Combining behavioural activation with physical activity promotion for adults with depression: findings of a parallel-group pilot randomised controlled trial (BAcPAc).
BACKGROUND
Depression is associated with physical inactivity, which may mediate the relationship between depression and a range of chronic physical health conditions. However, few interventions have combined a psychological intervention for depression with behaviour change techniques, such as behavioural activation (BA), to promote increased physical activity.


METHODS
To determine procedural and clinical uncertainties to inform a definitive randomised controlled trial (RCT), a pilot parallel-group RCT was undertaken within two Improving Access to Psychological Therapies (IAPT) services in South West England. We aimed to recruit 80 adults with depression and randomise them to a supported, written self-help programme based on either BA or BA plus physical activity promotion (BAcPAc). Data were collected at baseline and 4 months post-randomisation to evaluate trial retention, intervention uptake and variance in outcomes to inform a sample size calculation. Qualitative data were collected from participants and psychological wellbeing practitioners (PWPs) to assess the acceptability and feasibility of the trial methods and the intervention. Routine data were collected to evaluate resource use and cost.


RESULTS
Sixty people with depression were recruited, and a 73 % follow-up rate was achieved. Accelerometer physical activity data were collected for 64 % of those followed. Twenty participants (33 %) attended at least one treatment appointment. Interview data were analysed for 15 participants and 9 study PWPs. The study highlighted the challenges of conducting an RCT within existing IAPT services with high staff turnover and absences, participant scheduling issues, PWP and participant preferences for cognitive focussed treatment, and deviations from BA delivery protocols. The BAcPAc intervention was generally acceptable to patients and PWPs.


CONCLUSIONS
Although recruitment procedures and data collection were challenging, participants generally engaged with the BAcPAc self-help booklets and reported willingness to increase their physical activity. A number of feasibility issues were identified, in particular the under-use of BA as a treatment for depression, the difficulty that PWPs had in adapting their existing procedures for study purposes and the instability of the IAPT PWP workforce. These problems would need to be better understood and resolved before proceeding to a full-scale RCT.


BACKGROUND
ISRCTN74390532 . Registered on 26 March 2013.
Complex Interventions Research Group, University of Exeter Medical School, South Cloisters 1.32, Heavitree Road, Exeter, EX1 2LU, UK. c.pentecost@exeter.ac.uk.
Claire
C
Pentecost
Clinical Education Development and Research, Psychology, Washington Singer Laboratories, University of Exeter, Perry Road, Exeter, EX4 4QG, UK. p.a.farrand@exeter.ac.uk.
Paul
P
Farrand
University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. c.j.greaves@exeter.ac.uk.
Colin J
CJ
Greaves
University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. r.taylor@exeter.ac.uk.
Rod S
RS
Taylor
University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. f.c.warren@exeter.ac.uk.
Fiona C
FC
Warren
Sport & Health Sciences, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. m.hillsdon@exeter.ac.uk.
Melvyn
M
Hillsdon
University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. c.green@exeter.ac.uk.
Colin
C
Green
Lived Experience Group, Mood Disorders Centre, Psychology, Washington Singer Laboratories, University of Exeter, Perry Road, Exeter, EX4 4QG, UK. j.r.welsman@exeter.ac.uk.
Jo R
JR
Welsman
Clinical Education Development and Research, Psychology, Washington Singer Laboratories, University of Exeter, Perry Road, Exeter, EX4 4QG, UK. k.rayson@exeter.ac.uk.
Kat
K
Rayson
University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. p.h.evans@exeter.ac.uk.
Philip H
PH
Evans
Plymouth University Peninsula Schools of Medicine & Dentistry, N6 ITTC Building, Plymouth Science Park, Derriford, Plymouth, PL6 8BU, UK. adrian.taylor@plymouth.ac.uk.
Adrian H
AH
Taylor
D000293:Adolescent; D000328:Adult; D001521:Behavior Therapy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D003863:Depression / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D004739:England; D005081:Exercise Therapy; D005260:Female; D015438:Health Behavior; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000191:economics; D006801:Humans; D008297:Male; D010174:Pamphlets; D010349:Patient Compliance; D010353:Patient Education as Topic; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult