A pilot randomised controlled trial of a web-based intervention using behavioural activation and physical activity for adults with depression: The eMotion study

Background: Physical activity (PA) is a potentially effective treatment for depression and depressive relapse. However, promoting PA in people with depression is challenging. Interventions informed by theory and evidence are therefore needed to support people with depression to become more physically active. eMotion is a web-based intervention combining behavioural activation and PA promotion for people in the community with symptoms of depression.
Objective: The objectives were to assess the feasibility and acceptability of delivering eMotion to people with depression in the community, and to explore outcomes.
Methods: Participants with elevated depressive symptoms were recruited from the community through a variety of methods (e.g. social media) and randomised to eMotion or a waiting list control group for eight weeks. eMotion is an administratively supported weekly modular programme aiming to help people use key behaviour change techniques (e.g. graded tasks, action planning and self-monitoring) to re-engage in routine, pleasurable or necessary activities, with a focus on physical activities. Feasibility data were collected which included: recruitment and trial retention rates, the fidelity of intervention delivery, receipt and enactment, and the acceptability of the intervention and data collection procedures. Data were collected for the primary (depression) and secondary outcomes (e.g. anxiety, PA, fidelity and client satisfaction) at baseline and two months post-randomisation using self-reported online questionnaires and accelerometers. Fidelity of delivery (logins, modules accessed, time spent) was tracked using web usage statistics. Exploratory analyses were conducted on the primary and secondary outcomes.
Results: Of the 183 people who made contact, 62 were recruited and randomised with a mean PHQ-8 score of 14.6 (SD = 3.2). Of those randomised, 52 provided accelerometer recorded PA data at baseline which showed a baseline median of 35.8 (Interquartile Range (IQR) = 0.0 to 98.6) minutes of moderate to vigorous physical activity (MVPA) recorded in at least 10-minute bouts per week, with only seven people (13%) achieving guideline levels (150 minutes of MVPA per week). Eighty-one percent of participants provided follow-up data for the primary outcome (PHQ-8), but only 42% provided follow-up accelerometer data. Within the intervention group, the median number of logins, modules accessed and total minutes spent on eMotion was 3 (IQR = 2.0 to 8.0), 3 (IQR = 2.0 to 5.0) and 41.3 (IQR = 18.9 to 90.4) respectively. Acceptability was mixed. Exploratory data analysis showed that PHQ-8 levels were lower for the intervention group than the control group at two months post-randomisation (adjusted mean difference: -3.6, 95% CI: -6.1 to -1.1).
Conclusions: It is feasible to deliver eMotion in UK communities to inactive populations. eMotion has the potential to be effective and is ready for testing in a full-scale trial. Further work is needed to improve engagement with both the intervention and data collection procedures.
Trial Registration: ClinicalTrials.gov NC-T03084055