Home-Based Activity Program for Older People With Depressive Symptoms: DeLLITE-A Randomized Controlled Trial

Abstract

PURPOSE We wanted to assess the effectiveness of a home-based physical activity program, the Depression in Late Life Intervention Trial of Exercise (DeLLITE), in improving function, quality of life, and mood in older people with depressive symptoms. METHODSWe undertook a randomized controlled trial involving 193 people aged 75 years and older with depressive symptoms at enrollment who were recruited from primary health care practices in Auckland, New Zealand. Participants received either an individualized physical activity program or social visits to control for the contact time of the activity intervention delivered over 6 months. Primary outcome measures were function, a short physical performance battery comprising balance and mobility, and the Nottingham Extended Activities of Daily Living scale. Secondary outcome measures were quality of life, the Medical Outcomes Study 36-item short form, mood, Geriatric Depression Scale (GDS-15), physical activity, Auckland Heart Study Physical Activity Questionnaire, and self-report of falls. Repeated measures analyses tested the differential impact on outcomes over 12 months' follow-up. RESULTSThe mean age of the participants was 81 years, and 59% were women. All participants scored in the at-risk category on the depression screen, 53% had a Diagnostic and Statistical Manual of Mental Disorders or International Classifi cation of Diseases, Tenth Revision diagnosis of major depression or scored more than 4 on the GDS-15 at baseline, indicating moderate or severe depression. Almost all participants, 187 (97%), completed the trial. Overall there were no differences in the impact of the 2 interventions on outcomes. Mood and mental health related quality of life improved for both groups. CONCLUSIONThe DeLLITE activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. Future social and activity interventions should be tested against a true usual care control. 2010;8:214-223. doi:10.1370/afm.1093. Ann Fam Med INTRODUCTIONL ow mood in community-dwelling older people is common and is associated with poor physical function.1 Poor physical function predicts development of depression, 2 disability, health service use, and institutionalization, 3 and disability in turn predicts development of depression.2 Physical activity has the potential to interrupt the development of disability from both depression 4 and poor physical function. 5Even small gains in physical performance and mood may result in signifi cant benefi ts in functional status (ability to perform activities of daily living) and quality of life. 6 Physical activity programs improve physical performance, 7 and there are several established ways of promoting physical activity to older people, such as physician advice with community folNgaire Kerse, PhD, MBChB Karen J. Hayman, RN 215 AC T IV I T Y PRO GR A M A ND DEPR ES SED EL DER LYlow-up, 8 supervised group activity programs, and wider community level intervention. 7,9 The most frail may...

Healthy Steps Trial: Pedometer-Based Advice and Physical Activity for Low-Active Older Adults

“…At the end of the intervention (3-4 months), 278 remained, and at follow-up (12 months), 270 remained. Reasons for dropping out of the study included death (3 patients), a change in health (14), being too busy or changing one's mind (31), not receiving any intervention (1), being told by a nurse they were too active for the study (1), traveling (3), moving (4), and being out of contact (3). Figure 1 shows the fl ow of participants through each stage of the trial.…”

“…Second, the response rate (57%) should be considered in relation to the fi ndings, although such a rate is consistent with our experience in primary care physical activity trials. 3,27 Third, despite the sample size calculations, the sample may have been insuffi cient to detect smaller, but still clinically important, improvements in outcomes. Finally, use of self-reported physical activity could be seen as a limitation in this study; however, the AHSPAQ is valid using pedometer data as the comparator.…”

“…2 Participation in physical activity also improves psychological functioning, [3][4][5] quality of life, and independent living for older people. 6 Despite mounting evidence of the benefi ts of activity, populationlevel data show adults aged 80 years and older to be 7 times more likely to be inactive than those aged 60 to 64 years.…”

Impact of physical exercise on quality of life of older adults with depression or Alzheimer's disease: a systematic review

“…[21][22][23][24] Exercises were different, especially in type, intensity, and duration of the intervention. Control groups were also different: three studies used social contact and health education [21][22][23] and one, no intervention. …”

“…15,20 Few studies have included older individuals with a clinical diagnosis of major depression and AD. [21][22][23][24][25][26] Although data about this association are scarce, previous reviews concluded that the differences in exercise type and QoL evaluations might have affected comparisons between studies. 27,28 Moreover, some of those reviews included adults in general and analyzed other variables, in addition to QoL.…”