title: Physical Exercise for Late-Life Depression: Customizing an Intervention for Primary Care.
abstract: OBJECTIVE
  To identify which individual- and context-related factors influence the translation into clinical practice of interventions based on physical exercise (PE) as an adjunct to antidepressants (AD) for the treatment of late-life major depression (LLMD).
  
  
  METHODS
  Secondary analysis of a randomized controlled trial.
  
  
  METHODS
  Primary care with psychiatric consultation-liaison programs (PCLPs)-organizational protocols that regulate the clinical management of individuals with psychiatric disorders.
  
  
  METHODS
  Individuals aged 65 and older with major depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (N = 121).
  
  
  METHODS
  Participants with LLMD were randomized to AD (sertraline) or AD plus PE (AD + PE).
  
  
  METHODS
  Participant characteristics that were associated with greater effectiveness of AD + PE (moderators) were identified, and effect sizes were calculated from success rate differences. Whether the characteristics of the study setting influenced participant flow and attendance at exercise sessions was then explored, and primary care physicians (PCPs) were surveyed regarding their opinions on PE as a treatment for LLMD.
  
  
  RESULTS
  The following participant characteristics were associated with greater likelihood of achieving remission from depression with AD + PE than with AD alone: aged 75 and older (effect size 0.32), polypharmacy (0.35), greater aerobic capacity (0.48), displaying psychomotor slowing (0.49), and less-severe anxiety (0.30). The longer the PCLP had been established at a particular center, the more individuals were recruited at that center. After participating in the study, PCPs expressed positive views on AD + PE as a treatment for LLMD and were more likely to use this as a therapeutic strategy.
  
  
  CONCLUSIONS
  The combination of PE and sertraline could improve the management of LLMD, especially when customized for individuals with specific clinical features. Liaison programs might influence the implementation of similar interventions in primary care, and PCPs viewed them positively.
authors.affiliation: Department of Mental Health, Consultation Liaison Psychiatry Service, Bologna, Italy.
authors.forename: Stamatula
authors.initials: S
authors.lastname: Zanetidou
authors.affiliation: Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy.|Department of Psychological Medicine, King's College London, London, United Kingdom.
authors.forename: Martino
authors.initials: M
authors.lastname: Belvederi Murri
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Menchetti
authors.affiliation: Cardiology Unit, S. Sebastiano Hospital, Correggio, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Toni
authors.affiliation: Primary Care Physician, Bologna, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Asioli
authors.affiliation: Primary Care Physician, Bologna, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bagnoli
authors.affiliation: Primary Care Physician, Bologna, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Zocchi
authors.affiliation: Primary Care Physician, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Siena
authors.affiliation: Primary Care Physician, Bologna, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Assirelli
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Luciano
authors.affiliation: Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Masotti
authors.affiliation: Primary Care Physician, Bologna, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Spezia
authors.affiliation: Primary Care Physician, Bologna, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Magagnoli
authors.affiliation: Department of Geriatrics, Nuovo Ospedale Civile, Modena and Reggio Emilia University, Modena, Italy.
authors.forename: Mirco
authors.initials: M
authors.lastname: Neri
authors.affiliation: Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Amore
authors.affiliation: Department of Family and Community Medicine, School of Medicine, University of California, Davis, Sacramento, California.|Center for Healthcare Policy and Research, School of Medicine, University of California, Davis, Sacramento, California.
authors.forename: Klea D
authors.initials: KD
authors.lastname: Bertakis
mesh_terms: D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000628:therapy; D001291:Attitude of Health Personnel; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000628:therapy*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D010101:Oxygen Consumption; D058007:Physicians, Primary Care; D019338:Polypharmacy; D011320:Primary Health Care; D011597:Psychomotor Performance; D012074:Remission Induction; D020280:Sertraline / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016037:Single-Blind Method
chemical_list: D000928:Antidepressive Agents; D020280:Sertraline
keywords: antidepressant; depression; elderly; physical exercise; primary care; randomized controlled trial