International Journal of Health & Allied Sciences

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 9  |  Issue : 2  |  Page : 122--126

Walk with mobile app to fight depression: An interventional study


Pradeep Tarikere Satyanarayana1, Suhas Chandran2,  
1 Department of Community Medicine, Sri Devaraj Urs Medical College, SDUAHER, Kolar, India
2 Department of Psychiatry, St Johns Medical College, Bengaluru, Karnataka, India

Correspondence Address:
Pradeep Tarikere Satyanarayana
Department of Community Medicine, Sri Devaraj Urs Medical College, SDUAHER, Tamaka, Kolar, Karnataka
India

Abstract

BACKGROUND: Mobile health solutions can address looming problems of health. Smartphones have been integrated into global population with minimal constraints. Walking is the most convenient exercise as it can be self-regulated in intensity, duration, and frequency. MATERIALS AND METHODS: A single group pre–post experimental study without any comparison group was carried out for a period of 12 months. A total of 150 study participants were enrolled using nonprobability sampling from households who had to walk for 40 min/day for 5 days in a week for 3 months with Google Fit health app as an exercise adherence tool, and mental health status was assessed using Patient Health Questionnaire-9. Data were entered using Microsoft Excel and were analyzed using SPSS version 22 (IBM Corp, USA). Statistically significant P value was defined asP < 0.05. RESULTS: Of the 150 study participants, 64 (42.7%) belonged to 21–25 years, majority belonged to nuclear family, 100 (66.7%) participants had completed high school, and 86 (57.3%) of study participants were females. Around 14 participants (9.3%) before the intervention were found to have depression postintervention of exercise therapy, only 2 (1.3%) had depression. The baseline evaluation done showed higher depression scores, and postintervention had lower scores there was a statistically significant difference in scores. The study participants in all age groups, different educational status, different type of family, and gender showed statistically significant difference preexercise intervention and postexercise intervention. CONCLUSION: Walking as an exercise although has established beneficial effects in preventing noncommunicable diseases, but its beneficial effects in fighting depression needs more evidence. Exercise can be a substantial alternative guided with health app to cope with the emerging noncommunicable diseases.



How to cite this article:
Satyanarayana PT, Chandran S. Walk with mobile app to fight depression: An interventional study.Int J Health Allied Sci 2020;9:122-126


How to cite this URL:
Satyanarayana PT, Chandran S. Walk with mobile app to fight depression: An interventional study. Int J Health Allied Sci [serial online] 2020 [cited 2020 May 30 ];9:122-126
Available from: http://www.ijhas.in/text.asp?2020/9/2/122/282138


Full Text



 Introduction



Mobile health (M-health) solutions are able to address the looming problems of health services such as the increasing number of chronic diseases related to lifestyle, at a very high level, the need to empower patients and families not only self-care but also brace their own healthcare with the continuous need to provide direct access to health services, regardless of time and place.[1] A smartphone is a mobile phone with advanced functions not lesser than handheld computer capable of running software apps. For the past decade, smartphones have been integrated into the personal, social, and occupational routines of substantial proportion of the global population with torrential increase in number of apps. The expediency of smartphones is that they are not constrained by geography and is usually used privately by one individual. This means that smartphone apps can be extremely flexible and attractive to users, empowered by the confidentiality of their engagement.[2] Lifestyle modifications could be a cost-effective way to improve the health and quality of life, especially in an era of metabolic syndrome and mental health issues.[3] One of the effective and economical ways of lifestyle modification is exercise. It has been proposed and concluded that exercise improves the muscle strength, improves cardiac health, and gives healthy bones preventing osteoporosis.[4] Lifestyle modifications can assume, especially great importance in individuals with serious mental illness. According to Firth et al., exercise can improve the clinical outcomes in people with severe mental illness.[5] Aerobic exercises, including jogging, swimming, cycling, walking, gardening, and dancing, have been proved to reduce the anxiety and depression.[6] Improvements in mood are proposed to be caused by exercise-induced increase in blood circulation to the brain and by an influence on the hypothalamic–pituitary–adrenal axis mediated by the communication with several regions of the brain, especially limbic system, which controls motivation and mood; the amygdala, which generates fear in response to stress and the hippocampus, which plays an important part in memory formation as well as in mood and motivation.[7] Walking is the most natural sustained dynamic aerobic exercise common to everyone except for the seriously disabled or very frail urging for no requirements of special skills or equipment. Walking is the most convenient exercise and can be accommodated in occupational and domestic routines. The biggest advantage of walking is that it can be self-regulated in intensity, duration, and frequency and is inherently safe.[8] Evidence suggests supervised aerobic exercise, undertaken three times weekly at moderate intensity for a minimum of 9 weeks can be extremely helpful in the treatment of depression.[9],[10] Hence, with this background, the study was started with objective effect of walking as health intervention on depression scores using mobile phone health app as a tool for adherence to health intervention given in the form of walking.

 Materials and Methods



The study being single group pre–post experimental study without any comparison group was carried out for a period of 12 months in MVJMC and RH, Urban Health Training Center (UHTC) field practice area, Hoskote, Bengaluru, from January 2018 to December 2018. Participants above 18 years from the households of UHTC who are android mobile users and are willing to walk 40 min/day for at least 5 days in a week for 3 months were included in the study, whereas those who have already undergone such intervention, individuals who cannot walk, those individuals on any kind of medications, or any form of substance abuse were excluded from the study. Written consent was obtained prior to the study. The sample size was calculated based on the pilot study estimates reporting with pretest mean depression score as 6.1 with an average variance estimate of 3.55, expecting a reduction of 20% in depression scores with 90% power with an alpha error of 1%, the estimated sample size per group was 126, expecting a noncompliance of 20% a final sample size was 150, which was calculated using nMaster (n Master version 2.0, CMC Vellore, Tamil Nadu, India). A predesigned semi-structured questionnaire was used to determine the sociodemographic profile, and Patient Health Questionnaire-9 questionnaire was used to assess the depression. The baseline evaluation was done and noted. Health intervention was given in the form of exercise. To check adherence and to establish equality in exercise, all participants should download free health app Google Fit. Google Fit is an app which uses sensors in a user's activity tracker or mobile device to record the physical fitness activities such as walking or cycling, which are measured against the user's fitness goals to provide a comprehensive view of their fitness. The present study used Google app only as an adherence tool for exercise intervention. After each individual finishes 40 min of stipulated exercise duration, the respective participant sends the confirmation to principle investigator with the help of Google Fit app. All participants should cover 40 min/day for at least 5 days in a week and send the same snap shot to the investigating team to check for the adherence through the Google Fit App. All participants were trained using Google Fit app before the start of the study. The app being extremely user-friendly requires no Internet to use.[11] After 2 months of intervention, all participants were reassessed using the same questionnaire. Both pre- and post-intervention, data were collected by the interview technique. By applying Wilcoxon-signed rank test, statistical significant difference was noted before and after the intervention, and statistical significance was defined for P < 0.05.

 Results



Of the 150 study participants, 64 (42.7%) belonged to 21–25 years and 46 (30.7%) belonged to 26–30 years; majority of participants belonged to nuclear family and majority had family members <5; 100 (66.7%) of study participants had completed high school and 86 (57.3%) of study participants were females [Table 1].{Table 1}

Around 14 participants (9.3%) before the intervention were found to have depression postintervention of exercise therapy, only 2 (1.3%) had depression [Table 2]a.{Table 2}

The baseline evaluation done showed higher depression scores, and postintervention had lower scores; there was a statistically significant difference in scores [Table 2]b.

The study participants in all age groups, different educational status, different type of family, and gender showed statistically significant difference preexercise intervention and postexercise intervention [Table 3].{Table 3}

 Discussion



The present study being a nonrandomized interventional study was carried among 150 study participants in the UHTC area of MVJMC and RH, Bengaluru, for a period of 6 months. Of the 150 study participants, 64 (42.7%) belonged to 21–25, majority of participants belonged to nuclear family, majority had family members <5, 100 (66.7%) participants had completed high school, and 86 (57.3%) of study participants were females. The baseline evaluation done showed around 14 (9.3%) had depression before the intervention and postintervention it was 2 (1.3%). Study done by Cramer et al. among sedentary women using Profile of Mood States questionnaire for depression showed no significant improvement in mood although anxiety levels were lowered postexercise intervention for five sessions/week each carried out for 45 min session.[12] Study done by Meyer et al. on women to see Influence of Exercise Intensity for Improving Depressed Mood showed exercise of any intensity significantly improved feelings of depression with no differential effect following light, moderate, or hard exercise, which was similar to the present study.[13] For mild to moderate depression, the effect of exercise may be comparable to antidepressant medication and psychotherapy, and for severe depression, exercise seems to be a valuable complementary therapy to the traditional treatments.[14],[15] The study done by Byrne and Byrne shows antidepressant, antianxiety, and mood-enhancing effects of exercises.[16] Rawson et al.'s study supports the role of a structured exercise program as an effective intervention for improving symptoms of depression and anxiety associated with methamphetamine abstinence.[17] Various studies show physical exercise is an effective intervention for depression.[18],[19],[20],[21],[22] Adherence to physical activity intervention among psychiatry patient appears to be comparable with that of general population.

The present study explores the user-friendly mobile app as an adjacent tool for the adherence of exercise. The health and medical apps have a wider social, cultural, and political roles played as a part of contemporary healthcare and public health practice and their contribution to notions of health, illness, and embodiment have been little explored.[23],[24] M-Health solutions address the emerging problems on health services, the increasing number of chronic diseases related to lifestyle, high costs of existing national health services, the need to empower patients and families to self-care and handle their own healthcare, and the need to provide direct access to health services, regardless of time and place.[23],[25],[26] For a mental health intervention to be effective, there must be a process of rigorous experimental testing to guide development. Appropriate theories of engagement and implementation should also be consulted when introducing an evidence-based intervention to the public.[27] Mobile apps can be promising tools in elevation of health.[28]

 Conclusion



It is well established that only a small fraction of people suffering from mental health problems seek professional help. Innovative solutions are need of the hour in the self-management of mental health issues. It is also time now for mental health service providers to provide evidence-based physical activity interventions irrespective of any suffering from mental illness if feasible. With emergence of many health apps, a validated health app can be a solution to many of the emerging modern lifestyle disorders including depression.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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