Long-term outcomes of physical activity counseling in in-patients with major depressive disorder: results from the PACINPAT randomized controlled trial.

Major depressive disorder (MDD) is an increasingly common psychiatric illness associated with a high risk of insufficient physical activity, which in turn is associated with negative mental and physical health outcomes. Theory-based, individually tailored, in-person and remote physical activity counseling has the potential to increase physical activity levels in various populations. Given this, the present study investigated the effect of such a physical activity intervention on the physical activity behavior of in-patients with MDD. This was a multi-center, two-arm randomized controlled trial including initially insufficiently physically active adult in-patients with MDD from four study sites in Switzerland. The sample consisted of 220 participants (Mage = 41 ± 12.6 years, 52% women), 113 of whom were randomized to the intervention group and 107 to the control group. The main outcome, moderate-to-vigorous physical activity (MVPA), was assessed at three time points via hip-worn accelerometer. According to accelerometer measures, there was no significant difference in minutes spent in MVPA over a 12-month intervention period when comparing the intervention with the control group (β = -1.02, 95% CI = -10.68 to 8.64). Higher baseline physical activity significantly predicted physical activity at post and follow-up. This study showed that it is feasible to deliver an individually tailored, theory-based physical activity counseling intervention to in-patients with MDD, however yielding no significant effects on accelerometer-based MVPA levels. Further efforts are warranted to identify efficacious approaches.Trial registration: ISRCTN, ISRCTN10469580, registered on 3rd September 2018, https://www.isrctn.com/ISRCTN10469580

Short-term outcomes of physical activity counseling in in-patients with Major Depressive Disorder: Results from the PACINPAT randomized controlled trial

IntroductionA physical activity counseling intervention based on a motivation-volition model was developed and delivered to in-patients with Major Depressive Disorders with the aim of increasing lifestyle physical activity. The aim of this study is to evaluate the short-term outcomes of this intervention.MethodsA multi-center randomized controlled trial was conducted in four Swiss psychiatric clinics. Adults who were initially insufficiently physically active and were diagnosed with Major Depressive Disorder according to ICD-10 were recruited. The sample consisted of 113 participants in the intervention group (Mage = 42 years, 56% women) and 107 in the control group (Mage = 40 years, 49% women). Motivation and volition determinants of physical activity were assessed with questionnaires. Implicit attitudes were assessed with an Implicit Association Test. Physical activity was self-reported and measured with hip-worn accelerometers over 7 consecutive days starting on the day following the data collection.ResultsAccording to accelerometer measures, step count decreased on average 1,323 steps less per day (95% CI = −2,215 to −431, p < 0.01) over time in the intervention group compared to the control group. A trend was recognized indicating that moderate-to-vigorous physical activity decreased on average 8.37 min less per day (95% CI = −16.98 to 0.23, p < 0.06) over time in the intervention group compared to the control group. The initial phase of the intervention does not seem to have affected motivational and volitional determinants of and implicit attitudes toward physical activity.ConclusionPhysical activity counseling may be considered an important factor in the transition from in-patient treatment. Methods to optimize the intervention during this period could be further explored to fulfill the potential of this opportunity.Clinical trial registrationhttps://www.isrctn.com/ISRCTN10469580, identifier ISRCTN10469580

Process evaluation of a lifestyle physical activity counseling intervention for in-patients with major depressive disorders

Background: Major Depressive Disorder is a wide-spread and often chronic psychiatric disease affecting physical and psycho-social health. The global lifetime prevalence is 15-18% and approximately 12% of afflicted people are admitted to in-patient treatment at least once during their lifetime. Insufficient physical activity is prevalent among afflicted individuals, despite its potential antidepressant and protective effects. Theory-based interventions targeting psycho-social determinants of and implicit attitudes towards physical activity behavior can be effective in increasing physical activity levels. In particular, physical activity counseling has proven positive effects in healthy people as well as in out-patients. It remains unknown how a physical activity counseling intervention can be implemented and work during and after inpatient treatment, which contextual factors may be influential and how physical activity levels may be affected. Aim: The aim of this PhD thesis was to conduct a process evaluation of a theory-based, tailored lifestyle physical activity counseling intervention for in-patients with Major Depressive Disorder within the PACINPAT (physical activity counseling for in-patients with Major Depressive Disorders) study. This was conducted according to the Medical Research Council Framework and entailed quantitatively and qualitatively evaluating contextual factors, intervention implementation, mechanisms of impact as well as behavioral outcomes (objectively measured and self-reported physical activity levels). Methods: The PACINPAT study is a multi-center randomized controlled trial set in four Swiss psychiatric clinics. Adults who were insufficiently physically active upon admission to inpatient treatment were recruited (N = 244) and randomized into an intervention group (n = 123) who received tailored lifestyle physical activity counseling sessions (two in-person sessions and 26 sessions via telephone) for 12 months or a control group (n = 121) who received two in-person non-tailored counseling sessions during in-patient treatment. Quantitative data were collected at baseline (approximately 2 weeks after admission to in-patient treatment), post (approximately 6 weeks after discharge from in-patient treatment) and follow-up (12 months after discharge from in-patient treatment). Qualitative data were collected upon completion of the intervention and study participation. Data pertaining to psycho-social health (perceived stress, health status and insomnia symptoms) as well as psycho-social determinants of physical activity were measured with validated and reliable questionnaires. Data pertaining to implicit attitudes towards physical activity were assessed with a computer-based Single Target Implicit Associations Test. Self-reported physical activity was assessed via structured interviews based on the Simple Physical Activity Questionnaire. Additionally, physical activity was measured with a hip worn accelerometer. Major Depressive Disorder symptoms were measured both by self-report with the Beck Depression Inventory as well as via structured interview based on the Hamilton Depression Scale. Data pertaining to the implementation of the intervention were collected from the implementers’ documentation and participant satisfaction data were collected via questionnaire. Qualitative data were gathered via semi-structured interviews conducted in-person and online. Results: The evaluation of contextual factors revealed that, the unforeseen contextual circumstance of a global pandemic caused by the Coronavirus Disease 2019 and ensuing state-mandated lockdown seems not have elicited differences in psycho-social health, psycho-social determinants of and implicit attitudes towards physical activity as well as self-reported physical activity levels among individuals who were in in-patient treatment at that time. Depression severity did, however, seem to negatively impact certain psycho-social determinants of physical activity. The evaluation of the intervention implementation showed that the intervention dose varied between early dropouts and completers with high and low participation rates. The in-person intervention fidelity was partly achieved and so adapted, whereas the remote intervention fidelity was well achieved. Additionally, the participants reported satisfaction with the intervention and implementers. Upon deeper investigation of the mechanism of impact, i.e., how the intervention was experienced, four experience patterns were recognizable (expansive, adoptive, stagnant and confirmatory), which influenced both physical activity behavior and well-being during and after the intervention. The evaluation of the short-term intervention outcomes (6 weeks after discharge from in-patient treatment) revealed that moderate-to-vigorous physical activity as well as step count decreased in both the intervention and control group, however less so in the intervention group, indicating that physical activity counseling may be a valuable asset to explore further. Additionally, psycho-social determinants of and implicit attitudes towards physical activity seemed to remain unchanged between the groups, but positive changes (decreases in negative outcome expectancies and increases in action and coping planning) were seen over time in both groups. Conclusion: The theory-based, tailored lifestyle physical activity counseling intervention was implemented successfully during and after in-patient treatment. The process evaluation of the contextual factors, intervention implementation, mechanism of impact and short-term outcomes revealed valuable insights into future intervention refinement. This may entail adapting physical activity counseling to illness severity and how the individual is managing their illness. Especially with potentially declining physical activity behavior during the transition out of inpatient treatment, offering support during this vulnerable phase is particularly important. Further research is required, to ascertain the long-term effects of physical activity counseling in in-patients with Major Depressive Disorder. Followed by the adaptation and broader dissemination of physical activity promotion programs to reach those most in need

The effects of psychotherapy on reducing depression in residential aged care: a meta-analytic review

Published and unpublished randomized controlled trials of psychotherapeutic treatments for depression in residential aged care were systematically reviewed. A medium effect size was found to favor psychotherapy for reducing symptoms of depression in residents (average age, 79.8 years) based on 17 trials. The effect was maintained at follow-up, but was weaker and not statistically significant when interventions were compared with active control conditions in 6 trials. There was heterogeneity across studies; however, potential moderating factors were difficult to identify due to large within-study variance. A sensitivity analysis revealed that the Geriatric Depression Scale (GDS) 15-item version produced a larger effect size than did the GDS-30, and an integrated care approach was more effective than providing psychological interventions independent of aged care staff

Association between depression severity and fitness in in-patients with major depressive disorders

Introduction It has been shown that people with major depressive disorder exercise less and have lower fitness levels than healthy individuals (Schuch et al., 2017). People with major depressive disorder have a decrease in their cardiovascular health which leads to a poorer autonomic function and heart rate variability (HRV; Kemp et al., 2010). However, not only objective parameters are influenced by major depressive disorder, but also subjective ones, like perceived fitness. As differences between people with major depressive disorder and healthy people have often been investigated, this study aims to investigate fitness, perceived fitness and HRV in individuals with different levels of depression severity. Methods The study is part of the multicentre randomised controlled PACINPAT trial, in which inpatients receive physical activity counselling. Data from baseline assessments are used for this analysis (Gerber et al., 2019). The classification according to depression severity is based on the Beck Depression Inventory (BDI-II). Fitness was determined using the submaximal Åstrand ergometer cycling test. Perceived fitness is self-reported and resting HRV was measured for 5 minutes. The three groups with different severity of depression were compared using ANCOVA for the three mentioned parameters. Results We analysed data from 215 patients. The average BDI-II score at baseline was 22.2 (SD 10.3; range 2-50). With regard to depression severity, 41.4% (n = 89) were classified as having mild depression, 34.4% (n = 74) presented with moderate depression, and 24.2% (n = 52) fell into the category of severe depression. Data analysis is not finalized yet. The presentation will focus on differences in terms of fitness, perceived fitness and HRV parameters between the three severity groups. Conclusion The study will show if there are differences in fitness, perceived fitness and autonomic function as measured by HRV between depressive patients of different severity levels. This complements previous research on differences between patients with major depressive disorder and healthy individuals. It may also help practitioners to tailor interventions more accurately to individuals with different levels of depression severity, as different levels of co-occurring symptoms need to be considered. References Gerber, M., Beck, J., Brand, S., Cody, R., Donath, L., Eckert, A., Faude, O., Fischer, X., Hatzinger, M., Holsboer-Trachsler, E., Imboden, C., Lang, U., Mans, S., Mikoteit, T., Oswald, A., Pühse, U., Rey, S., Schreiner, A.-K., Schweinfurth, N., . . . Zahner, L. (2019). The impact of lifestyle Physical Activity Counselling in IN-PATients with major depressive disorders on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers: Study protocol for a randomized controlled trial. Trials, 20(1), Article 367. https://doi.org/10.1186/s13063-019-3468-3 Kemp, A. H., Quintana, D. S., Gray, M. A., Felmingham, K. L., Brown, K., & Gatt, J. M. (2010). Impact of depression and antidepressant treatment on Heart Rate Variability: A review and meta-analysis. Biological Psychiatry, 67(11), 1067-1074. https://doi.org/10.1016/j.biopsych.2009.12.012 Schuch, F., Vancampfort, D., Firth, J., Rosenbaum, S., Ward, P., Reichert, T., Bagatini, N. C., Bgeginski, R., & Stubbs, B. (2017). Physical activity and sedentary behavior in people with major depressive disorder: A systematic review and meta-analysis. Journal of affective disorders, 210, 139-150. https://doi.org/10.1016/j.jad.2016.10.05

What is needed to promote physical activity? : Current trends and new perspectives in theory, intervention, and implementation

Despite the health-related benefits and published evidence-based physical activity (PA) guidelines, global PA levels have been stagnating since the 2000s, with around 80% of adolescents and 28% of adults not achieving the recommendations. As a result, a pandemic of physical inactivity is occurring, with far-reaching health consequences along with a substantial economic burden. This has led to the development of the Global Action Plan on Physical Activity 2018-2030 (GAPPA). GAPPA includes recommendations and 20 related evidence-based policy actions, which are adaptable across country contexts. The Irish PA Research Collaboration implemented strategies from the GAPPA at a national level and thus, conducted a systems map to identify gaps and strengths in PA policy. Using this approach, the Move for Life intervention was successfully developed, implemented, and evaluated. In line with a whole system approach, a better understanding of the individual is also required in the course of successfully promoting and maintaining PA. Affective-Reflective Theory of physical inactivity and exercise highlights the importance of learnt affective responses to exercise-related stimuli, and suggests that both automatic and controlled processes contribute to the adoption and maintenance of a physically active lifestyle. A method to shed light on motivational processes and people’s everyday behavior is longitudinal micro-temporal data. During the challenging situations such as the COVID-19, longitudinal micro-temporal data collected through mobile and wearable devices can capture processes and conditions that underlie flexible shifting between the automatic and controlled processes needed to maintain behavior. In summary, this paper compiles key concepts for PA promotion and maintenance, from which future directions follow: Gathering more extensive PA and sedentary behavior data; applying a whole system approach; considering new perspectives with a dual mode approach; avoiding unpleasant feelings during PA or exercise; conceiving interventions that promote flexibility; and capitalizing on technology to integrate and achieve these future directions

Cardiorespiratory fitness, perceived fitness and autonomic function in in-patients with different depression severity compared with healthy controls.

Over 300 million individuals worldwide suffer from major depressive disorder (MDD). Individuals with MDD are less physically active than healthy people which results in lower cardiorespiratory fitness (CRF) and less favorable perceived fitness compared with healthy controls. Additionally, individuals with MDD may show autonomic system dysfunction. The purpose of the present study was to evaluate the CRF, perceived fitness and autonomic function in in-patients with MDD of different severity compared with healthy controls. We used data from 212 in-patients (age: 40.7 ± 12.6 y, 53% female) with MDD and from 141 healthy controls (age: 36.7 ± 12.7 y, 58% female). We assessed CRF with the Åstrand-Rhyming test, self-reported perceived fitness and autonomic function by heart rate variability (HRV). In specific, we used resting heart rate, time- and frequency-based parameters for HRV. In-patients completed the Beck Depression Inventory-II (BDI-II) to self-assess the subjectively rated severity of depression. Based on these scores, participants were grouped into mild, moderate and severe MDD. The main finding was an inverse association between depression severity and CRF as well as perceived fitness compared with healthy controls. Resting heart rate was elevated with increasing depression severity. The time-based but not the frequency-based autonomic function parameters showed an inverse association with depression severity. The pattern of results suggests that among in-patients with major depressive disorder, those with particularly high self-assessed severity scores show a lower CRF, less favorable perceived fitness and partial autonomic dysfunction compared to healthy controls. To counteract these conditions, physical activity interventions may be effective

Elaborating the discussion on promoting physical activity: Response to Schwarzer, Biddle, Rhodes and Ntoumanis: Elaborating the discussion on promoting physical activity

We would like to thank our esteemed colleagues Stuart Biddle, Nikos Ntoumanis, Ryan Rhodes, and Ralf Schwarzer very much for taking the time to read the Target Article “What is needed to promote physical activity?” and to provide such important reflections and further insights into the topic. In the present commentary, the authors of the Target Article take the opportunity to respond to the comments of the aforementioned authors