Mitigating Feelings of Loneliness and Depression by Means of Web-Based or Print-Based Physical Activity Interventions: Pooled Analysis of 2 Community-Based Intervention Trials

Sonia Lippke; Tiara Ratz; Franziska Maria Keller; Dennis Juljugin; Manuela Peters; Claudia Pischke; Claudia Voelcker-Rehage

doi:10.2196/36515

Mitigating Feelings of Loneliness and Depression by Means of Web-Based or Print-Based Physical Activity Interventions: Pooled Analysis of 2 Community-Based Intervention Trials

JMIR Aging. 2022 Aug 9;5(3):e36515. doi: 10.2196/36515.

Authors

Sonia Lippke¹, Tiara Ratz², Franziska Maria Keller¹, Dennis Juljugin³, Manuela Peters⁴, Claudia Pischke^#⁵, Claudia Voelcker-Rehage^#⁶

Affiliations

¹ Psychology & Methods, Jacobs University Bremen, Bremen, Germany.
² Department of Reproductive Endocrinology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland.
³ Psychology, Universitaet Bremen, Bremen, Germany.
⁴ Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
⁵ Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.
⁶ Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Muenster, Muenster, Germany.

^# Contributed equally.

PMID: 35943790
PMCID: PMC9399846
DOI: 10.2196/36515

Abstract

Background: Physical activity (PA) is associated with benefits, such as fewer depressive symptoms and loneliness. Web- and print-based PA interventions can help older individuals accordingly.

Objective: We aimed to test the following research questions: Do PA interventions delivered in a web- or print-based mode improve self-reported PA stage of change, social-cognitive determinants of PA, loneliness, and symptoms of depression? Is subjective age a mediator and stage of change a moderator of this effect?

Methods: Overall, 831 adults aged ≥60 years were recruited and either allocated to a print-based or web-based intervention group or assigned to a wait-list control group (WLCG) in 2 community-based PA intervention trials over 10 weeks. Missing value imputation using an expectation-maximization algorithm was applied. Frequency analyses, multivariate analyses of variance, and moderated mediation analyses were conducted.

Results: The web-based intervention outperformed (47/59, 80% of initially inactive individuals being adopters, and 396/411, 96.4% of initially active individuals being maintainers of the recommended PA behavior) the print-based intervention (20/25, 80% of adopters, and 63/69, 91% of maintainers) and the WLCG (5/7, 71% of adopters; 141/150, 94% of maintainers). The pattern regarding adopters was statistically significant (web vs print Z=-1.94; P=.02; WLCG vs web Z=3.8367; P=.01). The pattern was replicated with stages (χ²₄=79.1; P<.001; contingency coefficient 0.314; P<.001); in the WLCG, 40.1% (63/157) of the study participants moved to or remained in action stage. This number was higher in the groups receiving web-based (357/470, 76%) or print-based interventions (64/94, 68.1%). A significant difference was observed favoring the 2 intervention groups over and above the WLCG (F_{19, 701}=4.778; P<.001; η²=0.098) and a significant interaction of time and group (F_{19, 701}=2.778; P<.001; η²=0.070) for predictors of behavior. The effects of the interventions on subjective age, loneliness, and depression revealed that both between-group effects (F_{3, 717}=8.668; P<.001; η²=0.018) and the interaction between group and time were significant (F_{3, 717}=6.101; P<.001; η²=0.025). In a moderated mediation model, both interventions had a significant direct effect on depression in comparison with the WLCG (web-based: c' path -0.86, 95% CI -1.58 to -0.13, SE 0.38; print-based: c' path -1.96, 95% CI -2.99 to -0.92, SE 0.53). Furthermore, subjective age was positively related to depression (b path 0.14, 95% CI 0.05-0.23; SE 0.05). An indirect effect of the intervention on depression via subjective age was only present for participants who were in actor stage and received the web-based intervention (ab path -0.14, 95% CI -0.34 to -0.01; SE 0.09).

Conclusions: Web-based interventions appear to be as effective as print-based interventions. Both modes might help older individuals remain or become active and experience fewer depression symptoms, especially if they feel younger.

Trial registration: German Registry of Clinical Trials DRKS00010052 (PROMOTE 1); https://tinyurl.com/nnzarpsu and DRKS00016073 (PROMOTE 2); https://tinyurl.com/4fhcvkwy.

International registered report identifier (irrid): RR2-10.2196/15168.

Keywords: depression; eHealth; intervention; loneliness; mHealth; mobile health; older adults; physical activity.

©Sonia Lippke, Tiara Ratz, Franziska Maria Keller, Dennis Juljugin, Manuela Peters, Claudia Pischke, Claudia Voelcker-Rehage. Originally published in JMIR Aging (https://aging.jmir.org), 09.08.2022.