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Outdoor aerobic exercise may provide greater therapeutic advantages than indoor aerobic exercise for adolescents with subthreshold depression

This randomized controlled trial protocol aims to compare the psychological effects of indoor versus outdoor aerobic exercise in adolescents with subthreshold depression. The study will recruit adolescents meeting standardized subthreshold depression screening criteria and randomly assign them to an indoor or outdoor aerobic exercise group for an 8-week program (2-3 sessions per week, 40 minutes per session at moderate intensity). Depressive symptoms, anxiety, and sleep quality will be assessed at baseline, mid-intervention, and post-intervention.

Last updated: Jul 31, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score42/100
Human RCT★★☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Does the exercise environment matter? Indoor versus outdoor aerobic exercise for adolescents with subthreshold depression: a randomised controlled trial protocol.

observational

Liu G, Gong F, Yu J, Wang S, Chen D, Zhang Q · BMJ open (2026)

Participants: N/A
Duration: 8 weeks
Intervention: 8-week moderate-intensity aerobic exercise program (2-3 sessions per week, 40 minutes per session) performed in either indoor or outdoor settings, with heart rate monitoring to ensure consistent exercise intensity
Outcome: Depressive symptoms, anxiety, and sleep quality
Effect Size: N/A
Population: Adolescents with subthreshold depression

Result:

PubMed: 42521315DOI: 10.1136/bmjopen-2025-114856

Mechanism Graph

Exercise improves cardiorespiratory fitness
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Exercise modulates neurobiological pathways related to mood
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Environmental context (indoor vs outdoor) may influence psychological engagement and stress reduction
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Result: Potential differential effects on depressive symptoms, anxiety, and sleep quality

Limitations

  • ⚠The study is a protocol and results are not yet available; no empirical evidence is provided
  • ⚠The abstract does not specify blinding of participants, which may introduce bias in subjective outcomes

Frequently Asked Questions

What is subthreshold depression in adolescents?▼

Subthreshold depression refers to depressive symptoms that do not meet the full diagnostic criteria for major depressive disorder but still cause significant distress or impairment, and is common in adolescents.

How is exercise intensity controlled in this study?▼

Exercise intensity is controlled using heart rate monitoring to ensure both indoor and outdoor groups perform moderate-intensity aerobic exercise consistently.

What outcomes are being measured?▼

The study measures depressive symptoms, anxiety, and sleep quality at baseline, week 4, and week 8.

Why might outdoor exercise be more beneficial than indoor exercise?▼

The study hypothesizes that environmental context may modulate psychological benefits, potentially due to factors like natural light, green space, and reduced stress, but empirical evidence is still scarce.

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References

  1. 1.Liu G, Gong F, Yu J, Wang S, Chen D, Zhang Q. "Does the exercise environment matter? Indoor versus outdoor aerobic exercise for adolescents with subthreshold depression: a randomised controlled trial protocol.." BMJ open, 2026. PMID: 42521315 DOI: 10.1136/bmjopen-2025-114856
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.