A systematic review exploring interventions to increase physical activity in people with physical-mental multimorbidity

Problem

Physical activity improves both depression and physical health, yet it is unclear how to increase physical activity among people with depression and long term physical health conditions. This is problematic because the number of people with long term physical health conditions is increasing and depression is prevalent in this population.

Approach

A systematic review of intervention trials for people with depression and one or more long term physical health conditions was carried out. The review explored the effectiveness of behaviour change interventions to increase physical activity and what characterised successful interventions (e.g., mode of delivery, behaviour change techniques). Intervention effects on depression, physical health outcomes, and health related quality of life were also explored. Narrative synthesis was used to explore the data because of its heterogeneity.

Findings

Seven studies (6 randomised and 1 non-randomised controlled trials) were included in the review. Studies were conducted in the United States and in Australia. Six studies had the aim of testing an intervention to reduce depression symptoms in people with a long term physical health condition; one study explored whether treatment for depression reduced heart rate variability in depressed people with coronary heart disease. Evidence for the effectiveness of interventions to increase physical activity was mixed. Overall, interventions did not significantly increase physical activity in this population group. Better effects were found among studies that included problem solving, goal setting, and feedback on physical activity behaviour. Delivering the intervention weekly or fortnightly within primary care settings was also associated with increased effectiveness. Five studies reported that their intervention significantly reduced the symptoms of depression at 9 or 12 months follow up. Studies reported on different physical health outcomes, making it difficult to synthesise this data. Measures of blood glucose levels in diabetes trials were the most commonly reported. Three of these four studies reported non-significant intervention effects on glucose levels. Three studies measured health related quality of life; all three reported significant improvements at 6 to 12 month follow-ups.

Consequences

There is a lack of research in physical activity interventions for people with depression and long term physical health conditions. To date, no intervention has been developed or tested in the UK. With the rising prevalence of long term conditions, research should design an intervention in the UK to increase physical activity in this population group. Such an intervention should be delivered weekly or fortnightly in primary care settings, and minimally include problem solving, goal setting, and feedback.