title: A pragmatic randomised controlled trial to evaluate the cost-effectiveness of a physical activity intervention as a treatment for depression: the treating depression with physical activity (TREAD) trial.
abstract: OBJECTIVE
  The TREAting Depression with physical activity (TREAD) study investigated the cost-effectiveness of a physical activity intervention, in addition to usual general practitioner care, as a treatment for people with depression.
  
  
  METHODS
  An individually randomised, pragmatic, multicentre randomised controlled trial with follow-up at 4, 8 and 12 months. A subset of participants took part in a qualitative study that investigated the acceptability and perceived benefits of the intervention.
  
  
  METHODS
  General practices in the Bristol and Exeter areas.
  
  
  METHODS
  Aged 18-69 years with an International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10) diagnosis of depression and scoring ≥ 14 on the Beck Depression Inventory (BDI). Those who were unable to complete self-administered questionnaires in English, with medical contraindications to physical activity or with psychosis, bipolar disorder or serious drug abuse were excluded.
  
  
  METHODS
  We devised an intervention designed to encourage choice and autonomy in the adoption of physical activity. It consisted of up to three face-to-face and ten telephone contacts delivered by a trained physical activity facilitator over an 8-month period.
  
  
  METHODS
  The primary outcome was the BDI score measured at 4 months. Secondary outcomes included depressive symptoms over the 12 months and quality of life, antidepressant use and level of physical activity.
  
  
  RESULTS
  The study recruited 361 patients, with 182 randomised to the intervention arm and 179 to the usual care arm; there was 80% retention at the 4-month follow-up. The intervention group had a slightly lower BDI score at 4 months [-0.54, 95% confidence interval (CI) -3.06 to 1.99] but there was no evidence that the intervention improved outcome for depression. Neither was there any evidence to suggest a difference in the prescription of or self-reported use of antidepressants. However, the amount of physical activity undertaken by those who had received the intervention was increased (odds ratio 2.3, 95% CI 1.3 to 3.9) and was sustained beyond the end of the intervention. From a health-care perspective, the intervention group was more costly than the usual care group, with the cost of the intervention £220 per person on average. It is therefore extremely unlikely that the intervention is cost-effective as a treatment for depression using current willingness-to-pay thresholds.
  
  
  CONCLUSIONS
  This physical activity intervention is very unlikely to lead to any clinical benefit in terms of depressive symptoms or to be a cost-effective treatment for depression. Previous research has reported some benefit and there are three possible reasons for this discrepancy: first, even though the intervention increased self-reported physical activity, the increase in activity was not sufficiently large to lead to a measurable influence; second, only more vigorous activity might be of benefit; and third, previous studies had recruited individuals with a pre-existing commitment to physical activity. Future research is needed to identify and explain the mechanisms by which depression might be effectively treated, including, in particular, specific guidance on the optimum type, intensity and duration of physical activity required to produce a therapeutic effect.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN16900744.
  
  
  BACKGROUND
  This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 16, No. 10. See the HTA programme website for further project information.
authors.affiliation: Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: M
authors.initials: M
authors.lastname: Chalder
authors.forename: N J
authors.initials: NJ
authors.lastname: Wiles
authors.forename: J
authors.initials: J
authors.lastname: Campbell
authors.forename: S P
authors.initials: SP
authors.lastname: Hollinghurst
authors.forename: A
authors.initials: A
authors.lastname: Searle
authors.forename: A M
authors.initials: AM
authors.lastname: Haase
authors.forename: A H
authors.initials: AH
authors.lastname: Taylor
authors.forename: K R
authors.initials: KR
authors.lastname: Fox
authors.forename: H
authors.initials: H
authors.lastname: Baxter
authors.forename: M
authors.initials: M
authors.lastname: Davis
authors.forename: H
authors.initials: H
authors.lastname: Thorp
authors.forename: R
authors.initials: R
authors.lastname: Winder
authors.forename: C
authors.initials: C
authors.lastname: Wright
authors.forename: M
authors.initials: M
authors.lastname: Calnan
authors.forename: D A
authors.initials: DA
authors.lastname: Lawlor
authors.forename: T J
authors.initials: TJ
authors.lastname: Peters
authors.forename: D J
authors.initials: DJ
authors.lastname: Sharp
authors.forename: K M
authors.initials: KM
authors.lastname: Turner
authors.forename: A A
authors.initials: AA
authors.lastname: Montgomery
authors.forename: G
authors.initials: G
authors.lastname: Lewis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D001521:Behavior Therapy / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D003863:Depression / Q000628:therapy*; D005081:Exercise Therapy / Q000191:economics* / Q000379:methods*; D005260:Female; D058005:General Practitioners / Q000523:psychology; D017048:Health Care Costs / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology; D013997:Time Factors; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents