Table 2.

Systematic review – exercise interventions (Methodological issues/Risk of bias)

Study	Country	Participants & setting	Design	Recruitment	Baseline sample	Number completing trial	Methodological issues/Risk of bias
Beebe et al. [41]	USA	Patients attending outpatient clinic at a Veterans Hospital	RCT	Volunteers	12	10	Participants – eligibility criteria specified - yes
							- standardised diagnostic criteria - Yes
							- non-random recruitment
							- similar baseline groups
							Intervention – details of therapists training not indicated
							- no treatment manual
							- compliance of medication non- checked
							Measurement of Outcome
							- outcome assessors blinded to treatment allocation
							- adequate follow- up period
							Risk of Bias - adequate sequence generation- unclear
							allocation concealment- unclear
							blinding of participants, personnel and outcome assessors - yes
							incomplete data outcome - yes
							free of selective outcome reporting- yes
							free of other sources of bias- yes
							Small sample, majority male, control group awareness of exercise programme.
							Attendance at sessions variable.
Skrinar et al. [45]	USA	Patients from inpatient, partial hospitalisation, outpatient and community centres in area of McLean Hospital.	RCT	Selection/ invitation	30	20	Participants – eligibility criteria specified - yes
							- standardised diagnostic criteria -yes
							- non-random recruitment
							- similar baseline groups –
							Intervention – details of therapists training not indicated
							- no treatment manual
							Measurement of Outcome
							- outcome assessors not blinded to treatment allocation
							- adequate follow- up period
							Risk of Bias - adequate sequence generation - unclear
							allocation concealment - unclear
							blinding of participants, personnel and outcome assessors - no
							incomplete data outcome - no
							free of selective outcome reporting - yes
							free of other sources of bias - yes
							Small sample, variable adherence to programme and attendance, inclusion criteria include mood disorders as well.
							Control group may be affected by exercise “influence” of study.
Acil et al. [47]	Turkey	Inpatient and outpatient. Diagnosis of schizophrenia	RCT	Recruitment method not described, 30 outpatients and inpatients.	30	30	Participants – eligibility criteria poorly specified
							- standardised diagnostic criteria- yes
							- non-random recruitment
							- similar baseline group
							Intervention – details of therapists training not indicated
							- no treatment manual
							Measurement of Outcome
							- outcome assessors not blinded
							- adequate follow- up period
							Risk of Bias - adequate sequence generation - no
							allocation concealment - no
							blinding of participants, personnel and outcome assessors - no
							incomplete data outcome - unclear
							free of selective outcome reporting - unclear
							free of other sources of bias - yes
							Non-standardized exercise intervention. No measurement of existing exercise level or patient participation in the programme.
							Number completed trial not given.
Marzolini et al. [46]	Canada	Identified from Community Mental Health Programme. Majority lived supported accommodation.	RCT	Volunteers	13	13	Participants – eligibility criteria specified - yes
							- standardised diagnostic criteria -yes
							- non-random recruitment
							- similar baseline groups –
							Intervention – details of therapists training not indicated
							- no treatment manual
							Measurement of Outcome
							- outcome assessors not blinded to treatment allocation
							- adequate follow- up period
							Risk of Bias - adequate sequence generation - yes
							allocation concealment - yes
							blinding of participants, personnel and outcome assessors - unclear
							incomplete data outcome - no
							free of selective outcome reporting - yes
							free of other sources of bias - yes
							Small sample, participants supported accommodation. Inclusion criteria – patients had to have one or more cardiovascular risk factors.
Beebe et al. [43]	USA	Outpatients	RCT	Volunteers	97	79	Participants – eligibility criteria specified
							- standardised diagnostic criteria
							- non-random recruitment
							- similar baseline groups
							Intervention – details of therapists training indicated
							- treatment manual - yes
							- compliance of medication non- not checked
							Measurement of Outcome
							- outcome assessors not blinded to treatment allocation
							- adequate follow- up period
							Risk of Bias - adequate sequence generation - yes
							allocation concealment - unclear
							blinding of participants, personnel and outcome assessors - unclear
							incomplete data outcome - unclear
							free of selective outcome reporting - yes
							free of other sources of bias - yes
							Well-designed programme. Adequate sample size.
							No assessment of mental health changes - improvement in mental health may have contributed to increase in exercise by itself.
Methapatara et al. [44]	Thailand	Inpatient & Outpatients	RCT	Volunteers	64	64	Participants – eligibility criteria specified
							- standardised diagnostic criteria – not indicated
							- volunteers
							- dissimilar baseline groups –
							younger control population
							Intervention – details of therapists training not indicated
							- treatment manual - no
							- compliance of medication not checked
							Measurement of Outcome
							- outcome assessors blinded to treatment allocation
							- adequate follow- up period
							Risk of Bias - adequate sequence generation - yes
							allocation concealment - yes
							blinding of participants, personnel and outcome assessors - no
							incomplete data outcome - yes
							free of selective outcome reporting - yes
							free of other sources of bias - yes
							Small sample size, no record of daily steps recorded or measurement of change in exercise levels. Compliance with programme unknown (as no recording of pedometer). No assessment of nutritional intake which may have affected outcome. Effect on mental health unknown.
Scheewe et al. [42]	USA	Community	RCT	Volunteers	118	92	Participants – eligibility criteria specified - yes
							- standardised diagnostic criteria – not indicated
							- non-random recruitment
							- dissimilar baseline groups
							Intervention – details of therapists training indicated
							- treatment manual
							Measurement of Outcome
							- outcome assessors not blinded to treatment allocation
							- adequate follow-up period
							Risk of Bias - adequate sequence generation - yes
							allocation concealment - yes
							blinding of participants, personnel and outcome assessors - no
							incomplete data outcome - unclear
							free of selective outcome reporting - yes
							free of other sources of bias - yes
							Well-designed programme. Large sample size. Computer generated randomisation. Study part of larger research trials. No results from mental health assessment. Baseline group differences. Mean weight greater in patients than controls. Motivated group of patients with higher level of fitness at baseline. No follow up of participants to show whether improvement in exercise maintained.
Pelham et al. [48]	USA	Community Rehabilitat-ion	RCT	Volunteers	10	10	Participants – eligibility criteria specified - yes
							- standardised diagnostic criteria – not indicated
							- non-random recruitment
							- baseline groups unclear
							Intervention – details of therapists training indicated - no
							- treatment manual- no
							Measurement of Outcome
							- outcome assessors not blinded to treatment allocation
							- adequate follow-up period
							Risk of Bias - adequate sequence generation - unclear
							allocation concealment - unclear
							blinding of participants, personnel and outcome assessors - no
							incomplete data outcome - unclear
							free of selective outcome reporting - unclear
							free of other sources of bias – unclear
							Small study. Control also using exercise activity. Data not available to include in meta-analysis. Early study 21 years ago. Beneficial effects on exercise fitness and depression scores.