Accepted for/Published in: Interactive Journal of Medical Research
Date Submitted: Apr 30, 2023
Date Accepted: Aug 28, 2023
Daily Steps in the Treatment of Major Depressive Disorder: Predictors and Moderators of Symptom Improvement and Behavioral Change Over a 6-month Internet-Based Mindfulness-Based Cognitive Behavioral Therapy Trial for Youth: A Secondary Analysis
ABSTRACT
Background:
Current evidence supports physical activity (PA) as an adjunctive treatment for major depressive disorder (MDD). Few studies, however, have examined the relationship between objectively-measured PA and depression treatment outcomes.
Objective:
This study examined average daily step counts in relation to MDD symptom reduction, and whether changes in step activity (i.e. step trajectories) during treatment were associated with baseline symptoms and symptom improvement.
Methods:
Participants were part of a randomized controlled trial evaluating the effects of a 24-week internet-based, mindfulness-based cognitive-behavioral therapy program for young adults (18-30 years old). Data from twenty intervention completers were analysed. PA, in the form of steps, was measured using the Fitbit-HR Charge 2 and depression severity was measured with the Beck Depression Inventory-II (BDI-II). Regression analysis was used to test PA’s relationship with depression improvement and the moderating effect of pain severity and pain interference. Growth curve and multivariable regression models were used to test longitudinal associations.
Results:
Participants walked an average of 8,269 steps per day, and each additional +1,000-step difference between participants was significantly associated with a 2.66-point greater improvement (reduction) in BDI-II, controlling for anxiety, pain interference, and adherence to Fitbit monitoring (P=.02). Pain severity appeared to moderate (reduce) the positive effect of average daily steps on BDI-II improvement (P=.03). Higher baseline depression and anxiety symptoms predicted less positive step trajectories throughout treatment (Ps≤.001), and more positive step trajectories early in the trial predicted greater MDD improvement at the end of the trial (Ps<.04).
Conclusions:
Treatment response was associated with average levels of daily PA and early PA increases. Pain appeared to moderate the effect of PA on outcomes. Future research should consider additional moderators of treatment success and the extent to which success is related to PA change in multimodal interventions. Clinical Trial: Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052
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