COVID-19 Pandemic and Exercise (COPE) trial: a multigroup pragmatic randomised controlled trial examining effects of app-based at-home exercise programs on depressive symptoms.

BACKGROUND: The number of adults across the globe with significant depressive symptoms has grown substantially during the COVID-19 pandemic. The extant literature supports exercise as a potent behaviour that can significantly reduce depressive symptoms in clinical and non-clinical populations. OBJECTIVE: Using a suite of mobile applications, at-home exercise, including high intensity interval training (HIIT) and/or yoga, was completed to reduce depressive symptoms in the general population in the early months of the pandemic. METHODS: A 6-week, parallel, multiarm, pragmatic randomised controlled trial was completed with four groups: (1) HIIT, (2) Yoga, (3) HIIT+yoga, and (4) waitlist control (WLC). Low active, English-speaking, non-retired Canadians aged 18-64 years were included. Depressive symptoms were measured at baseline and weekly following randomisation. RESULTS: A total of 334 participants were randomised to one of four groups. No differences in depressive symptoms were evident at baseline. The results of latent growth modelling showed significant treatment effects in depressive symptoms for each active group compared with the WLC, with small effect sizes (ESs) in the community-based sample of participants. Treatment groups were not significantly different from each other. Effect sizes were very large (eg, week 6 ES range=-2.34 to -2.52) when restricting the analysis only to participants with high depressive symptoms at baseline. CONCLUSIONS: At-home exercise is a potent behaviour to improve mental health in adults during the pandemic, especially in those with increased levels of depressive symptoms. Promotion of at-home exercise may be a global public health target with important personal, social and economic implications as the world emerges scathed by the pandemic. TRIAL REGISTRATION NUMBER: NCT04400279.

Effects of 12 Weeks of At-Home, Application-Based Exercise on Health Care Workers' Depressive Symptoms, Burnout, and Absenteeism: A Randomized Clinical Trial.

Importance: During the COVID-19 pandemic, health care workers (HCWs) reported a significant decline in their mental health. One potential health behavior intervention that has been shown to be effective for improving mental health is exercise, which may be facilitated by taking advantage of mobile application (app) technologies. Objective: To determine the extent to which a 12-week app-based exercise intervention can reduce depressive symptoms, burnout, and absenteeism in HCWs, compared with a wait list control condition. Design, Setting, and Participants: A 2-group randomized clinical trial was conducted, with participants screened from April 6 to July 4, 2022. Participants were recruited from an urban health care organization in British Columbia, Canada. Participants completed measures before randomization and every 2 weeks thereafter. Interventions: Exercise condition participants were asked to complete four 20-minute sessions per week using a suite of body weight interval training, yoga, barre, and running apps. Wait-listed control participants received the apps at the end of the trial. Main Outcomes and Measures: The primary outcome consisted of the between-group difference in depressive symptoms measured with the 10-item Center for Epidemiological Studies Depression Scale. The secondary outcomes corresponded to 3 subfacets of burnout (cynicism, emotional exhaustion, and professional efficacy) and absenteeism. Intention-to-treat analyses were completed with multilevel structural equation modeling, and Feingold effect sizes (ES) were estimated every 2 weeks. Results: A total of 288 participants (mean [SD] age, 41.0 [10.8] years; 246 [85.4%] women) were randomized to either exercise (n = 142) or wait list control (n = 146) conditions. Results revealed that ESs for depressive symptoms were in the small to medium range by trial's end (week 12, -0.41 [95% CI, -0.69 to -0.13]). Significant and consistent treatment effects were revealed for 2 facets of burnout, namely cynicism (week 12 ES, -0.33 [95% CI, -0.53 to -0.13]) and emotional exhaustion (week 12 ES, -0.39 [95% CI, -0.64 to -0.14]), as well as absenteeism (r = 0.15 [95% CI, 0.03-0.26]). Adherence to the 80 minutes per week of exercise decreased from 78 (54.9%) to 33 (23.2%) participants between weeks 2 and 12. Conclusions and Relevance: Although exercise was able to reduce depressive symptoms among HCWs, adherence was low toward the end of the trial. Optimizing adherence to exercise programming represents an important challenge to help maintain improvements in mental health among HCWs. Trial Registration: ClinicalTrials.gov Identifier: NCT05271006.