It's more than just a referral: Development of an evidence-informed exercise and depression toolkit

Glowacki, Krista; Arbour-Nicitopoulos, Kelly P.; Burrows, Meghan; Chesick, Leslie; Heinemann, Lyn; Irving, Sarah; Lam, Raymond W.; Macridis, Soultana; Michalak, Erin E.; Scott, Aidan; Taylor, Adrian; Faulkner, Guy

doi:10.1016/j.mhpa.2019.100297

Cited by 21 publications

(21 citation statements)

References 24 publications

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“…Several studies [42][43][44], including the earlier RCT [19], have shown the positive impacts of ERS for individuals suffering from anxiety and depression, with improved mental health outcomes post-scheme completion. Moreover, above and beyond the ERS literature, exercise is recommended as an evidence-based treatment for depression, the first and only mental health disorder whereby exercise is recommended in clinical guidelines [45]. In the present study, however, we found that patients referred for a mental health reason were substantially less likely to take up the scheme compared to those with a CHD referral.…”

Section: Discussioncontrasting

confidence: 65%

Patterning in Patient Referral to and Uptake of a National Exercise Referral Scheme (NERS) in Wales from 2008 to 2017: A Data Linkage Study

Morgan

Rahman

Moore

2020

IJERPH

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Exercise referral schemes have shown small but positive impacts in randomized controlled trials (RCTs). Less is known about the long-term reach of scaled up schemes following a RCT. A RCT of the National Exercise Referral Scheme (NERS) in Wales was completed in 2010, and the scheme scaled up across Wales. In this study, using a retrospective data linkage design, anonymized NERS data were linked to routine health records for referrals between 2008 and 2017. Rates of referral and uptake were modelled across years and a multilevel logistic regression model examined predictors of uptake. In total, 83,598 patients have been referred to the scheme and 67.31% of eligible patients took up NERS. Older adults and referrals for a musculoskeletal or level four condition were more likely to take up NERS. Males, mental health referrals, non-GP referrals and those in the most deprived groupings were less likely to take up NERS. Trends revealed an overall decrease over time in referrals and uptake rates among the most deprived grouping relative to those in the least deprived group. Findings indicate a widening of inequality in referral and uptake following positive RCT findings, both in terms of patient socioeconomic status and referrals for mental health.

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Section: Discussioncontrasting

confidence: 65%

Patterning in Patient Referral to and Uptake of a National Exercise Referral Scheme (NERS) in Wales from 2008 to 2017: A Data Linkage Study

Morgan

Rahman

Moore

2020

IJERPH

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“…They are encouraged to also use the mood ratings at home to monitor direct mood benefits. This is a technique used in clinical practice, to motivate patients to engage in exercise [67] and can thereby contribute to adherence and long-term exercise [68].…”

Section: Moodmentioning

confidence: 99%

“…To motivate patients, different strategies are used that are integrated in the personalized plan. These strategies are based on previous research [67,68] and psychomotor clinical practice and include psychoeducation, weekly exercise session scheduling, and goal setting.…”

Section: At-home Exercisementioning

confidence: 99%

Exercise enhances: study protocol of a randomized controlled trial on aerobic exercise as depression treatment augmentation

et al. 2020

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Background Major depressive disorder (MDD) is a considerable public health concern. In spite of evidence-based treatments for MDD, many patients do not improve and relapse is common. Therefore, improving treatment outcomes is much needed and adjunct exercise treatment may have great potential. Exercise was shown to be effective as monotherapy for depression and as augmentation strategy, with evidence for increasing neuroplasticity. Data on the cost-effectiveness and the long-term effects of adjunct exercise treatment are missing. Similarly, the cognitive pathways toward remission are not well understood. Methods The present study is designed as a multicenter randomized superiority trial in two parallel groups with follow-up assessments up to 15 months. Currently depressed outpatients (N = 120) are randomized to guideline concordant Standard Care (gcSC) alone or gcSC with adjunct exercise treatment for 12 weeks. Randomization is stratified by gender and setting, using a four, six, and eight block design. Exercise treatment is offered in accordance with the NICE guidelines and empirical evidence, consisting of one supervised and two at-home exercise sessions per week at moderate intensity. We expect that gcSC with adjunct exercise treatment is more (cost-)effective in decreasing depressive symptoms compared to gcSC alone. Moreover, we will investigate the effect of adjunct exercise treatment on other health-related outcomes (i.e. functioning, fitness, physical activity, health-related quality of life, and motivation and energy). In addition, the mechanisms of change will be studied by exploring any change in rumination, self-esteem, and memory bias as possible mediators between exercise treatment and depression outcomes. Discussion The present trial aims to inform the scientific and clinical community about the (cost-)effectiveness and psychosocial mechanisms of change of adjunct exercise treatment when implemented in the mental health service setting. Results of the present study may improve treatment outcomes in MDD and facilitate implementation of prescriptive exercise treatment in outpatient settings. Trial registration This trial is registered within the Netherlands Trial Register (code: NL8432, date: 6th March, 2020).

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“…Thus, the 'Exercise and Depression Toolkit' was developed using a theoretically informed and systematic process described in detail elsewhere 3 (publicly available at www.exerciseanddepression.ca). In summary, the toolkit was designed to address the barriers and facilitators to health care provider promotion of exercise 4 and for individuals with depression to participate in physical activity 5 .…”

mentioning

confidence: 99%

“…The primary purpose of the toolkit is to enable health care providers (HCP) to discuss and consider exercise as a treatment collaboratively with individuals with depression 3,6 . The toolkit consists of three parts.…”

mentioning

confidence: 99%

Evaluation of health care providers’ use of the ‘Exercise and Depression Toolkit’: a case study

Glowacki

Zumrawi

Michalak

et al. 2021

Preprint

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Background Exercise is now recommended as a primary treatment for mild-moderate depression in Canada. The ‘Exercise and Depression Toolkit’ was developed to help health care providers (HCP) integrate these treatment guidelines into practice. The purpose of this study was to evaluate acceptability and perceived effectiveness of the toolkit in practice by HCPs working with individuals with depression. Methods A case study design was utilized. The toolkit was given to 6 HCPs to use in practice for four weeks. Pre- and post-intervention phone interviews were conducted, and weekly logs were provided to track use and satisfaction of interactions with individuals with depression when using the toolkit. The study was conceptually guided by a hybrid theoretical approach using the Diffusion of Innovation Theory and the Theoretical Framework of Acceptability. Results All HCPs used the toolkit at least once. Participants viewed their interactions when using the toolkit to be successful (considering individuals’ receptiveness, its usefulness and general satisfaction.) The average success score for all participants was 5.5/7. HCPs found the toolkit to be acceptable. All participants (n = 6) viewed the toolkit as having relative advantage in helping them to discuss exercise with individuals with depression, and as relatively simple and easy to use (not complex) and adaptable to their practice needs (having trialability). Participants liked the toolkit and had mostly positive things to say about it. Participants had mixed feelings about whether changes in the people they worked with (such as mood and activity levels) could be observed (observability) and whether the toolkit changed their belief in their ability to recommend or discuss exercise (self-efficacy). Recommended dissemination strategies were adopted in promoting the toolkit. Conclusions Future work should address observability and the ability for health care providers to see other providers using it, as well as effectiveness considering outcomes for people with depression such as mood and activity changes. The results of this initial evaluation seem promising for uptake and future adoption of the toolkit by health care providers working with adults with depression in Canada.

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It's more than just a referral: Development of an evidence-informed exercise and depression toolkit

Cited by 21 publications

References 24 publications

Patterning in Patient Referral to and Uptake of a National Exercise Referral Scheme (NERS) in Wales from 2008 to 2017: A Data Linkage Study

Patterning in Patient Referral to and Uptake of a National Exercise Referral Scheme (NERS) in Wales from 2008 to 2017: A Data Linkage Study

Exercise enhances: study protocol of a randomized controlled trial on aerobic exercise as depression treatment augmentation

Evaluation of health care providers’ use of the ‘Exercise and Depression Toolkit’: a case study

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