Sedentary time negatively influences health and is a risk factor for chronic low back pain (CLBP). Emerging evidence suggests breaking up prolonged sedentary behaviors may improve CLBP. This pilot trial examined the influence of decreasing sedentary behaviors on pain, mood, and quality of life in CLBP. Forty adults with CLBP and elevated depressive symptoms were randomized to wear an activity tracker with an idle alert along with receiving health coaching based on Motivational Interviewing and Habit Theory (INT) or a wait-list control condition (WLC) for eight weeks with a 12-week follow-up. Actigraphy-assessed time in total and prolonged sedentary behaviors, pain, depressed mood, quality of life, Patient Global Impression of Change (PGIC), and habits surrounding sedentary behavior were assessed at pre-intervention, post-intervention, and at follow-up. Repeated measures ANOVAs were used to examine changes in outcomes. Results demonstrated that INT reduced time spent in prolonged sedentary bouts by an average of 53 min/day (95

This secondary analysis explored pre- to post-intervention changes in accelerometer-derived activity and sleep data from adults with major depressive disorder (MDD). The CBT+ trial comprised two 8-week Cognitive Behavioral Therapy (CBT) arms: ActiveCBT (n = 13; 30 min of moderate-intensity exercise before each CBT session) and CalmCBT (n = 12; 30 min of quiet rest before each session). Pre- and post-intervention acceleromtetry data were included in mean-centered linear models for sleep (time in bed; TIB), activity and sedentary time. There were no significant between-group effects, but there was a significant average within-person decrease of 47.2 mins/day of sedentary time across all participants (95% CI: -82.0 to -14.4 min/day; p = .007), a significant increase of 36.5 mins/day of sleep duration-TIB (4.2 to 68.8 min/day; p = .028), and a non-significant increase of 12.3 mins/day of total physical activity (-34.5 to 59.1 min/day; p = .589). Overall, CBT was associated with beneficial changes in daily activity patterns. The findings of reduced sedentary time and increased TIB indicate possible additional health benefits of CBT for adults with depression, although replication in larger sample sizes is needed. Future work should explore whether these behavioral improvements can be sustained beyond the intervention period.

Major depressive disorder (MDD) is a debilitating condition with frequent relapses. Augmentation strategies may improve psychotherapy outcomes, particularly if they enhance mechanisms of change. Using an experimental therapeutics approach, this pilot trial evaluated whether 30 min of individual moderate exercise immediately before individual cognitive behavioral therapy (ActiveCBT) engages two mechanistic targets (behavioral activation and therapeutic alliance) compared to a time- and attention-matched control (CalmCBT). Forty adults with DSM-5 MDD were severity-stratified and randomized to 8 weeks of ActiveCBT (n = 19) or CalmCBT (n = 21). Primary outcomes were the Working Alliance Inventory-Short Revised (WAI; Bond, Task, Goals subscales) and Behavioral Activation for Depression Scale (BADS). Depression outcomes included Hamilton Rating Scale for Depression (HAMD) response (≥50% reduction) and remission (HAMD<8) from a masked assessor. Generalized estimating equations estimated group effects across time, standardized as Cohen's d, with a priori success defined as d ≥ 0.35 for both or d ≥ 0.55 for either WAI or BADS. The average standardized effect for WAI-Bond favoring ActiveCBT was d = 0.36 (95% CI: -0.19, 0.90, p = 0.20) and BADS was d = 0.43 (-0.07, 0.94; p = 0.09). Secondary exploratory analyses found a significant remission benefit for ActiveCBT over CalmCBT (69% vs 33%, p < 0.05), with similar response rates. Exercise priming demonstrated directional mechanistic signals in both specific (behavioral activation) and nonspecific (therapeutic bond) targets, with potential remission benefits from exploratory analyses. These findings preliminarily suggest that exercising before therapy could augment CBT and offer a safe, accessible way to potentially boost its antidepressant effects. CLINICAL TRIAL REGISTRATION: This study was prospectively registered at ClinicalTrials.gov (NCT06001346).

Many adults with major depressive disorder (MDD) do not engage in treatment and may also not respond when current frontline treatments are completed. Resistance exercise training (RET) is an understudied behavioral treatment option, which may help with MDD management through improving cerebral blood flow that is commonly impaired in adults with MDD. The purpose of this study is to use gold-standard research methods to determine the validity (clinical efficacy) of RET for treating MDD and to determine potential cerebrovascular pathways through which RET might improve MDD symptoms. This study will be a randomized controlled trial of 200 adults with DSM-5-diagnosed MDD of at least mild severity. Participants will be randomized to 16 weeks of twice-weekly RET at either guidelines-based high dose (60 https://clinicaltrials.gov/study/NCT06110897 ).

Abstract Background Depression is a leading cause of disability worldwide, and treatments could be more effective. Identifying methods to improve treatment success has the potential to reduce disease burden dramatically. Preparing or “priming” someone to respond more effectively to psychotherapy (e.g., cognitive behavioral therapy [CBT]) by preceding sessions with aerobic exercise, a powerful neurobiological activator, could enhance the success of the subsequently performed therapy. However, the success of this priming approach for increasing engagement of working mechanisms of psychotherapy (e.g., increased working alliance and behavioral activation) has yet to be formally tested. Methods The CBT + trial will be a parallel-arm randomized controlled trial that will recruit 40 adult participants with DSM-5 diagnosed depression (verified with clinical interview) via referrals, mass emails, local flyers, and social media posts. Participants will be randomized to an ActiveCBT or CalmCBT condition. The ActiveCBT group will receive an 8-week CBT intervention primed with 30 min of moderate-intensity aerobic exercise (cycling on a stationary bike at a 13 rating of perceived exertion). The CalmCBT group will receive the same 8-week CBT intervention while resting for 30 min before CBT (i.e., cycling vs no cycling is the only difference). The primary outcome measures will be mean working alliance (assessed with the client version of the Working Alliance Inventory—Short Revised) and mean behavioral activation (self-reported Behavioral Activation for Depression Scale) recorded at each of the 8 therapy sessions. Secondary outcomes include evaluation of state anhedonia and serum brain-derived neurotrophic factor before the active/calm conditions, between the condition and therapy, and after the therapy. Additional exploratory analyses will evaluate group differences in algorithm-generated ratings of therapist-participant interactions via the Lyssn platform. Discussion The novel approach of priming CBT with moderate-intensity aerobic exercise evaluated in a randomized controlled trial (CBT + trial) has the potential to demonstrate the usefulness of exercise as an augmentation strategy that improves working mechanisms of therapy and overall treatment outcomes for adults with depression. Trial registration ClinicalTrials.gov NCT06001346. Registered on August 21, 2023.

Falls are the leading cause of injury related morbidity and mortality in older adults. Primary and secondary prevention strategies that address modifiable risk factors are critically important to reduce the number of falls and fall related injuries. A number of evidence-based fall prevention programs are available, but few offer potential for broad dissemination and public health impact due to implementation barriers, such as a need for trained program leaders and clinicians. The study will use a randomized controlled trial design to evaluate incorporating physical therapy exercises (primary prevention strategy) within an existing intervention called Walk with Ease. While Walk with Ease has an established evidence-base related to the management of arthritis pain and symptoms, the present study will determine the potential to also reduce falls and fall risk in community-dwelling older adults. The integrated process and outcome evaluation will determine the relative effectiveness of individually-prescribed exercises (compared to standardized exercises) as well as the potential of ‘habit training’ resources (relative to generic behavior prompts) to improve compliance with exercises in this population. The study, conducted through a local clinical-community partnership will advance both the science and practice of community-based fall prevention programming, while also informing implementation strategies needed to promote broader dissemination. ClinicalTrials.gov, NCT05693025, Registered January 20, 2023, Updated March 1, 2023.

IntroductionLittle is known about physical activity behaviors among people with SUD. This study aimed to (a) describe self-reported moderate-to-vigorous physical activity (MVPA) and sedentary (SED) behaviors of adults with SUD initiating treatment (b), determine the potential contributions of drug of choice (DOC) on these behaviors, and (c) determine the potential contributions of level of care and demographic variables on these behaviors.MethodsSecondary data that was collected via surveys including demographic information, psychological health, drug of choice, MVPA (categorized as inactive, insufficiently active, meets guidelines, exceeds guidelines) and SED (<4 h/day, 4-<6 h/day, 6-8 h/day, >8 h/day) were analyzed from 1,293 patients in inpatient/outpatient treatment facilities across the United States. ResultsOn average, over half (51%) of patients entering treatment reported not meeting guidelines, but sitting time was generally low (median= 360 min/day). MVPA levels differed based on level of care (p<0.001) with 48% of patients in detox facilities reporting inactivity compared to 37% in residential and 29% in outpatient programs. MVPA and SED levels differed by sex with women less likely to report sitting <4 h/day (27.9% vs. 38.2%, p<0.001) and more likely to report sitting for >8 h/day (31.5% vs. 21.8%, p<0.001) compared to men. SED differed by race (p=0.01), with 54% of Black patients reporting <4 h/day compared to 33% of White patients. DiscussionUnderstanding activity behavior patterns among individuals entering SUD treatment provides opportunities for identifying the extent of lifestyle behavior needs and opportunities to develop personalized treatment strategies.

Many adults with major depressive disorder (MDD) do not receive effective treatment. The potential benefits of resistance exercise training (RET) are understudied and may be mechanistically related to cerebral blood flow changes.PurposeTo assess feasibility, acceptability, and preliminary efficacy of a 16-week, theory-informed RET trial for the treatment of MDD and explore changes in cerebral blood flow.MethodsTen adults with DSM-5-diagnosed MDD were enrolled in a single-arm, 16-week, twice-weekly, whole-body RET intervention, consistent with US and WHO Physical Activity resistance exercise guidelines. To build intrinsic motivation and develop exercise-preparatory habits, motivators and commitment were discussed weekly. Screening, enrollment, and intervention attendance and compliance rates documented feasibility. At baseline and weeks 8, 16, and 26, current MDD diagnosis, clinician-rated, and self-reported symptom severity were evaluated along with cerebral blood flow which was assessed as middle cerebral artery (MCA) mean blood velocity, conductance, and pulsatility.ResultsNine participants completed the intervention. Strong feasibility and acceptability (98% adherence, 93% compliance, and 90% retention) were found. MDD remission was reached by 8/9 participants at week 16 and persisted through week 26. There were large decreases in clinician-rated and self-reported symptoms at each assessment (Hedges’ g=0.84-2.13). There were small-to-moderate increases in MCA velocity (g=0.32-0.57) and conductance (g=0.20-0.76) across time, with minimal changes in pulsatility (all g<0.21).ConclusionsPreliminary results suggest RET for MDD treatment is feasible and plausibly efficacious, finding large antidepressant effects. A sufficiently powered randomized controlled trial to assess RET’s efficacy for treating MDD via potential cerebrovascular mechanisms is warranted.

A practicum course was designed to offer undergraduate students the opportunity to learn motivational interviewing (MI), a skill commonly used in health coaching (HC). The 16-week course included online video lectures, in-class activities, experiential training, and supervised practicum experiences. This study evaluated the process, impact, and outcomes of the course (n = 46; 74% female; age 21.9 +/- 3.7). Surveys were administered pre- and post-training to assess participant satisfaction of the course and the impact of training on communication using 7-point Likert scales. Recorded MI conversations were obtained after initial training (Week 8) and again following the supervised practicum (Week 16) to assess the fidelity outcomes (n = 23). Recordings were independently coded using the Motivational Interviewing Treatment Integrity (MITI) Coding Manual 4.2.1, with inter-rater agreement calculated between two trained coders. Paired samples t-tests and post-hoc analyses examined differences in pre-post fidelity levels, followed by Cohen's d effect sizes. Survey results demonstrated that students felt comfortable (5.0 +/- 0.7) and confident (4.8 +/- 0.6) using MI. Inter-rater reliability among coders was high (ICC = 0.92 [95% CI: 0.90-0.93]). MITI results showed that 97.5% of coaches met proficiency for technical and 90.0% for relational at week 8. At week 16, all trainees met proficiency levels for both technical and global ratings, with t-tests reporting improvements in fidelity scores. Behavior counts were much lower, with the majority of participants not meeting proficiency at either timepoint. Extended real-world practice enhanced MI fidelity levels, and trained students reported high likelihood of continued skill use 1 year after training completion.

Alcohol use disorder (AUD) treatment has high rates of relapse. Relapse likelihood is predicted by poor mental health and high alcohol craving. Moderate to vigorous physical activity (MVPA) and sedentary time (SED) may be modifiable risk factors of these relapse predictors. The purpose of this study was to examine relationships between MVPA and SED with mental health (depression, anxiety and stress) and craving (self-reported and cueinduced) in individuals with AUD. Cross-sectional data were collected from individuals upon entering AUD treatment (n = 670) in the US. Participants reported demographics, depression (Center for Epidemiologic Studies Depression Scale), anxiety (Penn State Worry Questionnaire), stress (Perceived Stress Scale-10), MVPA and SED (International Physical Activity Questionnaire-SF). Multiple linear regressions were conducted with MVPA and SED predicting depression, anxiety, and stress, with trend analyses, covarying for demographics and level of care. As SED decreases and MVPA increases, depression (-6.7 points, p < 0.0001), anxiety (-3.5 points, p = 0.02), and stress scores (-3.1 points, p < 0.001) are reduced. Neither MVPA nor SED were significant predictors of selfreported craving nor cue-induced craving. High SED and, especially, low MVPA may be behavioral risk factors associated with poor mental health during treatment admission in AUD. Improving engagement with these activity-related behaviors during treatment may have the potential to lead to lower relapse rates.

IntroductionFalls present a significant public health concern in the United States as a primary cause of unintentional injury-related deaths among older adults. A fall risk assessment toolkit STEADI developed by the CDC has been shown to predict future falls. However, STEADI has issues with accurate evaluations due to the disagreement on cut-off scores in functional assessments and history-taking questionnaires. Wearable sensor technology offers a practical and quantifiable alternative for assessing an individual's movement performance in real-world environments. The use of Inertial Measurement Units (IMUs) offers considerable potential to enhance fall risk screening.PurposeThe primary aim of this study is to test the agreement of STEADI functional assessment performance measured by the IMUs in comparison to human-based measurements.Method27 participants (Age: 74.37 ± 7.21) performed STEADI, including the Four-Stage Balance Test (4SBT), Timed Up & Go Test (TUG), 30-second Chair Stand (30sCS) with IMU placed at the fifth lumbar vertebra which is the proxy location of whole-body Center of Mass. By adopting an equivalent test, the STEADI agreement was tested between the human rater and IMU measurements, giving α = 0.05.ResultBetween the results from evaluators and IMU, the difference in TUG is -0.23 seconds, and the difference in 30sCS is 0.37, which is equivalent to within 4% and 8% for TUG and 30sCS, respectively. The difference in single-leg stance during the 4SBT is 0.59s; however, the calculated equivalence zone is larger (22.7%).ConclusionThis study demonstrates the feasibility of using IMU sensors to enhance fall risk screening protocols based on the STEADI. Future refinement may still need to enable broader application and effective screening practices on a larger scale of the population.

Background Physical activity is an effective method of reducing fall risk among older adults. Previous evaluations of the six-week Walk with Ease (WWE) program have documented benefits to functional outcomes, but the potential effects on reducing fall risk have not been evaluated. This pilot study evaluates outcomes of a community delivered WWE program for potential suitability as a fall risk reduction program. Methods A total of 59 older adults (age > 60) enrolled in a group version of WWE delivered by trained community-based leaders. Complete data (pre- and post-program) from functional fitness tests and behavioral instruments were obtained from 41 participants (aged 74.4 ± 6.6 years, 70% female). Functional outcomes included the 10-foot timed up and go (TUG), 30-second chair stand (CST) and 4-stage balance test (BT) included as part of STEADI, as well as a two-minute step test (ST) and normal gait speed test (GST). Survey assessments included STEADI fall risk screening, self-reported physical activity, and fear of falling measures. Analyses focused on reporting pre-post effect sizes, but paired t-tests were used to test statistical significance of differences. Results Improvements in functional performance approached significance for both CST (d = 0.31, p = 0.06) and ST (d = 0.26, p = 0.12), but all other tests were nonsignificant. Survey results demonstrated significant increases in self-reported walking (d = 0.54, p = 0.02) and moderate-to-vigorous physical activity (MVPA; d = 0.56, p = 0.004), but perceived fear of falling and overall fall risk scores had smaller, non-significant, effects (d ranging from 0.01 to 0.31). Stratified analysis suggested that participants screened at an elevated risk for falls at baseline consistently had larger effects on all functional and survey assessments, though the analysis was underpowered to test significance. Conclusions Walk with Ease participation significantly increased self-reported physical activity but did not significantly improve physical function or reduce fall risk. However, consistently larger effect sizes among participants screened as at-risk for falls suggest that the program may be beneficial for those with elevated risk for falls or functional limitations. Further research is needed to document the consistency of these effects among participants with elevated fall risk status.

Alcohol use disorder (AUD) treatment is challenging. Relapse is common and related to alcohol craving. Identifying modifiable risk factors for craving could improve treatment. PURPOSE: To determine associations of moderate-to-vigorous physical activity (MVPA) and sedentary time (SED) with alcohol craving in a large sample of adults entering treatment for AUD. METHODS: Data was collected from adults entering detox, residential, Psychiatric Partial Hospitalization/Intensive Outpatient Programs or private practice AUD treatment (n = 670) in the US. Demographics, verbal craving (Alcohol Craving Questionnaire), visual craving (assessed via a standardized series of pictures), and last-week MVPA and SED (International Physical Activity Questionnaire-SF) were self-reported. MVPA was categorized (mins/week): inactive [0], insufficiently active [1-149], meets recommendations [150-299], or exceeds recommendations [≥300]. SED was categorized (mins/day): ≤ 240, 241-360, 361-480, and 481+. Linear regressions with trend analyses estimated associations between MVPA/SED and craving, adjusted for demographics; group means were compared via Cohen’s d. RESULTS: Neither MVPA (p = 0.32) nor SED (p = 0.18) were significantly associated with verbal craving. Mean differences in verbal craving for MVPA were small (d = 0.23) between those meeting recommendations (mean = 16.2) and exceeding recommendations (mean = 14.1) and also small (d = 0.20) between those reporting ≤240 mins/day (mean = 15.8) and 481+ mins/day (mean = 13.9) SED. Neither MVPA (p = 0.18) nor SED (p = 0.21) were significantly associated with visual craving. Mean differences in verbal craving for MVPA were small (d = 0.24) between those meeting recommendations (mean = 5.49) and exceeding recommendations (mean = 3.84) and also small (d = 0.22) between those reporting ≤240 mins/day (mean = 5.32) and 241-360 mins/day (mean = 3.78) SED. CONCLUSION: Upon treatment entry, recent MVPA and SED had small, nonsignificant relationships with craving. Craving, MVPA and SED fluctuate throughout the day and over time during recovery; MVPA and SED may have stronger relationships when craving is at its highest. Evaluating behavioral and craving patterns during treatment will be informative for determining the potential impact of behavior modifications on craving.

PURPOSE: Research shows that Major Depressive Disorder (MDD) is associated with impaired cerebral blood flow (CBF). Resistance Exercise Training (RET) may improve CBF in healthy adults but RET’s effect on CBF in adults with MDD is unknown. The purpose of this pilot study was to explore the effects of 16 weeks of RET on middle cerebral artery (MCA) mean blood velocity and cerebrovascular reactivity (CVR) in adults with MDD. METHODS: Nine untrained adults with MDD (confirmed via Structured Clinical Interview for DSM-5) completed a 16-week full-body RET pilot intervention twice per week performing 3 sets of 8-12 repetitions of ten exercises. At baseline, midpoint, and final visits, CBF was assessed as mean blood velocity and conductance of the MCA via transcranial doppler and mean arterial pressure was measured via oscillometric cuff. CVR was assessed as the average change in MCA mean blood velocity expressed relative to change in end-tidal CO2 immediately following 8, 20-sec breath holds. The effects of RET on CBF from baseline to midpoint and final were described and evaluated via effect sizes (Hedges’ g) and paired t-tests. RESULTS: There were small, nonsignificant increases in MCA velocity (median [M] = 51.5, 55.4, 54.1 cm/s for baseline, 8-, and 16-wk; g = 0.07-0.32, p = 0.31-0.82) and conductance (M = 0.55, 0.59, 0.61 cm/s/mmHg for baseline, 8-, and 16-wk; g = 0.16-0.42, p = 0.19-0.62) during the intervention from baseline. There were small, nonsignificant decreases in MCA CVR from baseline [M = 1.25] to midpoint [M = 1.03, g = -0.22, p = 0.49] and final visit [M = 1.0, g = -0.13, p = 0.67]. CONCLUSIONS: These preliminary results suggest metrics of CBF may change in adults with MDD across 16 weeks of RET and may be a mechanistic target that warrants further research. Future research investigating the effects of RET on CBF in MDD with larger controlled trials is warranted.

High sedentary time negatively influences health and is associated with an increased risk for chronic low back pain (CLBP). Emerging evidence suggests breaking up prolonged bouts of sedentary behavior may be effective for reducing chronic pain. PURPOSE: This randomized controlled pilot study examined the efficacy of an intervention based on motivational interviewing (MI) and habit theory to reduce and break up sedentary behaviors on pain, depression, and quality of life in individuals with CLBP and elevated symptoms of depression. METHODS: Forty adults with CBLP were randomized to receive a wearable activity tracker with an idle alert along with MI-based health coaching (INT) or a wait-list control condition (WLC) for eight weeks with a 12-week follow-up. Time spent in total and prolonged sedentary behaviors (activPAL and SIT-Q-7D), pain (short-form McGill Pain Questionnaire (MPQ)), depressed mood (Patient Health Questionnaire 9 (PHQ-9)), quality of life (Short-Form 36 (SF-36), Patient Global Impression of Change (PGIC)), and habits surrounding sedentary behavior (Automaticity Scale of the Self-reported habit Index (AS-SRHI)) were assessed pre- and post-intervention and at follow-up. Effect size calculations and repeated measures ANOVAs were used to examine changes in outcomes over the course of the intervention and follow-up. RESULTS: Results demonstrated that, on average, INT reduced time spent in prolonged bouts of sedentary time by ~53 minutes/day compared to WLC who decreased by less than 1 minute/day. INT also experienced large, non-significant improvements in pain and depressed mood (g = 0.70-1.72, p > 0.05) over the intervention and follow-up periods. Quality of life (physical health and bodily pain SF-36 subscales and PGIC) and automaticity of habits surrounding sedentary behavior improved significantly for INT over WLC (p < 0.05). CONCLUSIONS: The present results provide support for the potential utility of decreasing prolonged sedentary behaviors to improve symptoms, and especially quality of life, in those with CLBP. Fully-powered efficacy trials are needed to thoroughly examine the use of this behavioral intervention strategy in clinical settings.

ABSTRACT Introduction Behavioral treatments, like increasing physical activity (PA), are recommended for chronic low back pain (CLBP). Finding methods for promoting behavior change with potential for translatability as well as effective behavioral targets remains challenging. Purpose This randomized controlled pilot study evaluated the effectiveness of low-dose facilitated health coaching with activity monitors to improve PA and sedentary behaviors (SB), symptoms, and Patient Global Impression of Change (PGIC) in CLBP. A secondary purpose was identifying behaviors associated with symptom change to inform future trials. Methods Seventy-one adults with CLBP were randomized to receive a wearable activity monitor alone (WAM) or with one primary session of health coaching and two check-ins based on motivational interviewing (WAM + HC) or a wait-list control (WLC) condition for 12 wk. Moderate and vigorous PA (MVPA), light PA (LPA), total and prolonged SB (i.e., sedentary >60 min per bout), and pain (Short Form McGill Pain Questionnaire (MPQ)) were assessed before and after intervention along with PGIC. Regression analyses examined group differences in MVPA, LPA, total and prolonged SB, MPQ, and PGIC after intervention as well as behavioral predictors of symptom improvement (change in MPQ). Results WAM + HC improved MPQ scores (β = −0.25, P = 0.02), LPA (β = 0.23, P = 0.04), MVPA (β = 0.21, P = 0.03), and total SB (β = −0.24, P = 0.03) compared with WLC over time. Both WAM + HC and WAM had significantly higher PGIC compared with WLC (P < 0.05). Change in prolonged SB was the only significant predictor of change in MPQ (β = 0.48, P = 0.01). Conclusions WAM + HC may be effective for changing activity-related behaviors and improving CLBP. Furthermore, reducing prolonged SB may be a meaningful target for future interventions in CLBP. Research focused on reducing prolonged SB including larger samples, and examining changes in symptoms will be important for identifying optimal translational treatment strategies for CLBP.

Depression (DEP) is prevalent and current treatments are ineffective for many people. This pilot study's purpose was to assess the feasibility, acceptability, and plausible efficacy of an 8-week intervention employing 30 min of prescribed moderate intensity exercise ("ActiveCBT") compared to 30 min of usual activities ("CalmCBT") immediately prior to weekly online CBT sessions. Ten adults with DSM-5-diagnosed current DEP were randomized to groups and completed: an intake assessment, eight weekly CBT sessions, final assessment, and 3-month follow-up. ActiveCBT participants were prescribed 30-min of moderate exercise immediately prior to each standardized 50-min CBT session. CalmCBT participants continued with normal activities for 30 min before therapy. Questionnaires regarding DEP symptom severity (Patient Health Questionnaire-9 [PHQ-9]), between-session effectiveness (Behavioral Activation for Depression Survey [BADS], Automatic Thoughts Questionnaire [ATQ]), in-session effectiveness (Working Alliance Inventory-Short Revised [WAI]), and state anhedonia (Dimension Analog Rating Scale [DARS], Visual Analog Scale [VAS]; assessed 3 times: before Active/Calm condition, after, and after therapy) were completed each week. Therapy fidelity ratings were independently coded via a standardized codebook. The Structured Clinical Interview for DSM-5 (SCID) and Hamilton Rating Scale for Depression (HAMD) were used to assess DEP at intake, final, and 3-month follow-up. We found strong feasibility and acceptability (100% adherence, 100% retention at final visit, 74.6% therapy fidelity, and high patient satisfaction ratings). Differences between groups favoring ActiveCBT in anhedonia (DARS, Hedges' g = 0.92; VAS, g = 3.16), within- (WAI, g = 0.1.10), and between-session effectiveness (ATQ g = -0.65; BADS g = -1.40), suggest plausible efficacy of ActiveCBT for enhancing CBT. DEP rates were reduced in both groups from baseline to final (60% MDD SCID remission) and at follow up (Active: 40%; Calm: 25%). Larger and potentially quicker symptom improvement was found favoring the Active condition to the final visit (HAMD, between-group changes g = -1.33; PHQ-9, g = -0.62), with small differences remaining at follow-up (HAMD, g = -0.45; PHQ-9, g = -0.19). Exercise priming appears acceptable and plausibly efficacious for enhancing mechanisms of CBT and overall outcomes, though the present small sample precludes efficacy determinations. It appears feasible to conduct a randomized controlled trial comparing ActiveCBT to CalmCBT. Future trials evaluating this potentially promising treatment approach and mediating mechanisms are warranted.

Acute exercise improves mood, cognitive function, energy and engagement in people suffering from depression. Priming cognitive behavioral therapy (CBT) sessions with acute exercise may enhance its effectiveness. Anxiety is a common major comorbidity of depression and can make treatments less effective but is also treated with CBT. Priming CBT with exercise may also enhance the anxiolytic response. PURPOSE: To quantitatively and qualitatively analyze the effects of eight weekly virtual CBT sessions primed with either 30 minutes of moderate intensity exercise (ActiveCBT) or quiet-rest (CalmCBT) on anxiety in adults with depression. METHODS: Ten adults diagnosed with DSM-5 depression were randomized to either ‘active’ (n = 5) or ‘calm’ (n = 5) conditions. Participants completed the Generalized Anxiety Disorder-7 (GAD-7) to provide anxiety symptom severity at baseline, final, and 3-month (3 m) follow-up visits. Mean GAD-7 scores and percent change from baseline to final and 3 m were calculated. A qualitative interview was conducted at the final visit. To investigate the conditions’ effects, three coders created a deductive codebook for initial coding to assess feasibility, satisfaction, and feedback of the overall treatment. The coded data was then used to identify the interventions’ effects on anxiety symptoms from the DSM-5 anxiety disorder criteria. RESULTS: Mean GAD-7 scores and standard deviations for the active condition were 15.0 (4.3) at baseline, 4.2 (2.7) at final, and 9.8 (6.5) at 3 m, and for the calm condition were 6.4 (4.4) at baseline, 5.0 (5.2) at final, and 5.3 (1.3) at 3 m. The active/calm conditions resulted in a 72%/22% decrease in GAD-7 score from baseline to final and 35%/17% from baseline to 3 m. Common themes from the qualitative interview included alleviating excessive anxiety and worry, improved ability to control anxiety and worry, and improved sleep quality that were potentially related to pre-CBT condition. CONCLUSIONS: The present results provide preliminary efficacy evidence that priming CBT sessions with exercise may more effectively treat anxiety in a depressed population than standard CBT. The 30 minutes before CBT sessions could be a useful window to engage in anxiolytic preparatory activities prior to therapy. Further research priming CBT with exercise is warranted.