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

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

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

Coach-athlete relationship and burnout symptoms among young elite athletes and the role of mental toughness as a moderator

Abstract: Introduction: Social and contextual factors play an important role for elite athletes’ mental health. In the present study, we examined how young elite athletes’ coach-athlete relationship appraisals are associated with and longitudinally predict general and athlete-specific burnout symptoms and whether mental toughness moderates the association between the coach-athlete relationship and burnout symptoms. Methods: In this prospective study, data were collected twice within a 6 to 10-month interval. The sample consisted of 295 athletes attending Swiss Olympic Partner Schools (186 boys, 109 girls), with a mean age of 16.73±1.38 years. The following instruments were applied: Coach-Athlete Relationship Questionnaire (CART-Q), Athlete Burnout Questionnaire (ABQ), Shirom-Melamed Burnout Measure (SMBM), and Mental Toughness Questionnaire (MTQ). Cross-lagged panel analyses were performed to examine reciprocal relationships across time. Interaction effects were tested via hierarchical regression analyses. Results: Cross-sectionally, athletes who perceived their coach-athlete relationship as negative reported more general and athlete-specific burnout symptoms. Burnout symptoms were relatively stable across time, which made it difficult to explain further variance via coach-athlete relationship appraisals in the prospective analyses. While higher mental toughness scores were associated with fewer burnout symptoms in the cross-sectional analyses, higher mental toughness did not moderate the association between the coach-athlete relationship and burnout symptoms. Conclusion: The coach-athlete relationship plays an important role in athletes’ mental health. Therefore, coaches need the ability to develop effective relationships with their athletes, including thoughtful and respectful communication about issues specific to sport and life generally