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      Facilitated physical activity as a treatment for depressed adults: randomised controlled trial

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          Abstract

          Objective To investigate the effectiveness of facilitated physical activity as an adjunctive treatment for adults with depression presenting in primary care.

          Design Pragmatic, multicentre, two arm parallel randomised controlled trial.

          Setting General practices in Bristol and Exeter.

          Participants 361 adults aged 18-69 who had recently consulted their general practitioner with symptoms of depression. All those randomised had a diagnosis of an episode of depression as assessed by the clinical interview schedule-revised and a Beck depression inventory score of 14 or more.

          Interventions In addition to usual care, intervention participants were offered up to three face to face sessions and 10 telephone calls with a trained physical activity facilitator over eight months. The intervention was based on theory and aimed to provide individually tailored support and encouragement to engage in physical activity.

          Main outcome measures The primary outcome was self reported symptoms of depression, assessed with the Beck depression inventory at four months post-randomisation. Secondary outcomes included use of antidepressants and physical activity at the four, eight, and 12 month follow-up points, and symptoms of depression at eight and 12 month follow-up.

          Results There was no evidence that participants offered the physical activity intervention reported improvement in mood by the four month follow-up point compared with those in the usual care group; adjusted between group difference in mean Beck depression inventory score −0.54 (95% confidence interval −3.06 to 1.99; P=0.68). Similarly, there was no evidence that the intervention group reported a change in mood by the eight and 12 month follow-up points. Nor was there evidence that the intervention reduced antidepressant use compared with usual care (adjusted odds ratio 0.63, 95% confidence interval 0.19 to 2.06; P=0.44) over the duration of the trial. However, participants allocated to the intervention group reported more physical activity during the follow-up period than those allocated to the usual care group (adjusted odds ratio 2.27, 95% confidence interval 1.32 to 3.89; P=0.003).

          Conclusions The addition of a facilitated physical activity intervention to usual care did not improve depression outcome or reduce use of antidepressants compared with usual care alone.

          Trial registration Current Controlled Trials ISRCTN16900744.

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          Most cited references11

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          Compendium of physical activities: an update of activity codes and MET intensities.

          We provide an updated version of the Compendium of Physical Activities, a coding scheme that classifies specific physical activity (PA) by rate of energy expenditure. It was developed to enhance the comparability of results across studies using self-reports of PA. The Compendium coding scheme links a five-digit code that describes physical activities by major headings (e.g., occupation, transportation, etc.) and specific activities within each major heading with its intensity, defined as the ratio of work metabolic rate to a standard resting metabolic rate (MET). Energy expenditure in MET-minutes, MET-hours, kcal, or kcal per kilogram body weight can be estimated for specific activities by type or MET intensity. Additions to the Compendium were obtained from studies describing daily PA patterns of adults and studies measuring the energy cost of specific physical activities in field settings. The updated version includes two new major headings of volunteer and religious activities, extends the number of specific activities from 477 to 605, and provides updated MET intensity levels for selected activities.
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            The MOS short-form general health survey. Reliability and validity in a patient population.

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              Interventions for promoting physical activity.

              Little is known about the effectiveness of strategies to enable people to achieve an increase in their physical activity. To assess the effects of interventions for promoting physical activity in adults aged 16 years and older, not living in an institution. We searched CENTRAL (Issue 4, 2001), MEDLINE, EMBASE, CINAHL, PsychLIT, BIDS ISI, SPORTDISCUS, SIGLE, SCISEARCH (from earliest date available to December 2001) and reference lists of articles. Randomised, controlled, trials comparing different interventions to encourage sedentary adults not living in an institution to become physically active. Studies required a minimum of six months follow up from the start of the intervention to the collection of final data and either used an intention to treat analysis or, failing that, had no more than 20% loss to follow up. At least two reviewers independently assessed each study quality and extracted data. Study authors were contacted for additional information where necessary. Standardised mean differences and 95% confidence intervals were calculated for continuous measures of self reported physical activity and cardio-respiratory fitness. For studies with dichotomous outcomes, odds ratios and 95% confidence intervals were calculated. The effect of interventions on self reported physical activity (11 studies; 3940 participants) was positive and moderate, with a pooled standardised mean difference of 0.31 (95% CI 0.12 to 0.50), as was the effect on cardio-respiratory fitness (7 studies; 1406 participants) pooled SMD 0.4 (95% CI 0.09 to 0.70). The effect of interventions in achieving a predetermined threshold of physical activity (6 studies; 2313 participants) was not significant with an odds ratio of 1.30 (95% CI 0.87 to 1.95). There was significant heterogeneity in the reported effects as well as heterogeneity in characteristics of the interventions. The heterogeneity in reported effects was reduced in higher quality studies, when physical activity was self-directed with some professional guidance and when there was on-going professional support. Our review suggests that physical activity interventions have a moderate effect on self reported physical activity and cardio-respiratory fitness, but not on achieving a predetermined level of physical activity. Due to the clinical and statistical heterogeneity of the studies, only limited conclusions can be drawn about the effectiveness of individual components of the interventions. Future studies should provide greater detail of the components of interventions.
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                Author and article information

                Contributors
                Role: research fellow
                Role: senior lecturer
                Role: professor
                Role: senior lecturer
                Role: senior lecturer
                Role: professor
                Role: professor
                Role: research associate
                Role: research associate
                Role: research associate
                Role: associate research fellow
                Role: associate research fellow
                Role: lecturer
                Role: professor
                Role: professor
                Role: professor
                Role: professor
                Role: reader
                Role: professor
                Journal
                BMJ
                BMJ
                bmj
                BMJ : British Medical Journal
                BMJ Publishing Group Ltd.
                0959-8138
                1756-1833
                2012
                2012
                06 June 2012
                : 344
                : e2758
                Affiliations
                [1 ]School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
                [2 ]Primary Care Research Group, Peninsula Medical School, Exeter, UK
                [3 ]School of Policy Studies, University of Bristol
                [4 ]Sport and Health Sciences, University of Exeter, Exeter
                [5 ]School of Social Policy, University of Kent, Canterbury, UK
                [6 ]School of Clinical Sciences, University of Bristol
                Author notes
                Correspondence to: M Chalder melanie.chalder@ 123456bristol.ac.uk
                Article
                cham002295
                10.1136/bmj.e2758
                3368484
                22674921
                b01c2145-4148-4e1a-ad54-b399ac5e7f43
                © Chalder et al 2012

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

                History
                : 22 March 2012
                Categories
                Research
                Clinical Trials (Epidemiology)
                General Practice / Family Medicine
                Mood Disorders (Including Depression)
                Drugs: Musculoskeletal and Joint Diseases

                Medicine
                Medicine

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