COVID-19 Pandemic and Exercise (COPE) trial: a multigroup pragmatic randomised controlled trial examining effects of app-based at-home exercise programs on depressive symptoms

Eli Puterman, Benjamin Hives, Nicole Mazara, Nikol Grishin, Joshua Webster, Stacey Hutton, Michael Stephen Koehle, Yan Liu, Mark R Beauchamp, Eli Puterman, Benjamin Hives, Nicole Mazara, Nikol Grishin, Joshua Webster, Stacey Hutton, Michael Stephen Koehle, Yan Liu, Mark R Beauchamp

Abstract

Background: The number of adults across the globe with significant depressive symptoms has grown substantially during the COVID-19 pandemic. The extant literature supports exercise as a potent behaviour that can significantly reduce depressive symptoms in clinical and non-clinical populations.

Objective: Using a suite of mobile applications, at-home exercise, including high intensity interval training (HIIT) and/or yoga, was completed to reduce depressive symptoms in the general population in the early months of the pandemic.

Methods: A 6-week, parallel, multiarm, pragmatic randomised controlled trial was completed with four groups: (1) HIIT, (2) Yoga, (3) HIIT+yoga, and (4) waitlist control (WLC). Low active, English-speaking, non-retired Canadians aged 18-64 years were included. Depressive symptoms were measured at baseline and weekly following randomisation.

Results: A total of 334 participants were randomised to one of four groups. No differences in depressive symptoms were evident at baseline. The results of latent growth modelling showed significant treatment effects in depressive symptoms for each active group compared with the WLC, with small effect sizes (ESs) in the community-based sample of participants. Treatment groups were not significantly different from each other. Effect sizes were very large (eg, week 6 ES range=-2.34 to -2.52) when restricting the analysis only to participants with high depressive symptoms at baseline.

Conclusions: At-home exercise is a potent behaviour to improve mental health in adults during the pandemic, especially in those with increased levels of depressive symptoms. Promotion of at-home exercise may be a global public health target with important personal, social and economic implications as the world emerges scathed by the pandemic.

Trial registration number: NCT04400279.

Keywords: depression; exercise; randomised controlled trial.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Consort diagram.
Figure 2
Figure 2
Exercise adherence rates by experimental condition.
Figure 3
Figure 3
Trajectories and effect sizes for depressive symptoms over the course of the study. Note: figure 3A shows each group’s trajectories, in the full sample, while figure 3B show the trajectories for those with high (CESD score ≥10) levels of depressive symptoms. Figure 3C, D represent the effect sizes at each time point, for all participants and those with high levels of depressive symptoms, respectively. CESD, Center for Epidemiological Studies – Depression Scale; HIIT, high intensity interval training; WLC, waitlist control.

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