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Physical Exercise for Late‐Life Depression: Customizing an Intervention for Primary Care
Author(s) -
Zanetidou Stamatula,
Belvederi Murri Martino,
Menchetti Marco,
Toni Giulio,
Asioli Fabrizio,
Bagnoli Luigi,
Zocchi Donato,
Siena Matteo,
Assirelli Barbara,
Luciano Claudia,
Masotti Mattia,
Spezia Carlo,
Magagnoli Monica,
Neri Mirco,
Amore Mario,
Bertakis Klea D.
Publication year - 2017
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14525
Subject(s) - medicine , depression (economics) , context (archaeology) , randomized controlled trial , attendance , polypharmacy , anxiety , sertraline , veterans affairs , psychological intervention , clinical trial , psychiatry , physical therapy , antidepressant , economics , biology , paleontology , macroeconomics , economic growth
Objectives To identify which individual‐ and context‐related factors influence the translation into clinical practice of interventions based on physical exercise ( PE ) as an adjunct to antidepressants ( AD ) for the treatment of late‐life major depression ( LLMD ). Design Secondary analysis of a randomized controlled trial. Setting Primary care with psychiatric consultation‐liaison programs ( PCLP s)—organizational protocols that regulate the clinical management of individuals with psychiatric disorders. Participants Individuals aged 65 and older with major depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (N = 121). Intervention Participants with LLMD were randomized to AD (sertraline) or AD plus PE ( AD + PE ). Measurements Participant characteristics that were associated with greater effectiveness of AD + PE (moderators) were identified, and effect sizes were calculated from success rate differences. Whether the characteristics of the study setting influenced participant flow and attendance at exercise sessions was then explored, and primary care physicians ( PCP s) were surveyed regarding their opinions on PE as a treatment for LLMD . Results The following participant characteristics were associated with greater likelihood of achieving remission from depression with AD + PE than with AD alone: aged 75 and older (effect size 0.32), polypharmacy (0.35), greater aerobic capacity (0.48), displaying psychomotor slowing (0.49), and less‐severe anxiety (0.30). The longer the PCLP had been established at a particular center, the more individuals were recruited at that center. After participating in the study, PCP s expressed positive views on AD + PE as a treatment for LLMD and were more likely to use this as a therapeutic strategy. Conclusions The combination of PE and sertraline could improve the management of LLMD , especially when customized for individuals with specific clinical features. Liaison programs might influence the implementation of similar interventions in primary care, and PCP s viewed them positively.