Summary Background Depression is common and is associated with poor outcomes among elderly care-home residents. Exercise is a promising low-risk intervention for depression in this population. We ...tested the hypothesis that a moderate intensity exercise programme would reduce the burden of depressive symptoms in residents of care homes. Methods We did a cluster-randomised controlled trial in care homes in two regions in England; northeast London, and Coventry and Warwickshire. Residents aged 65 years or older were eligible for inclusion. A statistician independent of the study randomised each home (1 to 1·5 ratio, stratified by location, minimised by type of home provider local authority, voluntary, private and care home, private and nursing home and size of home <32 or ≥32 residents) into intervention and control groups. The intervention package included depression awareness training for care-home staff, 45 min physiotherapist-led group exercise sessions for residents (delivered twice weekly), and a whole home component designed to encourage more physical activity in daily life. The control consisted of only the depression awareness training. Researchers collecting follow-up data from individual participants and the participants themselves were inevitably aware of home randomisation because of the physiotherapists' activities within the home. A researcher masked to study allocation coded NHS routine data. The primary outcome was number of depressive symptoms on the geriatric depression scale-15 (GDS-15). Follow-up was for 12 months. This trial is registered with ISRCTN Register, number ISRCTN43769277. Findings Care homes were randomised between Dec 15, 2008, and April 9, 2010. At randomisation, 891 individuals in 78 care homes (35 intervention, 43 control) had provided baseline data. We delivered 3191 group exercise sessions attended on average by five study participants and five non-study residents. Of residents with a GDS-15 score, 374 of 765 (49%) were depressed at baseline; 484 of 765 (63%) provided 12 month follow-up scores. Overall the GDS-15 score was 0·13 (95% CI −0·33 to 0·60) points higher (worse) at 12 months for the intervention group compared with the control group. Among residents depressed at baseline, GDS-15 score was 0·22 (95% CI −0·52 to 0·95) points higher at 6 months in the intervention group than in the control group. In an end of study cross-sectional analysis, including 132 additional residents joining after randomisation, the odds of being depressed were 0·76 (95% CI 0·53 to 1·09) for the intervention group compared with the control group. Interpretation This moderately intense exercise programme did not reduce depressive symptoms in residents of care homes. In this frail population, alternative strategies to manage psychological symptoms are required. Funding National Institute for Health Research Health Technology Assessment.
Abstract Background The benefits of physical activity in young people are well documented. Understanding of young people's physical activity behaviours is therefore important in promotion of ...participation in this group. Objective measures are increasingly used to quantify the amount and intensity of physical activity, and accelerometers are currently the favoured device. Previous studies have found some parents reporting their children as unwilling to wear accelerometers at school and during sports because of the risk of stigma and bullying. There is however, little evidence for how young people themselves feel about wearing accelerometers for physical activity research. We aimed to investigate young people's views on accelerometer use. Methods We undertook a user-involvement qualitative study, involving five focus group discussions with young people aged 7–18 years (n=35). Participants were members of two Medicines for Children Research Network (MCRN) young person's advisory groups and pupils from two local primary schools. Focus groups allowed for differences between participants to be revealed. Young people's views were analysed by thematic analysis. Findings Five broad themes emerged from the focus group discussions: first impressions, how it feels to wear an accelerometer, best time to wear an accelerometer, disadvantages of wearing an accelerometer, and how accelerometers can be made more appealing or incentives for use. First impressions of accelerometers were often negative, with issues related to size and comfort reported. In particular, participants felt that the accelerometer could be too bulky and that the elastic waistband used to attach it could be uncomfortable. Unwanted attention from wearing the device and the risk of bullying were also noted. Other disadvantages included feeling embarrassed and not being able to wear the device for certain activities (eg, swimming or contact sports). Many young people felt that they would find it difficult to keep an activity diary alongside their accelerometer use. Positive aspects included feeling special or having increased attention or curiosity from friends. Views on the best time to wear accelerometers (eg, term time or holidays) were mixed. Young people offered advice on how to make wearing accelerometers more appealing, including presenting the device in a positive way, using a clip rather than an elastic band to attach it, personalising the device, and being able to see activity levels via feedback afterwards. Interpretation There has been little focus on young people's views on wearing accelerometers in physical activity research. This small-scale user-involvement study provides initial data and provides practical issues for researchers to consider when embarking on accelerometer research in this group. Young people's views on accelerometer use are varied. Judgments over the way in which accelerometers are used should be made at the study development stage, and based on the individual population, to increase compliance. This study presents practical ideas for researchers to help to increase acceptability of accelerometer use in young people. This is a small-scale study within a specific group of young people in the West Midlands, UK, but initial findings are revealing and certainly warrant further exploration. Funding National Institute for Health Research Health Technology Assessment.
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