Telephone-based Exercise Promotion For Major Depression In People With MS.

TitleTelephone-based Exercise Promotion For Major Depression In People With MS.
Publication TypeJournal Article
AuthorsBombardier CH, Ehde DM, Wadhwani R, Gibbons LE, LaRotonda CJ, Hunter C, Madrone K, Wight K, Sullivan KM, Kraft GH
JournalInternational Journal of MS Care

Background: Major depression (MD) is prevalent and disabling among people with multiple sclerosis (MS). Epidemiologic and experimental studies suggest that exercise is a promising treatment for MD. We chose a telephone-based approach because it can be effective and overcomes barriers to treatment. Method: Subjects were 101 community- residing people with a confirmed diagnosis of MS and MD who were ambulatory and not exercising regularly. Participants underwent a baseline assessment and were randomized to a 12-week treatment condition (n = 50) or a wait-list control group (n = 51). Treatment consisted of a single faceto- face motivational interview to negotiate a home exercise plan plus eight scheduled telephone counseling sessions to promote adherence to the plan. Primary outcome: Hamilton Rating Scale for Depression (HAM-D) was the primary outcome. Secondary outcomes were Hopkins Symptom Checklist (SCL-20), metabolic equivalent units (METs) as estimated by the 7-Day Physical Activity Recall, minutes of exercise, and the Modified Fatigue Impact Scale (MFIS). Analyses: Intent-to-treat analysis of posttest outcomes, controlling for pretest, was performed. Results: Of the sample, 85% were women, 92% were white, and 75% had relapsing MS. Randomization was effective, although the treatment group had higher HAM-D scores at baseline. Efficacy analyses demonstrated that, at 12 weeks, significant improvement was seen on the HAM-D in the treatment group (17.7 to 11.4) but not among control subjects (15.8 to 14.2; P = .0005). Similar results emerged on the SCL-20 (P = .002) and MFIS (P < .0001). Nonsignificant trend was found for exercise, as measured by METs, to improve more in the treatment versus control group (P = .08). Conclusion: This intervention is a promising approach for treating MD in people with MS who can walk but are not exercising regularly. Mechanisms other than exercise dose may account for the antidepressant effect. Future research should include an attention control group and methods to identify potential biopsychosocial mediators of the antidepressant effect of this intervention.

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