The Effectiveness of Internet-guided Self-help Interventions to Promote Physical Activity Among Individuals with Depression: Systematic Review (Preprint)

BACKGROUND Depression is a prevalent and debilitating mental disorder and one of the leading causes of disability in Canada and around the world. Structured exercise interventions have been identified as effective in alleviating depression, and exercise is now recommended as a treatment for mild-to-moderate depression in Canada. It may not always be possible, however, to access supervised and structured exercise interventions for depression. Internet-guided self-help (IGSH) interventions, a type of eHealth intervention, may be an effective alternative in increasing physical activity among people with depression who cannot, or prefer not to, access supervised exercise treatment. OBJECTIVE The objective of this systematic review (PROSPERO 2020 CRD42020221713) is to evaluate the effectiveness of IGSH interventions in increasing physical activity and alleviating depressive symptoms among people with depression (PWD). METHODS Two rounds of systematic literature searches for randomized controlled trials (RCTs) and quasi-experimental studies were conducted in nine electronic databases (e.g., Medline, PsycINFO) in December 2020 and November 2021 from their inception. RESULTS Five RCTs (502 participants) met the inclusion criteria. Four were web-based and one was app-based. Three studies indicated that IGSH interventions have medium to large effects on decreasing depressive symptoms but not on increasing physical activity compared to waitlist/usual care groups. Two studies showed increased self-reported physical activity but no significant change in depressive symptoms in the intervention groups compared to control groups. None of the included studies reported changes in physical activity as a primary outcome. Goal-setting, problem solving, feedback on behaviour, and self-monitoring of behaviour were the four most common behaviour change techniques used in the interventions. Dropout rates in intervention groups were relatively low (0% - 21.9%). CONCLUSIONS Our findings suggest that IGSH physical activity interventions are feasible and moderately effective in improving depressive symptoms among PWD. More well-designed and tailored interventions with different combinations of BCTs, particularly those targeting the emotion domain, are needed to assess the overall effectiveness and feasibility of using IGSH interventions for increasing physical activity among PWD.