UPLIFT study- Linking the health and leisure sectors: using physical activity in the management of depressive symptoms in older people with depression

AIMS: The aim is to test whether a 10-week progressive resistance training (PRT) program for depressed people aged 65 and over from the general practice setting will result in a reduced prevalence of depression at ten weeks and six months and a concomitant improvement in physical and psychological health, functional and quality of life status. The hypothesis to be tested is that the PRT program will produce a 60% reduction in depression rates amongst older people (akin to standard active therapies), compared to a 40% reduction in those receiving usual care. BACKGROUND: The prevalence of depression in older people ranges from 5 to 30%. Depressive illness results in reduced activity levels, functional disability and decreased quality of life, and can occur concurrently with other illnesses (e.g., cardiovascular disease) and impact adversely on these conditions. Depressed older people have much to gain from being physically active, with benefits reported in both physical and mental health. Physical activity offers an alternative to drug management for some older people, reducing iatrogenic and polypharmacy problems. PRT is one form of physical activity with a growing evidence base in depression management. It is both timely and critical that we test the effectiveness of PRT in improving mental and physical health of older people with depression when applied in the Australian primary health care context. RESEARCH PLAN: Older people will be recruited from primary and community care settings, via mailed invitations and referrals. Eligibility will be established via completion of the GDS-30 and medical clearance against proscribed criteria. Following baseline assessment, participants will be randomly allocated to a community-based, supervised PRT exercise program or usual care (comparison group). The PRT group will attend a local ‘Living Longer, Living Stronger’™ facility three times/week for 10 weeks. We will repeat baseline assessments at ten weeks and six months to determine whether the intervention’s impact is sustained. Sustainability is vital if the model is to be transferred into routine service delivery. Our approach will optimize the generalisability of study findings and the interventions’ subsequent adoption and implementation. Given the nature of the intervention, participants and exercise facilitators are not blinded to group allocation, but the data analyst is. OUTCOMES & SIGNIFICANCE: The primary endpoint is a clinically significant reduction in depressive symptoms. The secondary endpoint is a significant improvement in health and wellbeing status, measured using the Human Activities Profile, the Philadelphia Geriatric Morale Scale and the WHOQOL-Bref.