Abstract
There is a lack of knowledge about internet-based cognitive behavioural therapy in patients with cardiovascular disease, and its effects on depressive symptoms and physical activity. To examine trajectories of depressive symptoms and physical activity, and to explore if these trajectories are linked with the delivery of internet-based cognitive behavioural therapy. A secondary-analysis of data collected in a randomised controlled trial that evaluated the effects of a 9-week internet-based cognitive behavioural therapy programme compared to an online discussion forum on depressive symptoms in cardiovascular disease patients. Data were collected at baseline, once weekly during the 9-week intervention period and at the 9-week follow-up. The Montgomery Åsberg depression rating scale - self-rating (MADRS-S) was used to measure depressive symptoms. Two modified items from the physical activity questionnaire measuring frequency and length of physical activity were merged to form a physical activity factor. After 2 weeks the internet-based cognitive behavioural therapy group had a temporary worsening in depressive symptoms. At 9-week follow-up, depressive symptoms (P<0.001) and physical activity (P=0.02) had improved more in the internet-based cognitive behavioural therapy group. Only in the internet-based cognitive behavioural therapy group, was a significant correlation (r=-0.39, P=0.002) between changes in depressive symptoms and changes in physical activity found. Structural equation analyses revealed that internet-based cognitive behavioural therapy decreased depressive symptoms, and that a decrease in depression, in turn, resulted in an increase in physical activity. Internet-based cognitive behavioural therapy was more effective than an online discussion forum to decrease depressive symptoms and increase physical activity. Importantly, a decrease in depressive symptoms needs to precede an increase in physical activity.
Highlights
There is a lack of knowledge about internet-based cognitive behavioural therapy in patients with cardiovascular disease, and its effects on depressive symptoms and physical activity
ANCOVA analysis revealed a significant improvement in depressive symptoms at follow-up favouring internet-based cognitive behavioural therapy (ICBT) (F=24.7, P
The aim of this study was to examine trajectories of depressive symptoms and physical activity in relation to ICBT and online discussion forum (ODF), and to investigate the associations between these trajectories to discern the temporal order of change
Summary
There is a lack of knowledge about internet-based cognitive behavioural therapy in patients with cardiovascular disease, and its effects on depressive symptoms and physical activity. Cognitive behavioural therapy (CBT) has been proposed as a treatment option for depressive symptoms in CVD patients.[3] there is poor access to CBT in clinical care and other treatment options are needed.[4] In non-CVD populations, physical activity has been reported as a treatment option for depressive symptoms,[5] whereas the evidence for patients with CVD is scarce This could at least partly be due to the fact that a significant proportion of studies evaluating the effect of physical activity on depression in CVD has included patients irrespective of their levels of depressive symptoms.[6] There are other aspects that may act as barriers to the use of physical activity as treatment for depression in CVD, for instance lack of motivation, which can be seen as an inherent aspect of depression.[7,8,9] Another barrier is a fear that physical activity might be harmful.[9] This is interesting, as depressive symptoms in CVD are associated with a decline in exercise confidence despite participation in a cardiac rehabilitation programme.[10] To conclude, recommending physical activity as a treatment option for depressive symptoms in CVD patients may not be feasible.
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