Beth A. Lewis, Ph.D. - US grants

[unreadable] DESCRIPTION (provided by applicant): Physical inactivity is related to many health problems including increased risk of cardiovascular disease, hypertension, and cancer. Despite the health consequences of a sedentary lifestyle, only 25% of Americans meet the recommended levels of physical activity. Researchers postulate that theory-based interventions effectively influence physical activity behavior by changing theoretical constructs believed to be important for behavior change (i.e., potential mediators), such as self-efficacy (i.e., confidence in one's ability to be physically active). Unfortunately, previous studies have generally failed to adequately test the mediating effect of theoretical constructs using appropriate statistical mediator analyses as recommended by leading behavioral scientists and statisticians. The objective of our application is to examine the mediating effect of theoretical constructs based on the Transtheoretical Model (TTM) and Social Cognitive Theory (SCT). Our proposed study will address the methodological, measurement, and statistical limitations of previous studies. We will randomly assign 420 healthy sedentary individuals to either a theory-based physical activity intervention or a contact control group. Physical activity behavior and the potential mediators will be assessed monthly over 12 months. We hypothesize that constructs based on The TTM and SCT (i.e., behavioral processes, cognitive processes, self-efficacy, and decisional balance) will mediate the relationship between group assignment (intervention vs. contact control) and physical activity behavior, such that the effect of the intervention on physical activity behavior relative to the contact control group will be attenuated when controlling for the mediators. We will also examine the importance of particular mediators for different population groups (e.g., age, gender), which will help to create more effective interventions for these groups. Finally, we will conduct a cost analysis to not only to inform policy makers of the cost of delivering the intervention within our study but also to estimate the cost of delivering each component of the intervention (i.e., mediator). Our analysis will estimate the cost of future refined interventions that incorporate those active components that affect the mediators and physical activity in this study. In summary, our proposed study will identify which mediators (i.e., theoretical constructs) are most effective for increasing physical activity, which will have an important public health impact given that this will likely lead to more efficacious and less costly interventions. [unreadable] [unreadable]

DESCRIPTION (provided by applicant): This application is in response to PA-06-377 "Women's Mental Health in Pregnancy and the Postpartum Period." Recent estimates indicate that approximately 10-15 percent of women giving birth experience depression during the postpartum period (Dietz et al., 2007;Gaven et al., 2005). Research indicates that psychological interventions are efficacious for treating postpartum depression (Dennis &Hodnett, 2007). However, it is important to also focus on the prevention of postpartum depression given many women do not seek treatment (Dennis &Chung- Lee, 2006) and those who do seek treatment may have already experienced negative consequences related to depression including cessation of breastfeeding and poor maternal-child bonding (Dennis &McQueen, 2007;Murray et al., 1999). Unfortunately, research indicates that psychological interventions are not efficacious in the prevention of postpartum depression among women at risk for postpartum depression (for a review see Dennis &Creedy, 2004). Consequently, there is a need to test new and innovative interventions for the prevention of postpartum depression. Exercise interventions have been shown to be effective for the treatment of depression among adults and therefore, this intervention may be efficacious in the prevention of postpartum depression. The purpose of the present pilot study is to examine the feasibility of recruiting and retaining participants at risk for postpartum depression for a randomized trial examining an exercise intervention for the prevention of postpartum depression. We will also examine the preliminary efficacy of the exercise intervention on the prevention of postpartum depression. Specifically, 120 sedentary, healthy pregnant women who have a history of at least one depressive episode and/or have a maternal family history of depression will be recruited from various ObGyn clinics, psychiatry clinics, and via advertisements. Once the potential participants receive healthcare provider consent to exercise (approx. two weeks following a vaginal delivery and four weeks following a c-section), participants will be randomly assigned to either an exercise intervention or a health and wellness contact control condition. The exercise condition will consist of telephone-based counseling sessions designed to motivate postpartum women to become physically active. This theory-based intervention will be based on interventions shown to be effective in previous studies. The contact control condition will consist of scheduled telephone sessions with a health educator on issues related to health and wellness (e.g., stress reduction, sleep, nutrition). The specific aims of the study will be 1) to determine the feasibility of recruiting and retaining pregnant and postpartum women for an exercise inter-vention trial and 2) to determine the effect of a home-based behavioral exercise intervention on depression (as measured by the Structured Clinical Interview for DSM-IV Axis I Disorders;SCID-I and the PHQ-9) among postpartum women. Physical activity adherence will be assessed using the 7-Day Physical Activity Recall Interview (Blair et al., 1985;Sallis et al., 1985) and accelerometers (i.e., an objective assessment of physical activity). PUBLIC HEALTH RELEVANCE: Recent estimates indicate that approximately 10-15 percent of women giving birth experience depression during the postpartum period. The purpose of this study is to examine the feasibility and efficacy of an exercise intervention for the prevention of postpartum depression. If efficacious, our intervention could be disseminated in "real world settings" in an effort to prevent postpartum depression.

DESCRIPTION (provided by applicant): Our application is in response to PA-09-174 Women's Mental Health in Pregnancy and the Postpartum Period. Approximately 10 to13 percent of women experience postpartum depression (Banti et al., 2011, Gaynes et al., 2005). Psychological interventions are efficacious for treating postpartum depression (Dennis & Hodnett, 2009); however, the prevention of postpartum depression is preferable to treatment. Research indicates that a majority of psychological interventions are not efficacious for preventing postpartum depression (Dennis & Creedy, 2008) and thus, there is a need to test new and innovative prevention strategies. Research indicates that exercise is efficacious for the treatment of depression among adults (e.g., Blumenthal et al., 2007; Mead et al, 2009) and exercise may be an ideal intervention for postpartum women who are not willing or able to use traditional treatments. For example, research indicates that a majority of breastfeeding mothers are reluctant to use antidepressants (Buist et al., 2005; Whitton et al., 1996). The purpose of this study is to examine the efficacy of exercise and wellness/support interventions for preventing postpartum depression. Specifically, 450 sedentary postpartum women (two to six weeks) with a history depression prior to pregnancy will be randomized to one of three groups: (1) telephone-based exercise intervention; (2) telephone-based wellness/support intervention; or (3) usual care. Participants will be recruited via online, email, and print advertisements. We will obtain healthcare provider consent for each participant prior to randomization. The exercise intervention will consist of a theory-based telephone intervention shown to increase exercise among postpartum women in a previous study (Lewis et al., 2011). The wellness/support condition will be on the same schedule as the exercise intervention and will address several topics related to wellness. The primary dependent variable will be depression as measured by the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Edinburgh Postnatal Depression Scale (EPDS). Exercise adherence will be assessed using the Seven-Day Physical Activity Recall Interview (Blair et al., 1985; Sallis et al., 1985) and the ActiGraph (i.e, an accelerometer). PUBLIC HEALTH RELEVANCE: The primary purpose of this study is to examine if exercise prevents postpartum depression, which occurs in 10 to 13 percent of women giving birth. The goal is to provide practitioners with additional strategies for preventing postpartum depression. A significant impact on postpartum depression could be made if practitioners have the ability to tell their patients to exercise as a strategy to reduce their risk for postpartum depression.