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Response: Effects of physical activity on depressive symptoms during breast cancer survivorship: a meta-analysis of randomised control trials
  1. Efrossini D Patsou1,
  2. Michalis V Karamouzis2
  1. 1Department of Psychology, Panteion Panepistimio Koinonikon Kai Politikon Epistimon, Athena, Attikḗ, Greece
  2. 2Medical School, National and Kapodistrian University of Athens, Athens, Greece
  1. Correspondence to Professor Michalis V Karamouzis; m_karam{at}


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  • physical activity
  • breast cancer
  • survivors

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We would like to thank Alwardat et al for their comments about the effects of physical activity in depressive symptoms among breast cancer survivors.1 We would like to indicate that the current meta-analysis did not compare physical activity with pharmacological interventions. The purpose of the study was to present the results of physical activity and exercise interventions in terms of type and duration regarding the depressive symptoms among breast cancer survivors during and after treatment.

Physiotherapy Evidence Database (PEDro) scale is widely used to rate the quality of randomised controlled trials (RCT). PEDro scores are summarised and high-quality studies are those with scores from 6 to 11, fair quality from 4 to 5, and poor quality less than 4.2

For PEDro scale, points are only awarded when a criterion is clearly satisfied and reported. On a literal reading of the trial report it is possible that a criterion was not satisfied or reported; in this case, point is not awarded for that criterion. PEDro list has been used in the literature for systematic reviews and meta-analysis to assess the methodological quality of the studies.1–5

All studies included were RCTs and all of them were following the PICO (Population, Intervention, Comparison, Outcome) format. More inclusion criteria were added from the authors in order to make a better and regional study design.

Finally, the included RTCs and the results from the different types of exercise were tested for their heterogeneity with effect size measurements.


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  • Contributors Both authors agree to the content of the submitted letter.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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