What is the clinical evidence from this study?

Study design: RCT. Population: Depressive symptoms (n=193). Intervention: Home-based physical activity program (DeLLITE) vs. Social visits (time-matched). Primary outcome: Physical function (Short Physical Performance Battery [SPPB] score at 12 months) (p=0.274).

May 1, 2010Open Access

Home-Based Activity Program for Older People With Depressive Symptoms: DeLLITE-A Randomized Controlled Trial

Q: What does this research mean for the field?

A home-based physical activity program does not significantly improve physical function or mood compared to time-matched social visits in older adults with depressive symptoms. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

NKNgaire KerseUniversity of Auckland KHKaren HaymanUniversity of Auckland SMSimon MoyesUniversity of Auckland

Key Result

The DeLLITE home-based physical activity program did not significantly improve physical function (SPPB interaction p=0.274) or mood compared to time-matched social visits in older adults with depressive symptoms.

Study Design

Type

RCT (n=193)

Blinding

Single-blind

Randomization

Computer-generated random numbers

Multicenter

Yes

Structured PICO

Does an individualized home-based physical activity program improve physical function, quality of life, and mood in older people with depressive symptoms compared to social visits?

Population

193 community-dwelling adults aged 75 years and older with depressive symptoms, mean age 81.1 years, 58.5% female, recruited from 42 primary care practices in Auckland, New Zealand.

Intervention

Individualized home-based physical activity program (balance retraining, progressive resistance lower limb-strengthening exercises, walking, and goal setting) delivered by a trained nurse over 6 months (8 visits).

Comparator

Social visits (8 visits over 6 months) using a conversational guide without physical activity or goal setting, to control for the contact time of the activity intervention.

Outcome

Physical function measured by the Short Physical Performance Battery (SPPB) and the Nottingham Extended Activities of Daily Living (NEADL) scale over 12 months follow-up.patient reported

A home-based physical activity program did not significantly improve physical function, mood, or quality of life more than social visits in older adults with depressive symptoms.

Main Result

Absolute Event Rate: 7.5% vs 7.5%

p-value: p=0.274

Limitations

Lack of a true usual care control group without social visits to determine absolute efficacy.
Response rate of 61% of eligible participants may limit generalizability.
Potential selection bias as those with more severe depressive symptoms may have elected not to participate.
Double blinding was not possible due to the nature of the intervention.

Abstract

PURPOSE: We wanted to assess the effectiveness of a home-based physical activity program, the Depression in Late Life Intervention Trial of Exercise (DeLLITE), in improving function, quality of life, and mood in older people with depressive symptoms. METHODS: We undertook a randomized controlled trial involving 193 people aged 75 years and older with depressive symptoms at enrollment who were recruited from primary health care practices in Auckland, New Zealand. Participants received either an individualized physical activity program or social visits to control for the contact time of the activity intervention delivered over 6 months. Primary outcome measures were function, a short physical performance battery comprising balance and mobility, and the Nottingham Extended Activities of Daily Living scale. Secondary outcome measures were quality of life, the Medical Outcomes Study 36-item short form, mood, Geriatric Depression Scale (GDS-15), physical activity, Auckland Heart Study Physical Activity Questionnaire, and self-report of falls. Repeated measures analyses tested the differential impact on outcomes over 12 months' follow-up. RESULTS: The mean age of the participants was 81 years, and 59% were women. All participants scored in the at-risk category on the depression screen, 53% had a Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases, Tenth Revision diagnosis of major depression or scored more than 4 on the GDS-15 at baseline, indicating moderate or severe depression. Almost all participants, 187 (97%), completed the trial. Overall there were no differences in the impact of the 2 interventions on outcomes. Mood and mental health related quality of life improved for both groups. CONCLUSION: The DeLLITE activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. Future social and activity interventions should be tested against a true usual care control.

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