Physical activity and depression in MS: The mediating role of behavioral activation |
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| Affiliation: | 1. Department of Behavioral and Community Health Sciences (SMA, JK), Graduate School of Public Health, University of Pittsburgh, Pittsburgh;2. Department of Biostatistics (SA, MAD, JZ), University of Pittsburgh, Pittsburgh;3. Department of Psychiatry (MAD, STS, JFK, AGG, MAB, CFR), University of Pittsburgh, Pittsburgh;1. Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey;2. Gazi University, Faculty of Medicine, Department of Neurology, Ankara, Turkey;1. Department of Physical Therapy, University of Alabama at Birmingham, United States of America;2. Shepherd Center, United States of America;3. Department of Biostatistics, University of Alabama at Birmingham, United States of America;4. Accelerate Cure Project for Multiple Sclerosis, United States of America;5. Mellen Center for MS, Neurological Institute, Cleveland Clinic, United States of America;6. School of Medicine, University of Colorado Anschutz Medical Campus, United States of America;7. Program in Exercise Science, Department of Physical Therapy, Marquette University, United States of America;8. Department of Kinesiology, University of Georgia, United States of America;9. Division of Physical Therapy, University of North Carolina at Chapel-Hill, United States of America |
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| Abstract: | BackgroundDepression is a common comorbid condition among individuals with multiple sclerosis (MS) and is associated with greater overall disease burden and lower quality of life. Numerous clinical trials have supported physical activity interventions versus education, usual care, and attention control conditions for improving depressive symptoms in individuals with MS. However, little is known about the psychological mechanisms that may underlie physical activity-related improvements in depression. Behavioral activation posits that depression may stem from a reduction or loss of personally meaningful and rewarding activity. The process of behavioral activation involves re-engaging with these experiences. Behavioral activation might represent one mechanism by which physical activity interventions improve depression.ObjectiveTo examine behavioral activation as a mechanism mediating the effects of physical activity intervention on depressive symptom improvement in individuals with MS.MethodsMediational path analysis using data from a randomized controlled trial (N = 64) comparing telephone-based physical activity counseling (TC) to education (EC).ResultsParticipation in TC resulted in greater improvements in behavioral activation from months 0–3. Improvements in behavioral activation were associated with fewer baseline-adjusted depressive symptoms at month 6. The corresponding indirect (mediational) pathway was significant.ConclusionBehavioral activation may represent one mechanism by which physical activity improves depression in MS. Future physical activity trials should capitalize on this relationship and place additional emphasis on identifying and engaging in personally meaningful life activity. Future trials of therapies focused on behavioral activation might benefit from encouraging physical activity goals.Trial registrationTrial Registration clinicaltrials.gov Identifier: NCT01198977. |
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| Keywords: | Behavioral activation Depression Physical activity Multiple sclerosis |
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