Initiating and maintaining physical activity in depressed individuals

 描述（由申请人提供）：抑郁症是普遍存在的，抑郁症患者的许多身体健康问题的风险增加。更多的体育活动可以降低身体健康问题的风险，越来越多的证据表明体育活动可以减少抑郁症状。然而，抑郁症患者的身体活动率较低，相对于非抑郁症患者，他们对运动干预的坚持性较差。这可能是由于，至少部分是由于抑郁症的特定核心特征，如快感缺乏（缺乏享受），动力不足和疲劳，以及较差的解决问题的能力，这可能会阻碍科普认知/情感和环境障碍的能力。以前关于抑郁人群体育活动的研究主要集中在体育活动是否是抑郁症的有效治疗方法。然而，几乎没有研究已经解决了关键问题的最佳策略，以增加和维持体力活动的抑郁症患者。我们提出了一项随机临床试验，其中240名抑郁症患者被分配到三个臂中的一个，每个连续的臂都有一个额外的组成部分，可能有助于增加和维持体力活动：1）简短的建议（BA）锻炼（2）BA +家庭指导运动（SHE）+健康教育（HE）接触对照; 3）BA+SHE+认知行为训练（CBEX）。参与者有两个阶段：干预阶段（3个月），包括密集接触，以及后续阶段（6个月）。BA将包括一个45分钟的关于公共卫生建议和开始策略的会议。SHE将是一项为期12周的干预措施，包括每周1次有监督的运动加上家庭运动的运动处方，目标是逐步实现每周150分钟中度至剧烈体力活动（MVPA）的公共卫生建议。在干预阶段，CBEX和HE会议将是单独的，30分钟，每周一次。CBEX将解决在抑郁症中特别明显的身体活动障碍，以及应对障碍的解决问题技能。在随访阶段，在干预阶段接受SHE的小组将收到运动专家的简短每月电话检查。我们的主要目标是：比较3组在12周干预期和6个月随访期增加MVPA的疗效。次要目标包括：评估干预措施对抑郁症和身体健康结果的影响;确定MVPA的量是否介导组分配和抑郁症状变化之间的关联;检查基于行为改变理论的组分配和MVPA之间的关联中介;并检查运动的社会和环境障碍是否预测运动维持。鉴于抑郁症的高发病率和相关的发病率和死亡率，关键是要评估如何最好地结合联合收割机的干预措施，以增加MVPA在短期和长期。

 DESCRIPTION (provided by applicant): Depression is prevalent and depressed individuals are at increased risk for numerous physical health problems. More physical activity decreases risk of physical health problems, and there is growing evidence that physical activity reduces depression symptoms. However, depressed individuals have low rates of physical activity and poor adherence to exercise interventions relative to non-depressed groups. This is likely due, at least in part, to specific core features of depression such as anhedonia (lack of enjoyment), amotivation, and fatigue, as well poorer problem-solving abilities which may impede the ability to cope with cognitive/ affective and environmental barriers to exercise. Previous research on physical activity in depressed populations has focused primarily on whether physical activity is an efficacious treatment for depression. However, virtually no research has addressed key questions about optimal strategies for increasing and maintaining physical activity in depressed individuals. We propose a randomized clinical trial in which 240 depressed individuals are assigned to one of three arms, with each successive arm having an added component that may serve to increase and maintain physical activity: 1) brief advice (BA) to exercise (control condition); 2) BA + supervised & home-based exercise (SHE)+ health education(HE) contact control; and 3) BA+SHE+ cognitive-behavioral sessions focused on increasing and maintaining exercise (CBEX). There are two phases for participants: intervention phase (3 months), which consists of intensive contact, and the follow-up phase (6 months). BA will consist of one, 45-minute session about public health recommendations and strategies for getting started. SHE will be a 12-week intervention consisting of 1x/week supervised exercise plus exercise prescriptions for home-based exercise with the goal of gradually achieving the public health recommendation of 150 minutes/ week of moderate-to-vigorous physical activity (MVPA). CBEX and HE sessions will be individual, 30-minute, weekly sessions during the intervention phase. CBEX will address barriers to physical activity that are particularly pronounced in depression, as well as problem-solving skills for coping with barriers. During the follow-up phase, groups who received SHE during the intervention phase will receive brief, monthly phone check-ins from an exercise specialist. Our primary aims are to: compare the efficacy of the 3 arms for increasing MVPA during the 12-week intervention phase and during the 6 month follow-up phase. Secondary aims include: to assess the impact of the interventions on depression and physical health outcomes; to determine whether amount of MVPA mediates the association between group assignment and change in depressive symptoms; to examine behavior change theory-based mediators of the association between group assignment and MVPA; and to examine whether social and environmental barriers to exercise predict exercise maintenance. Given high rates of depression and associated morbidity and mortality, it is critical to evaluate whether how best to combine exercise interventions to increase MVPA in both the shorter- and longer- term.