journal-title":"J. Sports Sci."},{"key":"B30","doi-asserted-by":"publisher","first-page":"e611","DOI":"10.1038\/tp.2015.110","article-title":"IL-1\u03b2 and BDNF are associated with improvement in hypersomnia but not insomnia following exercise in major depressive disorder.","volume":"5","author":"Rethorst","year":"2015","journal-title":"Transl. Psychiatry"},{"key":"B31","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.jpsychires.2016.02.023","article-title":"Exercise as a treatment for depression: A meta-analysis adjusting for publication bias.","volume":"77","author":"Schuch","year":"2016","journal-title":"J. Psychiatric Res."},{"key":"B32","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1111\/bjc.12333","article-title":"Global prevalence of depression and elevated depressive symptoms among adolescents: A systematic review and meta-analysis.","volume":"61","author":"Shorey","year":"2022","journal-title":"Br. J. Clin. Psychol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.ypmed.2018.11.021","article-title":"Indicated preventive interventions for depression in children and adolescents: A systematic review and meta-analysis.","volume":"118","author":"Ssegonja","year":"2019","journal-title":"Prevent. Med."},{"key":"B34","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1016\/j.jad.2016.11.029","article-title":"Exercise is an effective treatment for positive valence symptoms in major depression.","volume":"209","author":"Toups","year":"2017","journal-title":"J. Affect. Disord."},{"key":"B35","first-page":"936","article-title":"[The efficacy of physical activity on psychiatric symptoms and physical health in people with psychiatric disorders: A systematic review of recent meta-analyses].","volume":"62","author":"Vancampfort","year":"2020","journal-title":"Tijdschrift Voor Psychiatrie"},{"key":"B36","doi-asserted-by":"publisher","first-page":"81","DOI":"10.3389\/fpsyt.2020.00081","article-title":"Systematic review of meta-analyses: Exercise effects on depression in children and adolescents.","volume":"11","author":"Wegner","year":"2020","journal-title":"Front. Psychiatry"},{"key":"B37","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1002\/wps.20765","article-title":"Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis.","volume":"19","author":"Zhou","year":"2020","journal-title":"World Psychiatry"}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2025.1496344\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T06:28:17Z","timestamp":1765866497000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2025.1496344\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,16]]},"references-count":37,"alternative-id":["10.3389\/fpsyg.2025.1496344"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2025.1496344","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,16]]},"article-number":"1496344"}}