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Combined Psychoeducational and Exercise Training Intervention to Improve Mental Health and Physical Functioning in
Margarita Alegria1, Walter Frontera2, Mario Cruz-Gonzalez3
1Disparities Research Unit, Department of Medicine (MA, MCG, SM, ZR, TBO, LF, YJW), Massachusetts General Hospital, Boston, MA; Department of Medicine (MA, MCG), Harvard Medical School, Boston, MA; Department of Psychiatry (MA), Harvard Medical School, Boston, MA.
Objective:
To assess the effectiveness of an enhanced psychoeducational and exercise training intervention (Positive Minds Strong Bodies-Enhanced [PMSB-E]) on depression and anxiety symptoms and physical functioning.
Design:
Randomized trial of 427 participants, assigned to intervention or usual care.
Setting:
51 community-based organizations and 17 clinics in Massachusetts, New York, Puerto Rico, and Maryland, US. Data collected from November 2020 to October 2024, at baseline and months 3, 6, and 12.
Participants:
Adults aged 60+ or older with mild to severe depression or anxiety symptoms, minor to moderate mobility limitations, and fluency in English, Spanish, Mandarin, or Cantonese.
Interventions:
Ten psychoeducational and 36 exercise sessions over 6 months compared to usual care (one-on-one phase; 1:1 ratio). Half of the intervention participants were offered an additional 6-month group maintenance phase (1:1 ratio). Control participants received up to 4 usual care calls.
Measurements:
Primary outcome was change from baseline to month 12 in depression and anxiety symptoms (Hopkins Symptom Checklist-25 [HSCL-25]) and physical functioning (Short Physical Performance Battery [SPPB] and Late-Life Functioning and Disability Instrument [LLFDI]). Secondary outcome was change in month 6.
Results:
Intervention participants showed improved SPPB scores in month 12 (standardized difference, 0.28; 95% CI, 0.07-0.49) and month 6 (0.34; 95% CI, 0.14-0.55). There were no effects on LLFDI or HSCL-25 scores, nor interaction effects by race and ethnicity. Completing the recommended number of sessions had a larger effect on SPPB scores.
Conclusions:
PMSB-E replicated previous findings of improving objective physical functioning but not self-reported physical functioning or mental health symptoms. We believe this is due to virtual administration during the pandemic.
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