Zanetidou Stamatula, Belvederi Murri Martino, Menchetti Marco, Toni Giulio, Asioli Fabrizio, Bagnoli Luigi, Zocchi Donato, Siena Matteo, Assirelli Barbara, Luciano Claudia, Masotti Mattia, Spezia Carlo, Magagnoli Monica, Neri Mirco, Amore Mario, Bertakis Klea D
Department of Mental Health, Consultation Liaison Psychiatry Service, Bologna, Italy.
Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy.
J Am Geriatr Soc. 2017 Feb;65(2):348-355. doi: 10.1111/jgs.14525. Epub 2016 Nov 21.
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).
Secondary analysis of a randomized controlled trial.
Primary care with psychiatric consultation-liaison programs (PCLPs)-organizational protocols that regulate the clinical management of individuals with psychiatric disorders.
Individuals aged 65 and older with major depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (N = 121).
Participants with LLMD were randomized to AD (sertraline) or AD plus PE (AD + PE).
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.
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.
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.
确定哪些个体相关因素和背景相关因素会影响基于体育锻炼（PE）作为抗抑郁药（AD）辅助手段治疗老年重度抑郁症（LLMD）的干预措施转化为临床实践。
一项随机对照试验的二次分析。
设有精神科会诊-联络项目（PCLPs）的初级保健——规范精神障碍患者临床管理的组织协议。
根据《精神障碍诊断与统计手册》第四版，年龄在65岁及以上的重度抑郁症患者（N = 121）。
LLMD患者被随机分为接受AD（舍曲林）治疗或AD加PE（AD + PE）治疗。
确定与AD + PE更有效（调节因素）相关的参与者特征，并根据成功率差异计算效应量。然后探讨研究背景的特征是否会影响参与者流量和锻炼课程的出勤率，并就初级保健医生（PCP）对PE作为LLMD治疗方法的看法进行调查。
以下参与者特征与AD + PE组比单独使用AD组更有可能实现抑郁症缓解相关：75岁及以上（效应量0.32）、联合用药（0.35）、有氧能力更强（0.48）、表现出精神运动迟缓（0.49）以及焦虑程度较轻（0.30）。特定中心设立PCLP的时间越长，该中心招募的个体就越多。参与研究后，初级保健医生对AD + PE作为LLMD的治疗方法表达了积极看法，并且更有可能将其用作治疗策略。
PE与舍曲林联合使用可以改善LLMD的管理，特别是针对具有特定临床特征的个体进行定制时。会诊-联络项目可能会影响初级保健中类似干预措施的实施，并且初级保健医生对其持积极看法。
