Healthy hearts healthy minds: A randomized trial of online interventions to improve physical activity.

INTRODUCTION: Depressed individuals are more likely to die from cardiovascular disease (CVD) than those without depression. People with CVD have higher rates of depression than those without and have higher mortality rates if they have comorbid depression. While physical activity (PA) improves both, few people engage in enough. We compared self-guided internet-based cognitive behavior therapy (CBT) + Fitbit or mindfulness-based cognitive therapy (MBCT) + Fitbit, with Fitbit only to increase daily steps for participants with depression who have low PA. METHODS: Adult participants (N = 340) were recruited from two online patient-powered research networks and randomized to one of three study interventions for 8 weeks with an additional 8 weeks of follow-up. Using linear mixed effects models, we evaluated the effect of the intervention on average daily steps (NCT03373110). RESULTS: Average daily steps increased 2.8 steps per day in MBCT+Fitbit, 2.9 steps/day in CBT + Fitbit, but decreased 8.2 steps/day in Fitbit Only. These changes were not statistically different between the MBCT+Fitbit and CBT + Fitbit groups, but were different from Fitbit Only across the initial 8-week period. Group differences were not maintained across follow-up. Exploratory analyses identified comorbid anxiety disorders, self-reported PA, and employment status as moderators. DISCUSSION: Changes in daily steps over both 8- and 16-week periods-regardless of intervention group-were minimal. The results emphasize the limits of using self-guided web-based psychotherapy with an activity tracker to increase PA in participants with a history of depression and low PA.

The relationship between suicidal thoughts and well-being among individuals with a history of depression and cardiovascular risk.

Prior work demonstrates a relationship between suicidal behavior and mood disorders, as well as between suicidal behavior and cardiovascular risk. When cardiovascular risk and mood disorders co-occur, people with these comorbid conditions tend to experience worse outcomes than people with only one of these conditions. As such, given the relevance of suicidal thoughts and behaviors among those with cardiovascular risk and mood disorders, suicidal thoughts and behaviors may be of particular concern in the comorbid population. However, the factors that differentiate those with or without suicidal thoughts or behaviors are unknown. Self-reported well-being is one factor that is shown to hold a relationship with suicidal risk, and may be relevant in the comorbid population. Thus, we evaluated whether different levels of well-being relate to suicidal thoughts and behaviors among individuals (N = 340) with lifetime mood disorders and cardiovascular risk who participated in a 16-week online exercise study. Participants completed self-report assessments of lifetime (per the MINI International Neuropsychiatric Interview) and current (per the Patient Health Questionnaire-9) suicidal thoughts and behaviors, as well as a self-report assessment of well-being (per the WHO-5 Well-Being Index). We found that individuals with lifetime and current suicidal thinking had lower total WHO-5 scores over the study period. These data suggest that, among those with a history of depression and who have or are at-risk for cardiovascular disease, the risk of current or lifetime suicidal thoughts and behaviors may be increased for those who experience decreased well-being.