Title: REACH: Development of a referral-based exercise therapy program for women with depression
Thesis Supervisor: Dr. Guy Faulkner
Committee Members: Dr. Eli Puterman, Dr. Heather Gainforth
Chair: Dr. Mark Beauchamp
Abstract: Exercise is an evidence-based intervention for treating depression and is now recognised as a frontline treatment for depression in Canada. However, limited research has investigated ways to translate exercise-based interventions for depression to community settings. Globally, research suggests more women than men are affected by depression. Applying a behavioural intervention development framework (The Obesity-Related Behavioural Intervention Trials: ORBIT) Model, the overarching aim of my thesis is to take a sequential approach to develop, implement, and evaluate a community-based exercise referral intervention for women with depression. The first formative study of my thesis involved interviews and focus groups with various community-partners (e.g., exercise professionals, healthcare providers, and women with lived experience of depression) to consider the design, development, and implementation of a potential intervention program. In addition, potential barriers to successful implementation were explored. Study one revealed all community partners believed a community-based exercise referral therapy program to be an acceptable and appropriate form of treatment for depression. Recommendations included an accessible program that is subsidised, individualised, supervised and delivered by experienced exercise professionals with training in mental health literacy. Following this, an appropriate community-based gym provider was identified as the intervention delivery partner. An in-depth review of this program was then conducted to gain a comprehensive understanding of the community-based program and to ensure it aligned with the needs of women with depression. This review was guided by the Theoretical Domains Framework (TDF) and the Behaviour Change Taxonomy v1 (BCTTv1) to retrofit the community-based program components (mode of delivery, setting, style of delivery) and program contents. Methods included participant observation and mapping behaviour change techniques (BCTs) onto program content and delivery. Study two established the community-based gym provider delivers an appropriate program but there were several gaps identified – there was no explicit inclusion of BCTs linked to the emotion domain of the TDF and no provision of regular behaviour change support for members. Collectively, study one and study two identified the need to supplement the community-based program with behaviour change counselling. This will be evaluated in study three which will be a mixed-method single-arm feasibility study assessing a 12-week exercise program for women with clinical depression supplemented with behaviour change counselling delivered over 9 sessions via telephone (referred to as ‘REACH’). In the fourth and final study, a protocol for a pilot randomized controlled trial will be proposed to evaluate the feasibility and preliminary efficacy of REACH. If successful, this program could be shared and implemented across Canada as an additional treatment option for the many Canadian women living with depression.