Exploring the effectiveness and cost-effectiveness of a whole home physical activity intervention to reduce depression in older people in residential and nursing homes

Acknowledgements

We wish to acknowledge that OPERA is funded by the UK Department of Health, Health Technology Assessment Programme.

Any opinions expressed here are those of the authors and do not necessarily reflect those of the UK National Health Service or the Department of Health.

Aim of the Project

To evaluate the impact of a "whole home" exercise intervention, consisting of training for residential and nursing home staff backed up with twice weekly physiotherapist led exercise classes.  We will also assess the cost-effectiveness of the exercise intervention from both a societal and an NHS perspective.

Method

Up to 40% of residential and nursing home residents are depressed. Both exercise and increased social interaction may have a positive effect on depression and a group exercise programme that combines a social element and improved exercise tolerance is a promising non-drug approach to managing depression. We believe that for such a programme to be maximally beneficial and sustainable residential home staff will also have to provide increased opportunities for residents to participate in safe physical activity in their daily lives.

This study will examine whether a 'whole home' intervention, consisting of training for residential and nursing home staff and an ongoing, twice weekly, group exercise programme delivered by experienced physiotherapists reduces the overall number of residents who are depressed after one year. We will also determine whether the programme reduces depression after six and 12 months amongst those residents identified as depressed at the start of the study. Following a pilot study in three homes to refine the interventions, the study will be conducted in 77 residential or nursing homes in north east London and central England. Staff in every home in the study will receive training in best practice for depression awareness and the homes will be allocated to the exercise intervention at random.

Individual residents in all the homes will be asked to consent to the study assessments; and residents in the homes receiving the intervention will be asked to consent separately to take part in the exercise class. Many participants will have mild/moderate dementia and may not be able to give informed consent to data collection or to participate in the exercise programme. We will explore this important issue, the use of carer assent and the acceptability of the overall study approach as part of this study. This will involve interviewing residents, staff and relatives parallel to the pilot phase of the study.

The study team has considerable experience of group exercise prescriptions for older people, research in residential and nursing homes, cluster randomised trials, old age psychiatry and research ethics. 

Funding

NHS HTA

Ethical Approval

The Joint UCL/UCLH Committees on the Ethics of Human Research (Committee A)

Project Schedule

1 February 2008 to 31 July 2011

Duration: 3 years 6 months

ISRCTN Registration

ISRCTN43769277

Lead Investigators

Name	Establishment	Role	Speciality
Professor Martin Underwood	University of Warwick	Chief Investigator	General Practice
Dr Bartley Sheehan	University of Warwick	Co-Applicant	Old Age Psychiatry
Professor Sallie Lamb	University of Warwick	Co-Applicant	Physiotherapy
Dr Sandra Eldridge	Barts and The London, Queen Mary University of London	Co-Applicant	Statistics
Ms Suzanne Parsons	Barts and The London, Queen Mary University of London	Co-Applicant	Health Services Research
Dr Anne-Marie Slowther	University of Warwick	Co-Applicant	Clinical Ethics
Dr Anne Spencer	Queen Mary University of London	Co-Applicant	Health Economics
Dr Stephanie Taylor	Barts and The London, Queen Mary University of London	Co-Applicant	Public Health
Professor Margaret Thorogood	University of Warwick	Co-Applicant	Epidemiology

  

Project team

Name	Establishment	Role
Jamil Ahmad	PCRN-GL	Recruitment Team
Nicky Atherton	University of Warwick	Clinical Research Fellow
Morag Barber	Barking and Dagenham PCT	Intervention Team
Shabana Bashir	Mental Health Research Network, Coventry and Warwickshire	Recruitment Team
Cheryl Billingham	University of Warwick	Study Administration
Stephen Bremner	Barts and The London, Queen Mary University of London	Statistician
David Ellard	University of Warwick	Process Evaluation Fellow
Susanne Finnegan	University of Warwick	Intervention Team
Sobhash Jhuree	Barts and The London, Queen Mary University of London	Recruitment Team
Janet Lowe	University of Warwick	Intervention Team
Namonga Mtonga	University of Warwick	Intervention Team
Vivien Nichols	University of Warwick	Recruitment Team
Rachel Potter	University of Warwick	Lead Research Nurse
Cheryl Ritchie	University of Warwick	Recruitment Team
Clare Rutterford	Barts and The London, Queen Mary University of London	Randomisation
Rumun Sandhu	Mental Health Research Network, Coventry and Warwickshire	Recruitment Team
Nancy Schumann	Barts and The London, Queen Mary University of London	Study Administration
Kathleen Spanjers	University of Warwick	Intervention Team
Denise Tedder	Barts and The London, Queen Mary University of London	Recruitment Team
Sue Webb	University of Warwick	Recruitment Team
Emma Withers	University of Warwick	Study Manager

  

Project collaborators

RNH Name	Location

Publications/Presentations to Date

None to date

 

 

Key people

• Prof Martin Underwood Vice Dean & Professor of Primary Care Research
• Prof Sallie Lamb Clinical Professor of Rehabilitation
• Dr Bart Sheehan Associate Clinical Professor in Psychiatry
• Dr Anne-Marie Slowther Associate Clinical Professor in Clinical Ethics
• Prof Scott Weich Professor of Psychiatry
• Prof Margaret Thorogood Professor of Epidemiology
• Prof Sandra Eldridge Barts & The London, Queen Mary University of London
• Ms Suzanne Parsons Barts & The London, Queen Mary University of London
• Dr Anne Spencer  Queen Mary University of London
• Dr Stephanie Taylor Barts & The London, Queen Mary University of London

Enquiries contact

• Emma Withers Study Manager

Links

• HTA
• HTA Project Information
• ISRCTN Register Entry
• Research at the Medical School
• Research themes
• WMS homepage