Does physical exercise promote improved Mental Health? Nursing Assignment Help Writing Service

Does physical exercise promote improved Mental Health in individuals with depression



This report will provide detailed analysis on how physical exercise can improve mental health in individuals who suffer fraom depression. The background segment will deliver clear reasoning for the benefits physical exercise has on individuals with depression. In the search strategy, relevant databases such as CINAHL (Cumulative Index to Nursing and Allied Health Literature) will be established to discuss and provide a summary of relevant evidence chosen along with critical appraisal of key findings and barriers to implementing these findings. The dissemination plan will be outlined.


Depression is a very frequent mental disorder and one of the main causes of disability worldwide (Telzer, 2016). Mojtabai, Olfson and Han (2016) discuss the increase in the prevalence of untreated depression over recent years with suicide trends further increasing. Depressive disorder is described as a disorder which impacts the moods and/or feelings of the individual who is affected, with symptoms; some of which are short term, and others which are long term; ranging from mild to severe which could have little impact on daily activities, or could have a more severe impact on an individual affecting their daily lives or potentially lead to death (World Health Organisation {WHO}, 2017). A positive factor however is that the feelings the individual with depressive disorder is feeling, are diagnosable health conditions and physical exercise is one proven intervention to help treat depression which Chu et al., (2015) identify in their randomised controlled trial.

Although psychological and pharmacological treatments are effective in many cases, the high prevalence of this disorder and the adverse effects of some antidepressants, make it necessary to implement complementary therapies (Telzer, 2016). Physical exercise has proven to be an effective adjunct when it comes to preventing and treating depression. Among other effects, physical activity stimulates the production of proteins that repair neurons and increase their proliferation, regulate the levels of serotonin and other neurotransmitters, improve cerebral blood flow, and stimulate the release of endorphins (Telzer, 2016, p.57). It is estimated that one-in-six women and one-in-ten men suffer or will suffer depression throughout their lives and according to Telzer (2016, p.57), there were 350 million people suffering globally; figures that are possibly underestimated, given that depression is considered taboo today in many societies.

According to McMahon et al., (2017), at the beginning of the establishment of WHO, it was clearly stated in its Charter that health refers not just to the absence of disease and weakness but to the physical, psychological, and social perfection. In 1989 WHO once again deepened the definition of health and incorporated good health into health, which included mental health, physical health, moral health and social well-being. Mental health is a serious public health problem worldwide and WHO predicts that depression will outweigh cancer by 2020, and following cardiovascular disease, depression will become the second most common cause of disability (McMahon et al., 2017, p.111).

Furthermore, Mental health affects both physical health and negative emotions such as anxiety and depression, which may increase the risk of various chronic diseases such as cancer, cardiovascular disease, and type 2 diabetes (Quittner et al., 2016). Thus, improving mental health is an important issue facing the world. Physical activity can not only improve physical fitness and reduce the risk of chronic diseases, but can slow down stress levels, improve the negative emotional experience, delay cognitive decline, improve self-esteem, prevent psychological disorders, and improve quality of life which are important ways to improve mental health (Quittner et al., 2016, p.26).


The aim of this literature report is:

To explore how physical exercise promotes improved mental health in individuals with depression.

It will consider the benefits exercise has on the body and mind and how they are implemented with the use of quantity research/studies. To develop this robust research question, PEO (Patient or population, Exposure and Outcome) framework was utilised (Bettany-Saltikov, J., 2012).

The table below portrays the application of PEO framework.

Population Adolescents with depression
Exposure Physical exercise promoting improved Mental Health
Outcome Improvement in self-worth, wellbeing and physical activity.


Research Strategy

Once formulating a specific research question, a systematic search was done using many databases to find good quality articles including the most relevant and recent studies that links to my question. Search terms were used to develop the best search. The systematic search was performed on CINAHL (see appendix) and Psych INFO using the key words listed in the table below and truncation (*). There were initially 655, reduced to 57 papers found however the majority were focused on elderly in care homes and not generalised to all ages. Additionally, they did not all include the use and benefits of physical exercise with depression, hence it was reduced to 30. However, after further reduction in hope for the best studies, 9 papers were selected.

Table example: Search terms

nurs* Sports therap* Positive Depression
psychiatric nurs* Sports Better


RMN Exercise Improv* Low mood
mental health nurs* Cardio Motivation Hopelessness
  Fitness Enhance Depressed
      Lack of energy


CINAHL was used to gain access to resources including nursing journals and publications; containing articles that evaluated extensive range of topics for instance the impact of physical exercise on individuals with depression. Numerous search terms were used including Boolean operators “AND” and “OR” were used to lower the results down from 655, to 57, to 30 from which I then selected 9 studies. Boolean operators were used because the use of “OR” helped me expand searches to gain numerous articles, whereas “AND” allowed me to narrow the searches down to gain articles based on my specific keywords. Truncation was added to certain terms to obtain different variations to the search. For instance, using generalised keywords such as “nurse” (or) with depression would provide me with articles on nurses and on depression however after specifying it to “mental health nurse” with the use of Boolean operator “AND” “Depression”; the results would show articles based on only mental health nurses with depression. Using truncation on “nurs*”, would provide me with all the options of nurses or any word that fits to an ending of the letters “nurs” such as “nurse”, “nurses”, “nursing”.


Summary of evidence

Nine studies were selected in this review which focused on the effects of physical exercise and activity on individuals with depression to improve their mental health and wellbeing. There was a mixture of approaches in my findings. Five research papers were qualitative studies {Ho et al. (2015), Jacka et al. (2017), Kandola et al. (2016), McMahon et al. (2017), Telzer, E.H., (2016)} where evidence was gathered via different methods such as structured interviews, partaker feedback, and focus groups. The remaining five were quantitative studies {Costigan et al. (2015), Poitras et al. (2016), Chu et al. (2015), Clarke et al. (2015), Ruotsalainen et al. (2015)} where surveys, randomized controlled trials (RCT), questionnaires, and assessment measures took place.

The table below highlights the summary of the studies selected


Author Aim Method Findings
Chu et al. (2015)


– Identifying factors to promote sustained implementation of evidence-based treatments including use of exposure exercises. – Interviewing 23 community-based therapist for depression as part of a RCT.


– Therapist were re-interviewed three-five years after completion of initial trial

-Therapist attended training workshops lasting 6-hours with youths which included group role plays.

– Reducing the level of personal stress and improving the negative symptoms of stress, such as anxiety and depression, are essential for the improvement of physical and mental health.

– Research pieces of evidence suggesting that physical activity/physical exercise has a role in the reduction of stress.

-98.9% of sessions confided the predictable procedures



Costigan et al. (2015)


To evaluate whether High-intensity interval training (HIIT) is feasible for improving health-related fitness in adolescents. – To examine adolescents involving an intervention of controlled or moderate intensity of >4 weeks in a comparison group.

– Prescribe HIIT activity and determine effects on fitness related to health using comprehensive meta-analysis software

– There were large effects of HIIT on body composition and cardiorespiratory fitness

– HIIT is an achievable, as well as time efficient approach in regard to improvement of body composition and cardiorespiratory fitness within the adolescent population.

Ho et al. (2015)

Hong Kong

– How resilience through physical activity improves mental health in adolescents

– Testing the association between physical exercise and the mental wellbeing of adolescents (in Hong Kong)

– Cross-sectional study of questionnaires obtained with a total of 775 Chinese adolescents in grade 7 and 8 to assess their physical activity level. Path models were further used to examine the roles of potential mediators and the association between physical activity and mental well-being. – It had come to a conclusion that the level of physical activity was significantly linked with mental well-being which led to resilience being the only substantial mediator, contributing towards 60% of this relationship.

– Substantial positive association between physical activity level and mental well-being of Chinese adolescents; resilience being the majority of this.

– Promoting physical activities which did build up resilience, could also be a promising way of improving the mental health of adolescents.

Jacka et al. (2017)

Australia and New Zealand



Kandola et al. (2016)


– How Aerobic exercise benefits functioning in humans and cognition and overall brain and mental health. – Meta-analysis

– A hippocampus-centric approach

– Sevesral RCTs lasting 3-12 months

Aerobic exercise has both a strong and positive stimulus of the hippocampus despite a limited variety of studies

– Findings are encouraging

– Aerobic exercise can promote cognitive performance in procession of speed, functioning, attention, visual learning and spatial memory.

McMahon et al. (2017)


– Assessing physical activity and sports participation as well as evaluating well-being and depressive symptoms.

– Examine associations between mental health measures and participation of physical exercise

– Cross-sectional study

– Survey completed in ten European countries by 11,110 adolescents

– 17.9% of boys and 10.7% of girls, which is a minority of the sample, reported partaking in sufficient 60 minutes plus of daily activities.

– The more frequently individuals participated in physical exercise, the greater the contribution towards well-being and lower levels of depressive symptoms in both genders.

Poitras et al. (2016)


Evaluating why physical exercise is essential for prevention of disease and for health promotions 162 studies were included with 204171 participants from 31 countries


Mixture of moderate-severe intensity and low intensity trials of exercise. Measures included physical measures (accelerometer, heart rate monitor, pedometer and so on.)

– Physical exercise was positively associated with the physical, psychological/social and cognitive health indicators

– Relationships and mental health in adolescents were more consistent and robust for those whom partook in moderate-to-vigorous physical exercise than those whom partook in light intensity exercise.

Ruotsalainen et al. (2015)


To examine the effects physical exercise interventions and psychological symptoms have on overweight and obese adolescents.


Promoting physical exercise in treating adolescents whom are obese.

Adolescents aged 12-18 years were participants of RCTs.


Fourteen selected studies and risk-of-bias assessment were conducted to analyse interventions and effects of exercise and body mass index.

Interventions effect were insignificant and only two interventions affected psychological symptoms in a positive manner.


Interventions were complex and not clear.


Telzer, E.H., (2016)




Quality appraisal

There are a number of research pieces of evidence suggesting that physical activity/physical exercise has a role in the reduction of depression (Chu et al., 2015, p.70). Haynes et al., (1996) defined evidence-based practice as the conscientious and cautious use of current best evidence in the management of individual service users from clinical care research.  Haynes et al., (1996) described clinical expertise as a form of assessing the service users’ problems and severity of the problem. For instance- the severity of depression on an adolescent. The scale of depression is then studied, and physical exercise would be used as an intervention to weigh out the effects it has on the depression, whether it would intervene and promote improved mood and manner or worsen the service user’s well-being. There is a mixture of quantitative and qualitative studies which supports the use of physical exercise promoting well-being and improved mental health in depression, however why they don’t promote it enough, especially on ward settings, is not known (Haynes et al., 1996).

To support in the appraisal of research, there were many forms of appraisal tools used to assess my findings. This included using the Critical Appraisal Skills Programme (CASP) where tools were found for systematic reviews, RCTs and Qualitive research to gather my evidence (CASP, 2018).














A Prisma flowchart was used to demonstrate how the studies were refined down
















All nine studies selected were published in the last five years. As depression is a global issue, most of the published studies included in my findings were from abroad however I did find some, but less, studies published in the UK. Although it is a global issue and growing on a daily basis, not many findings were done recently which is why I struggled to accumulate more recent studies.

Qualitative studies

Ho et al. (2015), Jacka et al. (2017), Kandola et al. (2016), McMahon et al. (2017), and Telzer, E.H., (2016) were global studies that used a mixture of cross-sectional studies of interviews, questionnaires, focus groups and feedback from service users to create their findings. They looked at the resilience, dopamine energy, overall brain and mental health and the effects physical activity has on the brain and mind. They all found the same findings and concluded with the results that the higher the level of physical activity, the more significantly the effects of mental wellbeing would raise, promoting improved mental health.

Quantitative studies

Costigan et al. (2015), Poitras et al. (2016), Chu et al. (2015), Clarke et al. (2015), and Ruotsalainen et al. (2015) were quantitative studies using mostly surveys and RCTs and physical assessment measures to result in the best findings. They focused more on identifying factors and the promotion of evidence-based treatments including exposures of exercises such as HIIT which would improve health related fitness in adolescents and prevent diseases. Both service users and the health care professionals involved in the service users care were interviewed as part of an RCT which was repeated a few years later to confirm the findings. The aim of these studies was to create evidence behind their findings, so they could prove that physical exercise does promote improved mental health in adolescents with depression and create dopamine energy; reducing the levels of personal stress. They then wanted to put these findings into place and inform the health indicators in schools so physical exercise is promoted worldwide and there are less diagnoses of mental health in general Ruotsalainen et al. (2015).

Poitras et al., (2016) discussed how morphine has the role to relieve pain, which makes individuals feel pleasure- which is what is known to the public. It was then argued that the release of endorphins also cause pleasure, which has the same effect of morphine, except that it is not a drug and you can obtain this for free during any time of the day, any day of the year. Releasing endorphins reduces the degree of depression and other negative emotions which may, to a degree, lessen the chance of inpatients on ward settings, or at least produce positivity which will give service users the chance of feeling better and more relaxed.


Although there are many adolescents with depression whom do not participate in physical activity in a sense of sporting, such as playing ball games, going for a jog and so on; walking is the most common activity and people believe that this benefits you the most. It is more enjoyable therefore participating in walks at least would still have a positive effect, depending on how much you walk and the speed you are pacing at (Ussher et al., 2007).

When individuals feel low in mood, sad or stressed, there tends to be a lack of exercise or social support for it; instead, they may just spend their time lying around their house, or some individuals tend to binge eat or maybe watch a movie or listen to music (Ussher et al., 2007). What many people do not do is respond to their emotions by exercising or going out for walks; individuals tend to lack in performing regular exercised and Ussher et al., (2007) noted that participants had the tendency to report very little confidence when it comes to their capacity to exercise when feeling sad or stressed. He argued low self-efficacy is generally one of the strongest elements of inactivity.

In the research REFERENCE in related fields, some studies have used high-volume pressure groups as research participants, such as police, emergency response centre staff, etc., to pay attention to the slowing down of physical activity/sports exercise. For example, Clarke et al., (2015, p.90) conducted a cross-sectional survey of 533 police and emergency response centre staff. It is found that although physical exercise has nothing to do with the level of chronic stress, it has a positive relationship with the subjective perception of the individual’s health level, that is, the more physical exercise, the better the personal health level, the less the psychosomatic symptoms, the less work absence, the prompter the effect of physical activity on the improvement of stress symptoms; moreover, for the slowing effect of stress, moderate-intensity physical activity has a better impact than higher-intensity physical exercise.

In addition, for a wider population, physical activity/sports exercise has a positive effect on reducing stress symptoms and buffering stress on physical and mental health. For example, a cross-sectional study of nearly 5,000 infant mothers, Hills et al., (2015, p.368), found that the frequency of physical activity during leisure time was negatively correlated with depressive symptoms caused by life stress and time stress. The higher the rate of physical activity, the less depressive symptoms caused by life stress. Another large sample of college students (n = 14,804) (Van Kim & Nelson, 2013) supports the buffering effect of physical activity/sports on stress. They found that college students who did not meet the recommended standards for physical activity reported a greater likelihood of feeling stress (odds ratio OR of 0.75) and more likely mental health than college students who met the criteria for high-intensity physical activity. The problem (the odds ratio is 0.79); moreover, the relationship is not regulated by race and gender; at the same time, the researchers found that physical activity can also improve their mental health by enhancing socialisation of college students (Asarnow et al., 2015, p.929). Additionally, some studies using randomised controlled trials have supported the positive effects of physical activity/sports exercise on stress.

These studies have found that physical activity/physical exercise interventions can reduce stress levels perceived by individuals and improve stress symptoms in different populations. Although there is currently no meta-analysis of the effects of physical activity/sports on stress, it is not possible to accurately assess the amount of influence. However, a comprehensive empirical study can be inferred that physical activity/sports exercise should have a moderate impact on the slowing down of stress for different populations. Therefore, improving the level of physical activity/sports exercise, especially the physical activity level of medium and above intensity, is an important practical way to deal with stress (Colberg et al., 2016, p.2065).


Characteristics of adolescent physiological development

With the progress of society, the growth of the economy, and the improvement of living standards, the physiological indicators of children and adolescents have exceeded the trend (Jacka et al., 2017, p.23.).

  • The body shape changes rapidly
  • Physiological functions, changes in the brain and nervous system
  • Sexual organs and sexual function mature

With the rapid growth of physiological changes, the psychological changes in adolescents are sharp. The specific performance is (Ho et al., 2015, p.48):

  • Affectionate, emotional ups and downs
  • Personality is not yet mature, good fantasy
  • Pursue fashion, sensitive to new things and curious
  • The heart is full of contradictions and shows the confrontation

Adolescents are prone to the crisis because of their rapid physical and psychological changes, growing upsets, learning pressures, family expectations and social changes. Therefore, the adolescent period is the period in which the mental state is the most unstable and prone to obstacles. Thus, a suitable guiding method is particularly important (Ho et al., 2015, p.48).

Impact of Sports on Adolescents’ Physical Health

Sports can not only promote bone growth and increase lean body mass, but support the growth and development of adolescents’ body fullness and strength and even improve heart and lung function, which will lay the foundation for the improvement of aerobic activities. Sports can also enhance the nervous system and function so that the body of adolescents can be fully developed and refined. Appropriate sports can improve the weight and health of children and adolescents and reduce the “double peak” of overweight and obesity (Gascon et al., 2015, p.4354).

Competition is usually a form of motivation that stimulates self-improvement in adolescents. Cooperation is a collective and collaborative activity. In sports activities, competition and collaboration appear alternately or simultaneously, showing the characteristics of competition and collaboration. Competition and collaboration play an active role in cultivating middle school students to be bold, enterprising, motivate individual motivation, establish a sense of unity, improve work efficiency, and form a sound personality (Bakker et al., 2016).

Sports learning, like cognitive activities, relies on students’ comprehensive cognitive abilities of perception, memory, thinking, and attention. Therefore, adhering to sports activities can improve one’s intelligence and improve learning. Regular physical activities can make the brain improve in concentration and mental sharpness. Sufficient oxygen enables brainpower to recover quickly; good physical education and exercise training can also improve people’s attention, observation, judgment, memory, thinking, and imagination, thus providing an effective guarantee for learning activities (Bakker et al., 2016).

Experiments show that adolescents in middle school who exercise 1 or 2 times a week have a higher desire for learning achievement; middle school students who exercise more than four times a week have stronger adaptability, and problem behaviours are less likely to appear. Adolescents with bad interpersonal relationships are often depressed and unhappy, and lack of fun in life. Sports activities are always carried out in a certain social environment. Adolescents can overcome loneliness, forget troubles and pains, like interpersonal relationships, and expand in sports. Social interactions to improve social adaptability. Researchers have found that extroverted personality is more intense than introverted social needs, which can be met through collective physical activity. It can be seen that sports activities play an important role in enhancing people’s mutual interaction, overcoming loneliness and cultivating psychological reaction ability (Gadomski et al., 2015, p.267).

In addition to the increasing academic and examination burden, the mental pressure from community, parents, friends and living environment is getting more and more. Long-term psychological stress can lead to various psychological disorders and behavioural abnormalities. Excessive psychological stress not only affects the physical development of adolescents but also seriously affects their mental health development (Gu et al., 2015, p.1).

Dissemination plan

To improve the wellbeing of adolescents with depression and increase the levels of fitness to promote their wellbeing, it is vital to dissimilate the outcome of this review, so it is acknowledged to the community and public and the awareness is spread on the importance of physical exercise, especially in young people and adolescents. Methods such as seminars, posters, presentations, guidelines on policies, journals, meetings and so on to target and provide evidence-based research to the public so they can gain more useful information would be very beneficial.

The National Health Service (NHS, n.d) state that effective dissemination revolves gathering the findings of your research those whom can make use of them, therefore the benefit of the research will be maximized without delay. Presentations in schools, colleges or university may benefit the students as well as to the multi-disciplinary teams in primary and secondary care settings. Furthermore, posters can be presented on the walls of the wards so not just the nursing team can see it, but it can also be a reminder for the service users. Posters would look more appealing to many people which would catch their eye and it is easy to read. Physical exercise groups can be allocated on certain days and times so that service users are getting maximum benefits and engagement, releasing endorphins to promote improved mental health (Poitras et al., 2016).

It remains a puzzling challenge to disseminate evidence-based treatments in community settings in a way which leads to sustained implementation (Chu et al. 2015). Additionally, on discussion, sports participations and increased levels of activity in adolescents and young people should be a target of both school-based and community interventions to promote well-being (McMahon, 2017).


Barriers to implementation

Sports can eliminate psychological barriers such as lack of self-confidence, phobia, depression, and so on. When using psychotherapy for depression in some countries, family-assisted treatment is often arranged to allow patients to participate in various sports, because participating in sports has a therapeutic effect on psychological disorders (Bakker et al., 2016).

Ussher et al., (2007) questioned service users to adopt psychological measures. Perceived barriers were assessed to physical through asking which reason is the most important as why you do not exercise as much as you would like; for instance, some responses to that would be that its time consuming or the service users are afraid of obtaining an injury. The service users were also asked how confident they feel about being able to exercise when they feel sad in which they responded, either not at all, somewhat, mildly, or very confident. Some individuals were aware that exercise was very important for their mental health whereas, other individuals disagreed with this point which may be due to poor knowledge on the benefits of fitness. (Ussher et al., 2007). The majority of service users believed in the benefits of exercising for physical and mental health however as much as they enjoyed it, they had little confidence in partaking in exercise due to minimum support from family and friends. The rest of the service users however reported that their motivation levels to frequently exercise had become higher after realizing the pros and cons.

Depression has become one of the most important public health problems in the world. Patel et al., (2016, p.1672) pointed out that according to the WHO about 350 million people worldwide have experienced depression. Moreover, depression is often undiagnosed or untreated for a variety of reasons. According to the report, the incidence of depression is 3.2%, which is at a low level. However, the important reason for the low prevalence of depression may be due to the diagnostic methods and criteria used, resulting in a higher rate of misdiagnosis or missed diagnosis, rather than a true low incidence. In related research fields, the relationship between physical activity/sports and depression has been widely concerned by researchers and has obtained relatively consistent research conclusions.

For example, Felver et al., (2016, p.34) surveyed 5003 11-16year old teenagers and found that longer screen time (using television, computers, mobile phones, etc.) was a risk factor for depression in middle school students (the odds ratio OR was 1.52, 95% CI: 1.31~1.76), while high-intensity physical-activity is a protective factor for depression (odds ratio OR 0.73, 95% CI: 0.62~0.85)


This report focused on the discussion of Physical exercise to help to maintain good health and improve depression in adolescents.

Physical exercise usually refers to physical activities that are planned, regular, and repetitive, and that are designed to enhance physical fitness. Studies have shown that physical exercise has an irreplaceable role in promoting people’s mental health. To sum it up, there are the following points: (Suchert et al., 2015, p.48).

Depressed people have altered neurotransmitters such as norepinephrine, dopamine and serotonin, factors that mediate our mood (hence, one of the most used drugs are inhibitors of serotonin reuptake). At the blood and brain level, exercise increases serotonin levels, reversing its alteration in patients with depression. In summary, whilst adolescents are doing physical exercise, many signals are modulated that counteract the metabolic and neuronal alterations that occur in depression, preventing its appearance or contributing to its treatment (Hoying et al., 2016, p.65). Thus, given that standard treatments present certain limitations, we can consider physical exercise as a powerful complementary tool that, in the short and long term, will provide improved mental health.

Also, more and more research evidence suggest that physical activity/sports exercise can relieve stress, improve negative emotional experiences such as depression and anxiety in adolescents, promote the establishment of positive self-esteem, slow down the decline of cognitive function, and enhance the subjective happiness of life. Sense has a positive effect on the individual’s mental health (Betancourt et al., 2015, p.475). Although research in related fields needs to be further explored in the following aspects, i.e. Dose-response effects of physical activity and psychological benefits; improvement of physical activity on different components of mental health; physical activity promotes mental health physiology neural mechanism. However, from a practical point of view, there is sufficient evidence to show that in the specific practice of improving mental health, physical activity/physical exercise intervention should promote and deepen its use.

To sum it up, whether its skipping, jumping, jogging or walking; it can exercise a variety of organs, enhance the body’s cardiovascular, respiratory and nervous system functions, prevent a variety of physical diseases as well as depression and other mental health diagnosis (Jacka et al., 2017, p.23). Lastly, exercise has a positive effect on relaxing emotions which benefits mental health and can reduce blood pressure and level of depression hormones (Bakker et al., 2016).




































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Posted on October 29, 2019 in Nursing Assignments

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