To evaluate whether internet-based, self-guided cognitive behavioral therapy (CBT) or mindfulness-based cognitive therapy (MBCT) in addition to an activity tracker (Fitbit®) increased daily steps compared with an activity tracker alone among patients with depression who have or are at risk for cardiovascular disease (CVD).
||Randomized controlled trial
||361 patients with self-reported bipolar or unipolar depression who have or are at risk for CVD; patients were from 2 PCORnet® PPRNs
- CBT with Fitbit activity tracking
- MBCT with Fitbit activity tracking
- Fitbit activity tracking alone
Physical activity measured as the number of steps per day
||2-month follow-up for primary outcome
This randomized controlled trial compared the effectiveness of two types of internet-based, self-guided mental health treatment plus activity tracking versus activity tracking alone on increasing physical activity in patients with depression who have or are at risk for CVD.
Researchers recruited patients from two Patient-Powered Research Networks (PPRNs), MoodNetwork and Health eHeart. These PPRNs were previously Network Partners in PCORnet®, the National Patient-Centered Clinical Research Network. In PPRNs, patients, caregivers, and community members contribute to all aspects of research.
Researchers randomized patients to one of three groups. In all groups, patients wore a Fitbit activity tracker for two months.
In the first group, patients viewed weekly, web-based CBT courses for two months. The CBT courses included content that could help patients change patterns in their thinking to encourage positive thoughts about physical activity. In the second group, patients viewed a weekly, web-based MBCT course for two months. The MBCT course included content on building awareness of daily experiences to understand impediments to a healthy lifestyle. Both courses encouraged patients to practice skills taught in each week’s course. In the third group, patients wore a Fitbit for two months and did not view any courses.
Patients completed surveys every other week for the first two months and again two months after the courses ended.
The study included 361 patients with bipolar or unipolar depression who had or were at risk for CVD. Of these patients, 83% were White, 7% were Black, 7% were more than one race, and 3% reported another race; 7% were Hispanic. The average age was 45, 83% were female, and 92% had a college degree or higher.
Patients from the two PPRNs helped create research questions and plan the study.
After two months, differences in daily steps across the three groups were statistically significant but not clinically meaningful. The number of steps (all p<0.05):
- Decreased by 8.2 steps per day for patients who received the Fitbit alone
- Increased by 2.8 steps per day for patients who also received MBCT
- Increased by 2.9 steps per day for patients who also received CBT
At four months, the three groups did not differ significantly in number of daily steps.
Most study participants were female, White, and had a college degree. Results may have differed if the study included participants with different backgrounds.
Conclusions and Relevance
In this study, an activity tracker with or without internet-based, self-guided mental health treatments did not meaningfully increase daily steps among patients with depression who have or are at risk for CVD.
Future Research Needs
Future research could test the CBT and MBCT interventions with live support from a coach or therapist.
|MoodNetwork and Health eHeart online networks formerly were Network Partners in PCORnet®, the National Patient-Centered Clinical Research Network. PCORnet has been developed with funding from the Patient-Centered Outcomes Research Institute (PCORI).