Symposia
Transdiagnostic
Louisa G. Sylvia, Ph.D.
Psychologist
Massachusetts General Hospital
Boston, Massachusetts
Evan A. Albury, B.S.
Clinical Research Coordinator
Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital
Boston, Massachusetts
Dustin J. Rabideau, Ph.D.
Instructor in Investigation
Biostatistics, Massachusetts General Hospital
Boston, Massachusetts
Nicole J. Stephan, B.S.
Clinical Research Coordinator
Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital
Boston, Massachusetts
Heidi Dohse, BA
Stakeholder
Massachusetts General Hospital
BOSTON, Massachusetts
Andrew Nierenberg, M.D.
Director, Dauten Family Center for Bipolar Treatment Innovation
Massachusetts General Hospital
boston, Massachusetts
Background: Individuals with depression are four times more likely to die from cardiovascular disease (CVD) than those without depression. Conversely, people with CVD have three times the rate of depression compared with the general population. Exercise improves both depression and risk factors for CVD, yet most Americans do not exercise regularly, especially those with depression or heart disease. The purpose of this study was to compare online psychotherapy interventions to increase exercise in individuals with a history of depression and CVD.
Methods: We recruited adult participants (N=340) who had received a diagnosis of unipolar depression and had or were at risk for CVD. Eligible participants were then randomized to: Cognitive Behavioral Therapy (CBT)+Fitbit, Mindfulness-based Cognitive Therapy (MBCT)+Fitbit, or Fitbit Only. The primary outcome of exercise (i.e., number of steps per day as measured by the Fitbit). We conducted general linear mixed models that accounted for the covariance of observations within participants. We also assessed potential treatment moderators to explore whether certain characteristics could be used to match treatments to specific sub-populations.
Results: Average daily steps changed by +2.8 steps per day in the MBCT+Fitbit group and by +2.9 steps/day in the CBT+Fitbit group but changed by -8.2 steps/day in the Fitbit Only group. The change in average daily steps were not different between the MBCT+Fitbit and CBT+Fitbit groups, but both were different from the Fitbit Only group across the initial 8-week period (and not maintained across the 16-week follow-up period). Potential moderators (i.e., anxiety disorders, self-reported physical activity, employment status) were identified. Specifically, analyses conducted with moderators suggest that the two active interventions in this study (MBCT+Fitbit and CBT+Fitbit) may have been more comparatively effective for those individuals without comorbid anxiety, higher physical activity, and those who were employed, whereas they were less comparatively effective for individuals with anxiety and unemployed at baseline.
Conclusions: These data suggest that an activity tracker with or without self-guided web-based psychotherapy interventions have limited effects on physical activity in participants with a history of depression who have or are at-risk for CVD.