title: Activity monitoring in patients with depression: a systematic review.
abstract: BACKGROUND
  Altered physical activity is an important feature of depression. It is manifested in psychomotor retardation, agitation and withdrawal from engagement in normal activities. Modern devices for activity monitoring (actigraphs) make it possible to monitor physical activity unobtrusively but the validity of actigraphy as an indicator of mood state is uncertain. We carried out a systematic review of digital actigraphy in patients with depression to investigate the associations between measured physical activity and depression.
  
  
  METHODS
  Systematic review and meta-analysis. Studies were identified from Medline, EMBASE and Psycinfo databases and included if they were either case control or longitudinal studies of actigraphy in adults aged between 18 and 65 diagnosed with a depressive disorder. Outcomes were daytime and night-time activity and actigraphic measures of sleep.
  
  
  RESULTS
  We identified 19 eligible papers from 16 studies (412 patients). Case control studies showed less daytime activity in patients with depression (standardised mean difference -0.76, 95% confidence intervals -1.05 to -0.47). Longitudinal studies showed moderate increase in daytime activity (0.53, 0.20 to 0.87) and a reduction in night-time activity (-0.36, -0.65 to -0.06) over the course of treatment.
  
  
  CONCLUSIONS
  All study participants were unblinded. Only seven papers included patients treated in the community.
  
  
  CONCLUSIONS
  Actigraphy is a potentially valuable source of additional information about patients with depression. However, there are no clear guidelines for use of actigraphy in studies of patients with depression. Further studies should investigate patients treated in the community. Additional work to develop algorithms for differentiating behaviour patterns is also needed.
authors.affiliation: University of Edinburgh, Centre for Population Health Sciences, Doorway 1, Medical Quad, Teviot Place, Edinburgh EH8 9AG, UK. chris.burton@ed.ac.uk
authors.forename: Christopher
authors.initials: C
authors.lastname: Burton
authors.forename: Brian
authors.initials: B
authors.lastname: McKinstry
authors.forename: Aurora
authors.initials: A
authors.lastname: Szentagotai Tătar
authors.forename: Antoni
authors.initials: A
authors.lastname: Serrano-Blanco
authors.forename: Claudia
authors.initials: C
authors.lastname: Pagliari
authors.forename: Maria
authors.initials: M
authors.lastname: Wolters
mesh_terms: D056044:Actigraphy; D000328:Adult; D003863:Depression / Q000503:physiopathology*; D003866:Depressive Disorder; D006801:Humans; D008137:Longitudinal Studies; D008991:Monitoring, Physiologic / Q000379:methods; D011595:Psychomotor Agitation; D012890:Sleep