Step away from depression—results from a multicenter randomized clinical trial with a pedometer intervention during and after inpatient treatment of depression

European Archives of Psychiatry and Clinical Neuroscience, vol. 274, pp. 709–721

Abstract

Evidence for the effectiveness of physical activity (PA) in the treatment of depression prevails for outpatients with mild and moderate symptom levels. For inpatient treatment of severe depression, evidence-based effectiveness exists only for structured and supervised group PA interventions. The Step Away from Depression (SAD) study investigated the effectiveness of an individual pedometer intervention (PI) combined with an activity diary added to inpatient treatment as usual (TAU). In this multicenter randomized controlled trial, 192 patients were randomized to TAU or TAU plus PI. The two primary outcomes at discharge were depression-blindly rated with the Montgomery-Åsberg Depression Rating Scale (MADRS)-and average number of daily steps measured by accelerometers. Secondary outcomes were self-rated depression and PA, anxiety, remission and response rates. Multivariate analysis of variance (MANOVA) revealed no significant difference between both groups for depression and daily steps. Mean MADRS scores at baseline were 29.5 (SD = 8.3) for PI + TAU and 28.8 (SD = 8.1) for TAU and 16.4 (SD = 10.3) and 17.2 (SD = 9.9) at discharge, respectively. Daily steps rose from 6285 (SD = 2321) for PI + TAU and 6182 (SD = 2290) for TAU to 7248 (SD = 2939) and 7325 (SD = 3357). No differences emerged between groups in secondary outcomes. For severely depressed inpatients, a PI without supervision or further psychological interventions is not effective. Monitoring, social reinforcement and motivational strategies should be incorporated in PA interventions for this population to reach effectiveness.

Authors 20

1. Julia Große corresponding

   Humboldt-Universität zu Berlin · Berlin Institute of Health at Charité - Universitätsmedizin Berlin · Freie Universität Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany. julia.grosse@charite.de

   Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité—Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin and Berlin Institute of Health, Berlin, Germany

2. Charlotte Huppertz Aachen Department of Psychiatry, Psychotherapy and Psychosomatics Faculty of Medicine

   RWTH Aachen University

   Affiliation as printed

   Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany

3. Astrid Röh

   University of Augsburg · Bezirkskrankenhaus Augsburg

   Affiliation as printed

   Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany

4. Viola Oertel

   University Hospital Frankfurt

   Affiliation as printed

   Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Frankfurt/Main, Frankfurt am Main, Germany

5. Sara Andresen

   DIAKO

   Affiliation as printed

   Fachklinik für Psychiatrie, Psychosomatik und Psychotherapie Flensburg der DIAKO NF, Flensburg, Germany

6. Franziska Goerke-Arndt
   Affiliation as printed

   Department of Psychiatry and Psychotherapy, Oberhavel Kliniken GmbH, Hennigsdorf, Germany

7. Anna Kastinger

   Paracelsus Medical University

   Affiliation as printed

   Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria

8. Nikola Schoofs

   Humboldt-Universität zu Berlin · Berlin Institute of Health at Charité - Universitätsmedizin Berlin · Freie Universität Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany

   Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité—Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin and Berlin Institute of Health, Berlin, Germany

9. Philipp Arthur Thomann
   Affiliation as printed

   Center for Mental Health, Odenwald District Healthcare Center, Erbach, Germany

10. Berend Malchow

    Universitätsmedizin Göttingen · University of Göttingen

    Affiliation as printed

    Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany

11. Jens Plag

    Humboldt-Universität zu Berlin · Berlin Institute of Health at Charité - Universitätsmedizin Berlin · Freie Universität Berlin · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany

    Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité—Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin and Berlin Institute of Health, Berlin, Germany

12. Aleksandra Terziska

    Humboldt-Universität zu Berlin · Berlin Institute of Health at Charité - Universitätsmedizin Berlin · Freie Universität Berlin · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany

    Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité—Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin and Berlin Institute of Health, Berlin, Germany

13. Ralf Brand

    University of Potsdam

    Affiliation as printed

    Sport and Exercise Psychology, University of Potsdam, Potsdam, Germany

14. F.J. Helmig

    DIAKO

    Affiliation as printed

    Fachklinik für Psychiatrie, Psychosomatik und Psychotherapie Flensburg der DIAKO NF, Flensburg, Germany

15. Alexander Schorb

    Paracelsus Medical University

    Affiliation as printed

    Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria

16. Dirk Wedekind

    Universitätsmedizin Göttingen · University of Göttingen

    Affiliation as printed

    Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany

17. Maria Christiane Jockers-Scherübl
    Affiliation as printed

    Department of Psychiatry and Psychotherapy, Oberhavel Kliniken GmbH, Hennigsdorf, Germany

18. Frank W. Schneider

    Düsseldorf University Hospital · Heinrich Heine University Düsseldorf

    Affiliation as printed

    University Hospital, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany

19. Moritz Bruno Petzold

    Humboldt-Universität zu Berlin · MSB Medical School Berlin · Berlin Institute of Health at Charité - Universitätsmedizin Berlin · Freie Universität Berlin · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Department of Psychology, Medical School Berlin, Berlin, Germany

    Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany

20. Andreas Ströhle

    Humboldt-Universität zu Berlin · Berlin Institute of Health at Charité - Universitätsmedizin Berlin · Freie Universität Berlin · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany

    Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité—Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin and Berlin Institute of Health, Berlin, Germany