title: Development, acceptability and efficacy of a standardized healthy lifestyle intervention in recurrent depression.
abstract: BACKGROUND
  Research evidence on the effects of integrated multifaceted lifestyle interventions for depression is scanty. The aim of the present study is to report on the development, acceptability and efficacy of a standardized healthy lifestyle intervention, including exercise, eating habits, sleep hygiene and smoking cessation in preventing relapses.
  
  
  METHODS
  One hundred-sixty outpatients with recurrent unipolar depression or bipolar disorder were recruited after achieving full remission or recovery from the most recent depressive episode. Patients were randomized to 3-months of usual care or to an intervention aimed at promoting a healthy lifestyle (HLI), as an augmentation of pharmacological maintenance treatment. Usual care consisted of clinical management visits. At the end of the intervention, follow-up visits were scheduled at 3,6,9 and 12 months.
  
  
  RESULTS
  During the intervention phase, 1 relapse occurred in the HLI group and 4 in the control group. Over the 12 months of follow-up, relapses were 5 in the HLI group and 16 in control group. Using an intent-to-treat approach, the overall percentage of relapses was 6/81 (7.4%) in the HLI group vs. 20/79 (25.3%) in the control group.. In a Kaplan-Meier survival analysis the risk of relapse was significantly lower in patients receiving the HLI intervention (log-rank test, p=0.003) over the 60 weeks of observation. The majority of patients assigned to HLI adhered to the program, and were highly motivated throughout the intervention.
  
  
  CONCLUSIONS
  The retention rate was low because patients were recruited during the maintenance phase and the 1-year follow-up was relatively short to detect a long-term effect of HLI.
  
  
  CONCLUSIONS
  The HLI program proved to be efficacious in preventing relapses. Given the absence of contraindications and its cost-effectiveness in routine practice, the use of HLI should be encouraged to promote the well-being of patients with recurrent depression.
authors.affiliation: Department of Molecular and Developmental Medicine, University of Siena, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Goracci
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Italy. Electronic address: paola.rucci2@unibo.it.
authors.forename: P
authors.initials: P
authors.lastname: Rucci
authors.affiliation: Department of Molecular and Developmental Medicine, University of Siena, Italy.
authors.forename: R N
authors.initials: RN
authors.lastname: Forgione
authors.affiliation: Department of Molecular and Developmental Medicine, University of Siena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Campinoti
authors.affiliation: Department of Molecular and Developmental Medicine, University of Siena, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Valdagno
authors.affiliation: Department of Molecular and Developmental Medicine, University of Siena, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Casolaro
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Carretta
authors.affiliation: Department of Molecular and Developmental Medicine, University of Siena, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bolognesi
authors.affiliation: Department of Molecular and Developmental Medicine, University of Siena, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Fagiolini
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000517:prevention & control* / Q000523:psychology; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057194:Intention to Treat Analysis; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010045:Outpatients; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods*; D016540:Smoking Cessation
chemical_list: D000928:Antidepressive Agents
keywords: Depression; Eating; Exercise; Maintenance; Sleep; Smoking