Preferred intensity exercise for adolescents receiving treatment for depression: a pragmatic randomised controlled trial.

BACKGROUND: Exercise has been shown to be effective in treating depression, but trials testing the effect of exercise for depressed adolescents utilising mental health services are rare. The aim of this study was to determine the effectiveness of a preferred intensity exercise intervention on the depressive symptoms of adolescents with depression. METHODS: We randomly assigned 87 adolescents who were receiving treatment for depression to either 12 sessions of aerobic exercise at preferred intensity alongside treatment as usual or treatment as usual only. The primary outcome was depressive symptom change using the Children's Depression Inventory 2(nd) Version (CDI-2) at post intervention. Secondary outcomes were health-related quality of life and physical activity rates. Outcomes were taken at baseline, post intervention and at six month follow up. RESULTS: CDI-2 score reduction did not differ significantly between groups at post-intervention (est. 95% CI -6.82, 1.68, p = 0.23). However, there was a difference in CDI-2 score reduction at six month follow-up in favour of the intervention of -4.81 (est. 95% CI -9.49, -0.12, p = 0.03). Health-related quality of life and physical activity rates did not differ significantly between groups at post-intervention and follow-up. CONCLUSIONS: There was no additional effect of preferred intensity exercise alongside treatment as usual on depressive reduction immediately post intervention. However, effects were observed at six months post-intervention, suggesting a delayed response. However, further trials, with larger samples are required to determine the validity of this finding. TRIAL REGISTRATION: ClinicalTrials.gov NCT01474837, March 16 2011.

The effectiveness of a preferred intensity exercise programme on the mental health outcomes of young people with depression: a sequential mixed methods evaluation.

BACKGROUND: People with mental illness are more likely to suffer physical health problems than comparable populations who do not have mental illness. There is evidence to suggest that exercise, as well has having obvious physical benefits, also has positive effects on mental health. There is a distinct paucity of research testing its effects on young people seeking help for mental health issues. Additionally, it is generally found that compliance with prescribed exercise programmes is low. As such, encouraging young people to exercise at levels recommended by national guidelines may be unrealistic considering their struggle with mental health difficulties. It is proposed that an exercise intervention tailored to young people's preferred intensity may improve mental health outcomes, overall quality of life, and reduce exercise attrition rates. METHODS/DESIGN: A sequential mixed methods design will be utilised to assess the effectiveness of an individually tailored exercise programme on the mental health outcomes of young people with depression. The mixed methods design incorporates a Randomised Controlled Trial (RCT), focus groups and interviews and an economic evaluation. PARTICIPANTS: 158 young people (14-17 years) recruited from primary care and voluntary services randomly allocated to either the intervention group or control group. Intervention group: PARTICIPANTS will undertake a 12 week exercise programme of 12 × 60 minutes of preferred intensity aerobic exercise receiving motivational coaching and support throughout. PARTICIPANTS will also be invited to attend focus groups and 1-1 interviews following completion of the exercise programme to illicit potential barriers facilitators to participation. CONTROL GROUP: PARTICIPANTS will receive treatment as usual. PRIMARY OUTCOME MEASURE: Depression using the Children's Depression Inventory 2 (CDI-2). SECONDARY OUTCOME MEASURES: Quality of Life (EQ-5D), physical fitness (Borg RPE scale, heart rate), incidents of self-harm, treatment received and compliance with treatment, and the cost effectiveness of the intervention. Outcome measures will be taken at baseline, post intervention and 6 month follow up. DISCUSSION: The results of this study will inform policy makers of the effectiveness of preferred intensity exercise on the mental health outcomes of young people with depression, the acceptability of such an intervention to this population and its cost effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01474837.

Pragmatic randomised controlled trial of preferred intensity exercise in women living with depression.

BACKGROUND: Exercise may be effective in treating depression, but trials testing its effect in depressed women are rare. AIM: To compare the effect of exercise of preferred intensity with exercise of prescribed intensity in thirty-eight women living with depression. METHODS: A Pragmatic RCT of 12 sessions of exercise at preferred intensity compared with 12 sessions at prescribed intensity. Beck Depression Inventory (BDI), Rosenberg Self Esteem Scale (RSES), General Health Questionnaire 12 (GHQ-12), heart rate (HR), Rating of Perceived Exertion Scale (RPE), Quality of Life in Depression Scale (QLDS), Multi-Dimensional Scale of Perceived Social Support (MDSPSS), SF12 Health Survey and exercise participation rates were compared between groups. RESULTS: Intervention participants had statistically better BDI (t = 2.638, df = 36, p = 0.006, 95% mean (SD) 26.5 (10.7), CI-20.4 to -2.7, d = 0.86), GHQ-12 (t = 3.284, df = 36, p = 0.001, mean (SD) 8.3 (3.7) 95% CI -6.5 to -1.5, d = 1.08), RSES (t = 2.045, df = 36, p = 0.024, mean (SD) 11.3 (5.8), 95% CI 0.3 -6.4, d = 0.25), QLDS (t = 1.902, df = 36, p = 0.0325, mean (SD) 15.5 (7.9), 95% CI -12.2 -0.4, d = 0.27) RPE scores (t = 1.755, df = 36, p = 0.0475, mean (SD) 9.2 (3.2), 95% CI -.5 - 5.2, d = 0.77) and attended more exercise sessions (t = 1.781, df = 36, p = 0.0415, number of sessions 8 (65%), 95% CI-0.3 -4.8, d = 0.58). SF-12, MSPSS and HR did not differ significantly between groups. CONCLUSIONS: Exercise of preferred intensity improves psychological, physiological and social outcomes, and exercise participation rates in women living with depression. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00546221.

Addressing diversity in mental health care: a review of guidance documents.

Discriminated against and marginalised groups of people within our communities continue to be over represented within mental health services and frequently their particular needs are not met. Challenging discrimination and working towards more equitable services are a vital part of anyone's role working within mental health services. This paper provides a review of guidance documents on diversity issues with a particular focus on ethnicity, gender, sexuality, learning disability, spirituality, homelessness and age. The review concludes with a summary of the range of approaches that are currently being advocated for translating guidelines and recommendations into improved and equitable mental health services that meet the needs of service users from a wide range of diverse groups.

Meeting the physical health-care needs of people with substance misuse problems: evaluation of a nurse-led blood-borne virus programme.

People who inject substances are at high risk of many physical health problems. The Blood-Borne Virus Programme (BBVP) is a nurse-led health screening programme for blood-borne conditions in substance misusers. The aim of this study was to evaluate the service delivery, organization, and outcomes of the BBVP. The researchers used a case study with three units of analysis: BBVP clinical activities during 1 year using a prospective audit; service users' (n = 20) and professional stakeholders' (n = 10) experiences of the BBVP using semistructured interviews; and service users' (n = 132) satisfaction with the BBVP using a satisfaction measure. The BBVP conducted 4450 consultations with 1940 service users; 847 of whom were new, and presented with many health problems compromising their physical health. The BBVP provided a range of interventions meeting its users' physical health needs. Users and other stakeholders were very satisfied with the service, and suggested ways in which the service might improve. The BBVP appeared to meet the physical health-care needs of people dependent on drugs. Nurse-led services, such as the BBVP, offer a solution that, in the view of users and professional stakeholders, is impacting significantly on the physical health and well-being of people dependent on drugs.

A prospective evaluation of the Transtheoretical Model of Change applied to exercise in young people.

OBJECTIVES: To investigate the utility of the Transtheoretical Model of Change in predicting exercise in young people. DESIGN: A prospective study: assessments were done at baseline and follow-up 6 months later. METHOD: Using stratified random sampling 1055 Chinese high school pupils living in Hong Kong, 533 of who were followed up at 6 months, completed measures of stage of change (SCQ), self-efficacy (SEQ), perceptions of the pros and cons of exercising (DBQ) and processes of change (PCQ). Data were analysed using one-way ANOVA, repeated measures ANOVA and independent sample t tests. RESULTS: The utility of the TTM to predict exercise in this population is not strong; increases in self-efficacy and decisional balance discriminated between those remaining active at baseline and follow-up, but not in changing from an inactive (e.g., Precontemplation or Contemplation) to an active state (e.g., Maintenance) as one would anticipate given the staging algorithm of the TTM. CONCLUSION: The TTM is a modest predictor of future stage of change for exercise in young Chinese people. Where there is evidence that TTM variables may shape movement over time, self-efficacy, pros and behavioural processes of change appear to be the strongest predictors.