Energetic activity for depression in young people aged 13–17 years: the READY feasibility RCT
Prevalence of depression is increasing in young people. Behaviour change interventions providing benefits equal to or greater than talking therapies or pharmacological alternatives are needed. Exercise could be beneficial for young people with depression, but we lack robust trials of its effectivene...
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| Published in: | Health technology assessment (Winchester, England) pp. 1 - 26 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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England
NIHR Journals Library
18.12.2024
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| ISSN: | 2046-4924, 1366-5278, 2046-4924 |
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| Abstract | Prevalence of depression is increasing in young people. Behaviour change interventions providing benefits equal to or greater than talking therapies or pharmacological alternatives are needed. Exercise could be beneficial for young people with depression, but we lack robust trials of its effectiveness.
To test whether an exercise intervention targeting young people with depression is feasible, including recruitment and retention of young people, recruitment and training of exercise professionals and intervention delivery.
Three-arm cluster feasibility randomised controlled trial with embedded process evaluation and health economic data collection.
Local community venues in Hertfordshire, Bedfordshire and Norfolk.
Young people aged 13-17 years experiencing mild to moderate low mood or depression (indicated by scoring 17-36 on the Child Depression Inventory version 2) identified by mental health services, schools or self-referral.
Participants were randomised to one of three groups: high-intensity exercise, low-intensity exercise or a social activity control. Group sessions ran twice-weekly for 12 weeks delivered by registered exercise professionals, supported by mental health support workers.
Referral, recruitment and retention rates; attendance at group sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data, and adverse events measured at baseline and at 3 and 6 months; resource use; and reach and representativeness.
Of 321 referrals to the study, 173 were assessed for eligibility, and of the target sample size of 81, 15 were recruited and 14 were randomised (one withdrew). The retention rate was 71.4% and attendance at intervention sessions was > 67%; data completeness was > 80% for baseline assessments. Follow-up completion rate at 14 weeks was > 80% for most outcomes, with 50% for accelerometer data in the low-intensity group. Trial processes and the intervention were acceptable to young people. Barriers to and facilitators of intervention delivery were identified.
Findings highlighted challenges around recruitment, delivery of exercise interventions and informed ways of addressing barriers to recruitment for future studies. The study was conducted between October 2020 and August 2022 and consequently the COVID-19 pandemic had a disruptive impact on implementation.
A large randomised trial of the effectiveness of the intervention is not feasible using the current study design, but issues relating to recruitment could be addressed with further work.
Developing appropriate recruitment strategies via triage services, general practitioner practices, schools and social media and early engagement with the local Clinical Research Network to support recruitment to the study would address the significant shortfalls identified. Young people who are deemed unsuitable for mental health services should be followed up to be offered participation in such interventions. Collaborations between the NHS services and sports delivery partners should consider in-person contact with young people rather than remote consultations. Recruiting through general practitioner practices is effective and relatively inexpensive. The role of community engagement (socialmedia, public health agencies, community groups) needs to be further explored. Strong public and patient involvement and engagement via young people advisory groups is important to ensure that research is relevant to young people.
This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/78/10. |
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| AbstractList | Prevalence of depression is increasing in young people. Behaviour change interventions providing benefits equal to or greater than talking therapies or pharmacological alternatives are needed. Exercise could be beneficial for young people with depression, but we lack robust trials of its effectiveness.
To test whether an exercise intervention targeting young people with depression is feasible, including recruitment and retention of young people, recruitment and training of exercise professionals and intervention delivery.
Three-arm cluster feasibility randomised controlled trial with embedded process evaluation and health economic data collection.
Local community venues in Hertfordshire, Bedfordshire and Norfolk.
Young people aged 13-17 years experiencing mild to moderate low mood or depression (indicated by scoring 17-36 on the Child Depression Inventory version 2) identified by mental health services, schools or self-referral.
Participants were randomised to one of three groups: high-intensity exercise, low-intensity exercise or a social activity control. Group sessions ran twice-weekly for 12 weeks delivered by registered exercise professionals, supported by mental health support workers.
Referral, recruitment and retention rates; attendance at group sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data, and adverse events measured at baseline and at 3 and 6 months; resource use; and reach and representativeness.
Of 321 referrals to the study, 173 were assessed for eligibility, and of the target sample size of 81, 15 were recruited and 14 were randomised (one withdrew). The retention rate was 71.4% and attendance at intervention sessions was > 67%; data completeness was > 80% for baseline assessments. Follow-up completion rate at 14 weeks was > 80% for most outcomes, with 50% for accelerometer data in the low-intensity group. Trial processes and the intervention were acceptable to young people. Barriers to and facilitators of intervention delivery were identified.
Findings highlighted challenges around recruitment, delivery of exercise interventions and informed ways of addressing barriers to recruitment for future studies. The study was conducted between October 2020 and August 2022 and consequently the COVID-19 pandemic had a disruptive impact on implementation.
A large randomised trial of the effectiveness of the intervention is not feasible using the current study design, but issues relating to recruitment could be addressed with further work.
Developing appropriate recruitment strategies via triage services, general practitioner practices, schools and social media and early engagement with the local Clinical Research Network to support recruitment to the study would address the significant shortfalls identified. Young people who are deemed unsuitable for mental health services should be followed up to be offered participation in such interventions. Collaborations between the NHS services and sports delivery partners should consider in-person contact with young people rather than remote consultations. Recruiting through general practitioner practices is effective and relatively inexpensive. The role of community engagement (socialmedia, public health agencies, community groups) needs to be further explored. Strong public and patient involvement and engagement via young people advisory groups is important to ensure that research is relevant to young people.
This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/78/10. Depression in adolescents is a serious problem that can lead to poor mental health and stigma throughout a person’s life. Antidepressants help some people but can have negative side effects. Research shows that adults with depression benefit from exercise, but it is unknown whether exercise is helpful for young people who are depressed. We wanted to find out whether it is possible to conduct a study examining the effect of exercise on depression in young people. We recruited young people aged 13–17 years, diagnosed with depression, from three locations in the UK. Those suitable for exercise participated in one of three groups: (1) high-intensity exercise (e.g. circuit training), (2) low-intensity exercise (e.g. chair based) or (3) social activity (non-exercise-based activities, e.g. quizzes and board games). Young people attended two 60-minute sessions per week for 12 weeks at local centres. Researchers collected data on mental health, session attendance and physical activity at the first session and at 14 and 26 weeks. We also asked some young people and staff about their experience in the study. Fourteen young people took part, mostly completing the study in full. Over two-thirds of sessions were attended, and over 80% of questionnaires were completed. We found that this study was acceptable to young people and to staff delivering the sessions. The small number of participants highlights the difficulties faced during the COVID-19 pandemic and reflects the challenges in reaching young people living with depression. We concluded that it is not possible to do a larger study with the current study design without finding out how to more effectively engage with young people with low mood. Nevertheless, by talking to members of the public (e.g. young people and their parents/carers), providing exercise and social activity sessions in-person instead of online, and engaging with NHS and sports organisations, we believe that young people could be encouraged to take part in future studies of this type. Prevalence of depression is increasing in young people. Behaviour change interventions providing benefits equal to or greater than talking therapies or pharmacological alternatives are needed. Exercise could be beneficial for young people with depression, but we lack robust trials of its effectiveness.BackgroundPrevalence of depression is increasing in young people. Behaviour change interventions providing benefits equal to or greater than talking therapies or pharmacological alternatives are needed. Exercise could be beneficial for young people with depression, but we lack robust trials of its effectiveness.To test whether an exercise intervention targeting young people with depression is feasible, including recruitment and retention of young people, recruitment and training of exercise professionals and intervention delivery.ObjectiveTo test whether an exercise intervention targeting young people with depression is feasible, including recruitment and retention of young people, recruitment and training of exercise professionals and intervention delivery.Three-arm cluster feasibility randomised controlled trial with embedded process evaluation and health economic data collection.DesignThree-arm cluster feasibility randomised controlled trial with embedded process evaluation and health economic data collection.Local community venues in Hertfordshire, Bedfordshire and Norfolk.SettingLocal community venues in Hertfordshire, Bedfordshire and Norfolk.Young people aged 13-17 years experiencing mild to moderate low mood or depression (indicated by scoring 17-36 on the Child Depression Inventory version 2) identified by mental health services, schools or self-referral.ParticipantsYoung people aged 13-17 years experiencing mild to moderate low mood or depression (indicated by scoring 17-36 on the Child Depression Inventory version 2) identified by mental health services, schools or self-referral.Participants were randomised to one of three groups: high-intensity exercise, low-intensity exercise or a social activity control. Group sessions ran twice-weekly for 12 weeks delivered by registered exercise professionals, supported by mental health support workers.InterventionsParticipants were randomised to one of three groups: high-intensity exercise, low-intensity exercise or a social activity control. Group sessions ran twice-weekly for 12 weeks delivered by registered exercise professionals, supported by mental health support workers.Referral, recruitment and retention rates; attendance at group sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data, and adverse events measured at baseline and at 3 and 6 months; resource use; and reach and representativeness.Main outcome measuresReferral, recruitment and retention rates; attendance at group sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data, and adverse events measured at baseline and at 3 and 6 months; resource use; and reach and representativeness.Of 321 referrals to the study, 173 were assessed for eligibility, and of the target sample size of 81, 15 were recruited and 14 were randomised (one withdrew). The retention rate was 71.4% and attendance at intervention sessions was > 67%; data completeness was > 80% for baseline assessments. Follow-up completion rate at 14 weeks was > 80% for most outcomes, with 50% for accelerometer data in the low-intensity group. Trial processes and the intervention were acceptable to young people. Barriers to and facilitators of intervention delivery were identified.ResultsOf 321 referrals to the study, 173 were assessed for eligibility, and of the target sample size of 81, 15 were recruited and 14 were randomised (one withdrew). The retention rate was 71.4% and attendance at intervention sessions was > 67%; data completeness was > 80% for baseline assessments. Follow-up completion rate at 14 weeks was > 80% for most outcomes, with 50% for accelerometer data in the low-intensity group. Trial processes and the intervention were acceptable to young people. Barriers to and facilitators of intervention delivery were identified.Findings highlighted challenges around recruitment, delivery of exercise interventions and informed ways of addressing barriers to recruitment for future studies. The study was conducted between October 2020 and August 2022 and consequently the COVID-19 pandemic had a disruptive impact on implementation.LimitationsFindings highlighted challenges around recruitment, delivery of exercise interventions and informed ways of addressing barriers to recruitment for future studies. The study was conducted between October 2020 and August 2022 and consequently the COVID-19 pandemic had a disruptive impact on implementation.A large randomised trial of the effectiveness of the intervention is not feasible using the current study design, but issues relating to recruitment could be addressed with further work.ConclusionsA large randomised trial of the effectiveness of the intervention is not feasible using the current study design, but issues relating to recruitment could be addressed with further work.Developing appropriate recruitment strategies via triage services, general practitioner practices, schools and social media and early engagement with the local Clinical Research Network to support recruitment to the study would address the significant shortfalls identified. Young people who are deemed unsuitable for mental health services should be followed up to be offered participation in such interventions. Collaborations between the NHS services and sports delivery partners should consider in-person contact with young people rather than remote consultations. Recruiting through general practitioner practices is effective and relatively inexpensive. The role of community engagement (socialmedia, public health agencies, community groups) needs to be further explored. Strong public and patient involvement and engagement via young people advisory groups is important to ensure that research is relevant to young people.Future workDeveloping appropriate recruitment strategies via triage services, general practitioner practices, schools and social media and early engagement with the local Clinical Research Network to support recruitment to the study would address the significant shortfalls identified. Young people who are deemed unsuitable for mental health services should be followed up to be offered participation in such interventions. Collaborations between the NHS services and sports delivery partners should consider in-person contact with young people rather than remote consultations. Recruiting through general practitioner practices is effective and relatively inexpensive. The role of community engagement (socialmedia, public health agencies, community groups) needs to be further explored. Strong public and patient involvement and engagement via young people advisory groups is important to ensure that research is relevant to young people.This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/78/10.FundingThis article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/78/10. Background Prevalence of depression is increasing in young people. Behaviour change interventions providing benefits equal to or greater than talking therapies or pharmacological alternatives are needed. Exercise could be beneficial for young people with depression, but we lack robust trials of its effectiveness. Objective To test whether an exercise intervention targeting young people with depression is feasible, including recruitment and retention of young people, recruitment and training of exercise professionals and intervention delivery. Design Three-arm cluster feasibility randomised controlled trial with embedded process evaluation and health economic data collection. Setting Local community venues in Hertfordshire, Bedfordshire and Norfolk. Participants Young people aged 13–17 years experiencing mild to moderate low mood or depression (indicated by scoring 17–36 on the Child Depression Inventory version 2) identified by mental health services, schools or self-referral. Interventions Participants were randomised to one of three groups: high-intensity exercise, low-intensity exercise or a social activity control. Group sessions ran twice-weekly for 12 weeks delivered by registered exercise professionals, supported by mental health support workers. Main outcome measures Referral, recruitment and retention rates; attendance at group sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data, and adverse events measured at baseline and at 3 and 6 months; resource use; and reach and representativeness. Results Of 321 referrals to the study, 173 were assessed for eligibility, and of the target sample size of 81, 15 were recruited and 14 were randomised (one withdrew). The retention rate was 71.4% and attendance at intervention sessions was > 67%; data completeness was > 80% for baseline assessments. Follow-up completion rate at 14 weeks was > 80% for most outcomes, with 50% for accelerometer data in the low-intensity group. Trial processes and the intervention were acceptable to young people. Barriers to and facilitators of intervention delivery were identified. Limitations Findings highlighted challenges around recruitment, delivery of exercise interventions and informed ways of addressing barriers to recruitment for future studies. The study was conducted between October 2020 and August 2022 and consequently the COVID-19 pandemic had a disruptive impact on implementation. Conclusions A large randomised trial of the effectiveness of the intervention is not feasible using the current study design, but issues relating to recruitment could be addressed with further work. Future work Developing appropriate recruitment strategies via triage services, general practitioner practices, schools and social media and early engagement with the local Clinical Research Network to support recruitment to the study would address the significant shortfalls identified. Young people who are deemed unsuitable for mental health services should be followed up to be offered participation in such interventions. Collaborations between the NHS services and sports delivery partners should consider in-person contact with young people rather than remote consultations. Recruiting through general practitioner practices is effective and relatively inexpensive. The role of community engagement (socialmedia, public health agencies, community groups) needs to be further explored. Strong public and patient involvement and engagement via young people advisory groups is important to ensure that research is relevant to young people. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/78/10. Plain language summary Depression in adolescents is a serious problem that can lead to poor mental health and stigma throughout a person’s life. Antidepressants help some people but can have negative side effects. Research shows that adults with depression benefit from exercise, but it is unknown whether exercise is helpful for young people who are depressed. We wanted to find out whether it is possible to conduct a study examining the effect of exercise on depression in young people. We recruited young people aged 13–17 years, diagnosed with depression, from three locations in the UK. Those suitable for exercise participated in one of three groups: (1) high-intensity exercise (e.g. circuit training), (2) low-intensity exercise (e.g. chair based) or (3) social activity (non-exercise-based activities, e.g. quizzes and board games). Young people attended two 60-minute sessions per week for 12 weeks at local centres. Researchers collected data on mental health, session attendance and physical activity at the first session and at 14 and 26 weeks. We also asked some young people and staff about their experience in the study. Fourteen young people took part, mostly completing the study in full. Over two-thirds of sessions were attended, and over 80% of questionnaires were completed. We found that this study was acceptable to young people and to staff delivering the sessions. The small number of participants highlights the difficulties faced during the COVID-19 pandemic and reflects the challenges in reaching young people living with depression. We concluded that it is not possible to do a larger study with the current study design without finding out how to more effectively engage with young people with low mood. Nevertheless, by talking to members of the public (e.g. young people and their parents/carers), providing exercise and social activity sessions in-person instead of online, and engaging with NHS and sports organisations, we believe that young people could be encouraged to take part in future studies of this type. |
| Author | Jones, Julia Turner, David Clarke, Timothy Mengoni, Silvana Murdoch, Jamie Wilson, Jonathan Rourke, Claire Smith, Megan David, Lee Wellsted, David Grant, Kelly Clark, Allan Bottoms, Lindsay Howlett, Neil Wyatt, Solange Chater, Angel James, Ryan Sharma, Shivani Jones, Andy Sims, Erika Guillard, Cecile Trivedi, Daksha |
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| Snippet | Prevalence of depression is increasing in young people. Behaviour change interventions providing benefits equal to or greater than talking therapies or... Depression in adolescents is a serious problem that can lead to poor mental health and stigma throughout a person’s life. Antidepressants help some people but... Background Prevalence of depression is increasing in young people. Behaviour change interventions providing benefits equal to or greater than talking therapies... |
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| SubjectTerms | behaviour change depression exercise feasibility randomised controlled trial low mood physical activity young people |
| Title | Energetic activity for depression in young people aged 13–17 years: the READY feasibility RCT |
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