Effects of an exercise program linked to primary care on depression in elderly: fitness as mediator of the improvement.

PURPOSE: The present study aimed to analyse the effects of 12 months of participation in a public physical activity program linked to primary care on depression level and fitness, and to determine which fitness components were responsible for the improvement in depression using mediation analysis. METHODS: Participants of this program were 2768 middle-aged and older adults from 67 municipalities throughout the Spanish region of Extremadura. In the analysis only participants with depression and without any missing values for fitness variables were included. This sample was 303 for exercise group and 74 for control group. Socio-demographic data, Geriatric Depression Scale and some fitness tests were applied at baseline and 1 year later. Exercise group performed the program 3 days/week for 50-60 min per session involving brisk walking with intermittent flexibility, strength and balance activities/exercises. Socializing within the group was encouraged in all sessions. Data analysis included analysis of covariance, chi-squared and effect size statistics. Additionally, a parallel model of mediation analysis was performed to determine the indirect effect of the participation in the exercise program on depression through improvements in fitness. RESULTS: A considerable reduction from mild, moderate or severe depression to non-depression were obtained for exercise group (68%) P-value < .05. The parallel mediation analysis showed that flexibility (sit-and-reach [ß - 0.04 (- 0.07 to - 0.01)], back scratch [ß - 0.06 (- 0.12 to - 0.02)]) and cardiorespiratory fitness (6-min walk [ß - 0.09 (- 0.15 to - 0.04)]) were mediators of the reduction in depression. CONCLUSION: This exercise program was effective in improving depression in older adults. Integrating aerobic and flexibility exercises in a group-based program of physical activity programs could improve the severity of depression in this population.

Cost-effectiveness of a follow-up program for older patients with heart failure: a randomized controlled trial.

PURPOSE: To assess the cost-utility of adding a disease management program (DMP) delivered by geriatric day hospital (GDH) for older patients with heart failure (HF) after hospital discharge. METHODS: 117 older HF patients discharged by a geriatric service were randomly assigned to DMP (n = 59) and usual care (UC) (n = 58) groups. The DMP group received health education, therapeutic control and monitoring through both telephone contacts and face-to-face visits at the GDH for 12 months. The UC group received standard health care. The main outcome measures were the costs from the health-care system and societal perspectives and quality-adjusted life-years (QALYs) using EuroQol (EQ-5D-3L). The cost-effectiveness analysis used the package ICEinfer in R 2.13.0. RESULTS: The mean age was 85 years, and 73% of the patients were women. The mean values of QALYs after 12 months were - 0.083 in DMP and - 0.154 in UC. Each extra QALY gained by the DMP relative to usual care cost was €38,274 and €25,390 from health-care or societal perspective, respectively. An investment of €44,000/QALY (Spanish Health System Threshold) showed a 91 and 85% of probability to be cost-effective from health-care and societal perspectives. CONCLUSION: The intervention was moderately cost-effective in delaying deaths and preserving the loss of health-related quality of life in older patients with HF. The study was internationally registered with the ISRCTN10823032.

Health-related quality of life and fitness of the caregiver of patient with dementia.

PURPOSE: : The aim was to assess the health-related quality of life and physical fitness of women who care for a relative with dementia compared with an age-matched group of noncaregiver women, for the purpose of designing adequate physical exercise programs. METHODS: : A cross-sectional study was conducted in Extremadura, Spain, with 54 caregivers and 56 noncaregivers who were assessed by the SF-36 questionnaire and a battery of fitness tests. RESULTS: : The reported mental health (mental, emotional role, and social categories of SF-36) of the carers was 22% lower than that of the noncaregivers, but both groups were similar in physical health. On the whole, the reported general health of the carers was 11% lower than that of the noncarers. In fitness outcomes, caregivers had better scores in body composition, bimanual strength, and leg strength but lower scores in the endurance capacity of the trunk extensor muscles. CONCLUSION: : Relative to the standard exercise programs of the general population, exercise programs for female caregivers should be more focused on preventing back pain by developing the endurance strength of the trunk extensors. A supervised exercise program including the interaction between caregiver and health professional could also help to minimize the psychosocial components that affect the health-related quality of life.

Cost-utility of a walking programme for moderately depressed, obese, or overweight elderly women in primary care: a randomised controlled trial.

BACKGROUND: There is a considerable public health burden due to physical inactivity, because it is a major independent risk factor for several diseases (e.g., type 2 diabetes, cardiovascular disease, moderate mood disorders neurotic diseases such as depression, etc.). This study assesses the cost utility of the adding a supervised walking programme to the standard "best primary care" for overweight, moderately obese, or moderately depressed elderly women. METHODS: One-hundred six participants were randomly assigned to an interventional group (n = 55) or a control group (n = 51). The intervention consisted of an invitation, from a general practitioner, to participate in a 6-month walking-based, supervised exercise program with three 50-minute sessions per week. The main outcome measures were the healthcare costs from the Health System perspective and quality adjusted life years (QALYs) using EuroQol (EQ-5D.) RESULTS: Of the patients invited to participate in the program, 79% were successfully recruited, and 86% of the participants in the exercise group completed the programme. Over 6 months, the mean treatment cost per patient in the exercise group was 41 euros more than "best care". The mean incremental QALY of intervention was 0.132 (95% CI: 0.104-0.286). Each extra QALY gained by the exercise programme relative to best care cost 311 euros (95% CI, 143 euros-394 euros). The cost effectiveness acceptability curves showed a 90% probability that the addition of the walking programme is the best strategy if the ceiling of inversion is 350 euros/QALY. CONCLUSION: The invitation strategy and exercise programme resulted in a high rate of participation and is a feasible and cost-effective addition to best care. The programme is a cost-effective resource for helping patients to increase their physical activity, according to the recommendations of general practitioners. Moreover, the present study could help decision makers enhance the preventive role of primary care and optimize health care resources. TRIAL REGISTRATION: [ISRCTN98931797].