The impact of lifestyle Physical Activity Counselling in IN-PATients with major depressive disorders on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers: study protocol for a randomized controlled trial

Markus Gerber, Johannes Beck, Serge Brand, Robyn Cody, Lars Donath, Anne Eckert, Oliver Faude, Xenia Fischer, Martin Hatzinger, Edith Holsboer-Trachsler, Christian Imboden, Undine Lang, Sarah Mans, Thorsten Mikoteit, Anja Oswald, Uwe Pühse, Sofia Rey, Ann-Katrin Schreiner, Nina Schweinfurth, Ursula Spitzer, Lukas Zahner, Markus Gerber, Johannes Beck, Serge Brand, Robyn Cody, Lars Donath, Anne Eckert, Oliver Faude, Xenia Fischer, Martin Hatzinger, Edith Holsboer-Trachsler, Christian Imboden, Undine Lang, Sarah Mans, Thorsten Mikoteit, Anja Oswald, Uwe Pühse, Sofia Rey, Ann-Katrin Schreiner, Nina Schweinfurth, Ursula Spitzer, Lukas Zahner

Abstract

Background: Major depressive disorder (MDD) is a widespread and burdensome psychiatric issue. Physical activity counselling may increase lifestyle physical activity and cardiorespiratory fitness in this specific and particularly vulnerable population, which often suffers from both mental and physical health problems. Therefore, this study will examine the impact of a lifestyle physical activity counselling intervention on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers among in-patients diagnosed with MDD compared to controls. Secondary purposes are to examine the acceptability and perceived usefulness of the intervention among these patients, to find out whether the effectiveness of the intervention is moderated by genetic factors, and to compare baseline values with an age- and gender-matched group of healthy controls.

Methods: The study is designed as a multi-centric two-arm randomized clinical trial including an intervention group and a placebo control group, allocation concealment, single-blinding, and intention-to-treat analysis. Participants (N = 334) will be continuously recruited from four clinics specialized in the treatment of MDD. The intervention builds on a standardized, theory-based, low-cost lifestyle physical activity counselling programme, which was specifically designed for an in-patient rehabilitation setting. The placebo control condition consists of general instructions about health-enhancing physical activity. Data assessments will take place 2-3 weeks after admission to in-patient treatment (baseline), and 6 weeks (post) and 12 months (follow-up) after discharge from in-patient treatment. The primary outcome is objectively assessed physical activity at follow-up.

Discussion: Because regular physical activity has proven to be an important predictor of long-term response and remission in patients with major depression, we believe that our planned study may lay important groundwork by showing how individually tailored lifestyle physical activity counselling can be integrated into given clinical structures. Improving physical activity may have important implications for tackling metabolic and cardiovascular disease and increasing mood and cognitive functioning in this at-risk population, hence limiting the future burden of multiple chronic conditions. Increased physical activity may also reduce the likelihood of future depressive episodes. By moving towards the primary prevention of chronic physical conditions, much can be done to enhance the quality and quantity of life of people with MDD.

Trial registration: ISRCTN, ISRCTN10469580 . Registered on 3 September 2018.

Keywords: Acceptability; Biomarkers; Cardiorespiratory fitness; Cardiovascular risk markers; Counselling; Depression; Exercise; In-patients; Physical activity; Psychiatry; Serotonin transporter polymorphic promoter region.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Overview of the planned randomized controlled trial study design. FTFC face-to-face counselling with coach (behaviour skill training for intervention group; written information and video clip about health-enhancing physical activity for placebo control group), RTC remote telephone counselling, T2 6 weeks after discharge
Fig. 2
Fig. 2
SPIRIT figure providing an overview of time points, interventions, and assessments of the PACINPAT randomised controlled trial. BDNF brain-derived neurotrophic factor, 5-HTTLPR serotonin transporter polymorphic promoter region, IGF-1 insulin-like growth factor 1, PACINPAT Physical Activity Counselling in IN-PATients, SPIRIT Standard Protocol Items: Recommendations for Interventional Trials, TNF-α tumor necrosis factor alpha

References

    1. WHO . Prevention of mental disorders. Effective interventions and policy option: summary report. Geneva: World Health Organization; 2004.
    1. Kessler RC, Berglund P, Demler O, Jein R, Koretz D, Merikangas KR, et al. The epidemiology of major depressive disorder. Results from the National Comorbidity Survey Replication. JAMA. 2003;18:3095–3105. doi: 10.1001/jama.289.23.3095.
    1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62:593–602. doi: 10.1001/archpsyc.62.6.593.
    1. Blumenthal JA, Michael A, Babjak A. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med. 2007;69:587–596. doi: 10.1097/PSY.0b013e318148c19a.
    1. Murray CJL, Lopez AD. Global mortality, disability, and the contribution of risk factors: global burden of disease study. Lancet. 1997;349:1436–1442. doi: 10.1016/S0140-6736(96)07495-8.
    1. Lépine J-P, Briley M. The increasing burden of depression. Neuropsychiatr Dis Treat. 2011;7:3–7.
    1. WHO . The World Health Report 2001—mental health: new understanding, new hope. Geneva: World Health Organization; 2001.
    1. Blumenthal JA, Smith PJ, Hofmann BM. Is exercise a viable treatment for depression? ACSMs Health Fit J. 2012;16:14–21. doi: 10.1249/01.FIT.0000416000.09526.eb.
    1. Vancampfort D, Mitchell AJ, Hert M, Sienaert P, Probst M, Buys R, et al. Type 2 diabetes in patients with major depressive disorder: a meta-analysis of prevalence estimates and predictors. Depress Anxiety. 2015;32:763–773. doi: 10.1002/da.22387.
    1. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Dis Child. 2010;67:220–229.
    1. Pan A, Sun Q, Okereke OI, Rexrode KM, Hu FB. Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review. J Am Med Assoc. 2011;306:1241–1249. doi: 10.1001/jama.2011.1282.
    1. Dhar AK, Baron DA. Depression and the link with cardiovascular disease. Front Psychiatry. 2016;7. 10.3389/fpsyt.2016.00033.
    1. Vancampfort D, Correll CU, Wampers M, Sienaert P, Mitchell AJ, De Herdt A, et al. Metabolic syndrome and metabolic abnormalities in patients with major depressive disorder: a meta-analysis of prevalences and moderating variables. Psychol Med. 2014;44:2017–2028. doi: 10.1017/S0033291713002778.
    1. Dishman RK, Berthoud H, Booth F, Cotman CW, Edgerton VR, Fleshner M, et al. Neurobiology of exercise. Obesity. 2006;14:345–356. doi: 10.1038/oby.2006.46.
    1. Meltzer H. Serotonergic dysfunction in depression. Br J Psychiatry. 1989;8:25e31.
    1. Goodnick PJ, Goldstein BI. Selective serotonin reuptake inhibitors in affective disorders—II. Efficacy and quality of life. J Psychopharmacol. 1998;12:21e54. doi: 10.1177/0269881198012003021.
    1. Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Harrington HL, et al. Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science. 2003;201:386e9.
    1. Lesch KP, Bengel D, Heils A, Sabol SZ, Greenberg BD, Petri S, et al. Association of anxiety-related traits with a polymorphism in the serotonin transporter gene regulatory region. Science. 1996;274:1527. doi: 10.1126/science.274.5292.1527.
    1. Risch N, Herrell R, Lehner T, Liang KY, Eaves L, Hoh J, et al. Interaction between the serotonin transporter gene (5-HTTLPR), stressful life events, and risk of depression: a meta-analysis. JAMA. 2009;301:2462. doi: 10.1001/jama.2009.878.
    1. Munafò MR, Durrant C, Lewis G, Flint J. Gene x environment interactions at the serotonin transporter locus. Biol Psychiatry. 2009;65:211e9. doi: 10.1016/j.biopsych.2008.06.009.
    1. Rethorst CD, Landers DM, Nagoshi CT, Ross JT. The association of 5-HTTLPR genotype and depressive symptoms is moderated by physical activity. J Psychiatr Res. 2011;45:185–189. doi: 10.1016/j.jpsychires.2010.05.007.
    1. Cuijpers P, Vogelzangs N, Twisk JW, Kleiboer A, Li J, Penninx BW. Differential mortality rates in major and subthreshold depression: meta-analysis of studies that measured both. Br J Psychiatry. 2014;202:22–27. doi: 10.1192/bjp.bp.112.112169.
    1. Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry. 2015;72:334–341. doi: 10.1001/jamapsychiatry.2014.2502.
    1. Lawrence D., Hancock K. J., Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ. 2013;346(may21 1):f2539–f2539. doi: 10.1136/bmj.f2539.
    1. Thornicroft G. Physical health disparities and mental illness: the scandal of premature mortality. Br J Psychiatry. 2011;199:441–442. doi: 10.1192/bjp.bp.111.092718.
    1. Farah WH, Alsawas M, Mainou M, Alahdab F, Farah MH, Ahmed AT, et al. Non-pharmacological treatment of depression: a systematic review and evidence map. Evid Based Med. 2016;21(6):214–221. doi: 10.1136/ebmed-2016-110522.
    1. Salehi I, Hosseini SM, Haghighi M, Jahangard L, Bajoghli H, Gerber M, et al. Electroconvulsive therapy (ECT) and aerobic exercise training (AET) increased plasma BDNF and ameliorated depressive symptoms in patients suffering from major depressive disorder. J Psychiatr Res. 2016;76:1–8. doi: 10.1016/j.jpsychires.2016.01.012.
    1. Mota-Pereira J, Silverio J, Carvalho S, Ribeiro JC, Fonte D, Ramos J. Moderate exercise improves depression parameters in treatment-resistant patients with major depressive disorder. J Psychiatr Res. 2011;45:1005–1011. doi: 10.1016/j.jpsychires.2011.02.005.
    1. Jahangard L, Sadeghi A, Ahmadpanah M, Holsboer-Trachsler E, Sadeghi Bahmani D, Haghighi M, et al. Influence of adjuvant omega-3-polyunsaturated fatty acids on depression, sleep, and emotion regulation among outpatients with major depressive disorders—results from a double-blind, randomized and placebo-controlled clinical trial. J Psychiatr Res. 2018;107:48–56. doi: 10.1016/j.jpsychires.2018.09.016.
    1. Olfson M, Marcus SC, Druss B, Elinson L, Tanielian T, Pincus HA. National trends in the outpatient treatment of depression. JAMA. 2002;287:203–209. doi: 10.1001/jama.287.2.203.
    1. Blumenthal JA, Babyak MA, Moore KA, Craighead WE, Herman S, Khatri P, et al. Effects of exercise training on older patients with major depression. Arch Intern Med. 1999;159:2349–2356. doi: 10.1001/archinte.159.19.2349.
    1. Bauer M, Pfennig A, Severus E, Whybrow PC, Angst J, Möller H-J. World Federation of Societies of Biological Psychiatry. Task Force on Unipolar Depressive Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 1: update 2013 on the acute and continuation treatment of unipolar depressive disorders. World J Biol Psychiatry. 2013;14:334–385. doi: 10.3109/15622975.2013.804195.
    1. Knapen Jan, Vancampfort Davy, Moriën Yves, Marchal Yannick. Exercise therapy improves both mental and physical health in patients with major depression. Disability and Rehabilitation. 2014;37(16):1490–1495. doi: 10.3109/09638288.2014.972579.
    1. Waring WS. Clinical use of antidepressant therapy and associated cardiovascular risk. Drug Healthcare Patient Safety. 2012;4:93–101. doi: 10.2147/DHPS.S28804.
    1. Lingam R, Scott J. Treatment non-adherence in affective disorders. Acta Psychiatr Scand. 2002;105:164–172. doi: 10.1034/j.1600-0447.2002.1r084.x.
    1. Smith D, Dempster C, Glanville J, Feemantle N, Anderson I. Efficacy and tolerability of venlafaxine compared with selective serotonin re-uptake inhabitors and other antidepresssants: a meta-analysis. Br J Psychiatry. 2002;180:396–404. doi: 10.1192/bjp.180.5.396.
    1. Trivedi MH, Daly EJ. Treatment strategies to improve and sustain remission in major depressive disorder. Dialogues Clin Neurosci. 2008;10:377–384.
    1. Nemeroff CB. Prevalence and management of treatment-resistant depression. J Clin Psychiatry. 2007;68:17–25. doi: 10.4088/JCP.0707e17.
    1. Trivedi MH, Fava M, Wisniewski M, Thase ME, Quitkin F, Warden D, et al. Medication augmentation after the failure of SSRIs for depression. N Engl J Med. 2006;354:1243–1252. doi: 10.1056/NEJMoa052964.
    1. Rethorst CD, Wipfli BM, Landers DM. The antidepressive effects of exercise: a meta-analysis of randomized trials. Sports Med. 2009;39:491–511. doi: 10.2165/00007256-200939060-00004.
    1. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration. PLoS Med. 2008;5:260–268. doi: 10.1371/journal.pmed.0050045.
    1. Cassano P, Fava M. Depression and public health—an overview. Psychosom Res. 2002;53:849–857. doi: 10.1016/S0022-3999(02)00304-5.
    1. Farnia V, Hojatitabar S, Shakeri J, Rezaei M, Yazdchi K, Bajoghli H, et al. Adjuvant Rosa damascena has a small effect on SSRI-induced sexual dysfunction in female patients suffering from MDD. Pharmacopsychiatry. 2015;48(4–5):156–163.
    1. Farnia V, Shirzadifar M, Shakeri J, Rezaei M, Bajoghli H, Holsboer-Trachsler E, et al. Rosa damascena oil improves SSRI-induced sexual dysfunction in male patients suffering from major depressive disorders: results from a double-blind, randomized, and placebo-controlled clinical trial. Neuropsychiatr Dis Treat. 2015;11:625–635.
    1. Alvarez-Jiménez M, Conzalez-Blanch C, Vazquez-Barquero JL, Pérez-Iglesias R, Martinez-Garcia O, Pérez-Pardal T, et al. Attenuation of antipsychotic-induced weight gain with early behavioral intervention in drug-naive first-episode psychosis patients: a randomized controlled trial. J Clin Psychiatry. 2006;67:1253–1260. doi: 10.4088/JCP.v67n0812.
    1. Kessler RC, Soukup J, Davis RB, Foster DF, Wilkey SA, Van Rompay MI, et al. The use of complementary and alternative therapies to treat anxiety and depression in the United States. Am J Psychiatr. 2001;158:289–294. doi: 10.1176/appi.ajp.158.2.289.
    1. Astin JA. Why patients use alternative medicine—results of a national study. JAMA. 1998;279:1548–1553. doi: 10.1001/jama.279.19.1548.
    1. Dunn AL, Trivedi MH, Kampert JB, Clark CG, Chambliss HO. Exercise treatment for depression. Efficacy and dose response. Am J Prev Med. 2005;28:1–8. doi: 10.1016/j.amepre.2004.09.003.
    1. Lawlor DA, Hopker SW. The effectiveness of exercise as intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials. Br Med J. 2005;322:1–8.
    1. Stubbs Brendon, Vancampfort Davy, Hallgren Mats, Firth Joseph, Veronese Nicola, Solmi Marco, Brand Serge, Cordes Joachim, Malchow Berend, Gerber Markus, Schmitt Andrea, Correll Christoph U., De Hert Marc, Gaughran Fiona, Schneider Frank, Kinnafick Florence, Falkai Peter, Möller Hans-Jürgen, Kahl Kai G. EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH) European Psychiatry. 2018;54:124–144. doi: 10.1016/j.eurpsy.2018.07.004.
    1. Mammen G, Faulkner G. Physical activity and the prevention of depression: a systematic review of prospective studies. Am J Prev Med. 2013;45:649–657. doi: 10.1016/j.amepre.2013.08.001.
    1. Gerber Markus, Minghetti Alice, Beck Johannes, Zahner Lukas, Donath Lars. Is improved fitness following a 12-week exercise program associated with decreased symptom severity, better wellbeing, and fewer sleep complaints in patients with major depressive disorders? A secondary analysis of a randomized controlled trial. Journal of Psychiatric Research. 2019;113:58–64. doi: 10.1016/j.jpsychires.2019.03.011.
    1. Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, et al. Exercise for depression. Cochrane Database Syst Rev. 2013;(9):CD004366. 10.1002/14651858.CD004366.pub6.
    1. Schuch FB, Vancampfort D, Richards J, Rosenbaum S, Ward PB, Stubbs B. Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J Psychiatr Res. 2016;77:42–51. doi: 10.1016/j.jpsychires.2016.02.023.
    1. Kvam S, Kleppe CL, Nordhus IH, Hovland A. Exercise as a treatment for depression: a meta-analysis. J Affect Disord. 2016;202:67–86. doi: 10.1016/j.jad.2016.03.063.
    1. Nebiker L, Lichtenstein E, Minghetti A, Zahner L, Gerber M, Faude O, et al. Moderating effects of exercise duration and intensity in neuromuscular versus endurance exercise interventions for the treatment of depression: a meta-analytical review with meta-regression and sensitivity analyses. Front Psychiatry. 2018;9(305). 10.3389/fpsyt.2018.00305.
    1. Minghetti A, Faude O, Hanssen H, Zahner L, Gerber M, Donath L. Sprint interval training (SIT) substantially reduces depressive symptoms in major depressive disorder (MDD): a randomized controlled trial. Psychiatry Res. 2018;265:292–297. doi: 10.1016/j.psychres.2018.04.053.
    1. Gerber M, Minghetti A, Beck J, Zahner L, Donath L. Sprint interval training and continuous aerobic exercise training have similar effects on exercise motivation and affective responses to exercise in patients with major depressive disorders: a randomized controlled trial. Front Psychiatry. 2018. 10.3389/fpsyt.2018.00694.
    1. Hoffman BM, Babyak MA, Craighead E, Sherwood A, Doraiswamy PM, Coons MJ, et al. Exercise and pharmacotherapy in patients with major depression: one-year follow-up of the SMILE study. Psychosom Med. 2011;73:127–133. doi: 10.1097/PSY.0b013e31820433a5.
    1. Babyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore KA, et al. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med. 2000;62:633–638. doi: 10.1097/00006842-200009000-00006.
    1. HWr K, Murray T. Foundations of physical activity and public health. Champaign: Human Kinetics. 2012.
    1. Blair SN, Kohl HW, 3rd, Barlow CE, Paffenbarger RS, Jr, Gibbons LW, Macera CA. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA. 1995;273:1093–1098. doi: 10.1001/jama.1995.03520380029031.
    1. Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301:2024–2035. doi: 10.1001/jama.2009.681.
    1. Lindwall M, Gerber M, Jonsdottir I, Börjesson M, Ahlborg GJ. The relationships of change in physical activity with change in depression, anxiety, and burnout: a longitudinal study of Swedish healthcare workers. Health Psychol. 2014;33:1309–1318. doi: 10.1037/a0034402.
    1. Gerber M, Jonsdottir IH, Lindwall M, Ahlborg G. Physical activity in employees with differing occupational stress and mental health profiles: a latent profile analysis. Psychol Sport Exerc. 2014;15:649–658. doi: 10.1016/j.psychsport.2014.07.012.
    1. Gerber M, Lindwall M, Lindegård A, Börjesson M, Jonsdottir IH. Cardiovascular fitness protects from stress-related symptoms of burnout and depression. Patient Educ Couns. 2013;93:146–152. doi: 10.1016/j.pec.2013.03.021.
    1. Voderholzer U, Dersch R, Dickhut HH, Herter A, Freyer T, Berger M. Physical fitness in depressive patients and impact of illness course and disability. J Affect Disord. 2011;128:160–164. doi: 10.1016/j.jad.2010.06.028.
    1. Krämer LV, Helmes AW, Seelig H, Fuchs R, Bengel J. Correlates of reduced exercise behaviour in depression: the role of motivational and volitional deficits. Psychol Health. 2014;29:1206–1225. doi: 10.1080/08870446.2014.918978.
    1. Firth J, Rosenbaum S, Stubbs B, Gorczynski P, Yung AR, Vancampfort D. Motivationg factors and barriers towards exercise in severe mental illness: a systematic review and meta-analysis. Psychol Med. 2016;46(1–13):2869–2881. doi: 10.1017/S0033291716001732.
    1. Stubbs B, Rosenbaum S, Vancampfort D, Ward PB, Schuch FB. Exercise improves cardiorespiratory fitness in people with depression: a meta-analysis of randomized controlled trials. J Affect Disord. 2016;190:249–253. doi: 10.1016/j.jad.2015.10.010.
    1. Knapen J, Vancampfort D. Evidence for exercise therapy in the treatment of depression and anxiety. Int J Psychosoc Rehabil. 2013;17:75–87.
    1. Schuch FB, Vasconcelos-Moreno MP, Borowsky C, Zimmerman AB, Rocha NS, Fleck MP. Exercise and severe major depression: effect on symptom severity and quality of life at discharge in an inpatient cohort. J Psychiatr Res. 2015;61:25–32. doi: 10.1016/j.jpsychires.2014.11.005.
    1. Lindegård A, Jonsdottir IH, Börjesson M, Lindwall M, Gerber M. Changes in mental health in compliers and non-compliers with physical activity recommendations in patients with stress-related exhaustion. BMC Psychiatry. 2015;15. 10.1186/s12888-015-0642-3.
    1. Pomp S, Fleig L, Schwarzer R, Lippke S. Depressive symptoms interfere with post-rehabilitation exercise: outcome expectancies and experience as mediators. Psychol Health Med. 2012;17:698–708. doi: 10.1080/13548506.2012.661864.
    1. Vancampfort D, Stubbs B, Sienaert P, Wyckaert S, De Hert M, Rosenbaum S, et al. What are the factors that influence physical activity participation in individuals with depression? A review of physical activity correlates from 59 studies. Psychiatr Danub. 2015;27:210–224.
    1. Gerber M, Holsboer-Trachsler E, Pühse U, Brand S. Exercise is medicine for patients with major depressive disorders. But only if the “pill” is taken! Neuropsychiatr Dis Treat. 2016;12:1977–1981. doi: 10.2147/NDT.S110656.
    1. Gerber M, Holsboer-Trachsler E, Pühse U, Brand S. Author’s reply to the Letter to the Editor “Exercise is medicine for depression: Even if the “pill” is small” of Hallgren, Stubbs and Vancampfort. Neuropsychiatr Dis Treat. 2016;12:2717–2720. doi: 10.2147/NDT.S110656.
    1. Nigg CR. ACSM's behavioral aspects of physical activity and exercise. Little Rock: Lippincott Williams & Wilkins; 2013.
    1. Schwarzer R, Lippke S, Luszczynska A. Mechanisms of health behavior change in persons with chronic illness or disability: the Health Action Process Approach (HAPA) Rehabil Psychol. 2011;56:161–170. doi: 10.1037/a0024509.
    1. Fuchs R, Göhner W, Seelig H. Long-term effects of a psychological group intervention on physical exercise and health: the MoVo concept. J Phys Act Health. 2011;8:794–803. doi: 10.1123/jpah.8.6.794.
    1. Fuchs R, Göhner W, Seelig H. Effects of a standardized group intervention on physical exercise and health: the MoVo-concept. J Phys Act Health. 2011;8:794–803. doi: 10.1123/jpah.8.6.794.
    1. Gerber M, Fuchs R, Pühse U. Der Einfluss eines Kurz-Interventionsprogramms (MoVo-Lisa) auf das Bewegungsverhalten und die Determinanten köperlich-sportlicher Aktivität bei übergewichtigen und fettleibigen Personen [Effects of a short exercise-intervention on sport participation and cognitive-behavioral antecedents of sport participation in a sample of overweight and obese individuals] Zeitschrift für Gesundheitspsychologie. 2010;18:159–169. doi: 10.1026/0943-8149/a000025.
    1. Sniehotta FF, Scholz U, Schwarzer R, Fuhrmann B, Kiwus U, Voller H. Long-term effects of two psychological interventions on physical exercise and self-regulation following coronary rehabilitation. Int J Behav Med. 2005;12(4):244–255. doi: 10.1207/s15327558ijbm1204_5.
    1. Lippke S, Ziegelmann JP, Schwarzer R. Behavioral intentions and action plans promote physical exercise: a longitudinal study with orthopedic rehabilitation patients. J Sport Exerc Psychol. 2004;26:470–483. doi: 10.1123/jsep.26.3.470.
    1. Garcia-Toro M, Ibarra O, Gili M, Serrano MJ, Olivan B, Vicens E, et al. Four hygienic-dietary recommendations as add-on treatment in depression: a randomized-controlled trial. J Affect Disord. 2012;140:200–203. doi: 10.1016/j.jad.2012.03.031.
    1. Chalder M, Wiles NJ, Campbell J, Hollinghurst SP, Haase AM, Taylor AH, et al. Facilitated physical activity as a treatment for depressed adults: randomized controlled trial. BMJ. 2012;344:e2758. doi: 10.1136/bmj.e2758.
    1. Baxter H, Winder R, Chalder M, Wright C, Sherlock S, Haase A, et al. Physical activity as a treatment for depression: the TREAD randomised trial protocol. Trials. 2010;22:105. doi: 10.1186/1745-6215-11-105.
    1. Chalder M, Wiles NJ, Campbell J, Hollinghurst SP, Searle A, Haase A, et al. A pragmatic randomised controlled trial to evaluate the cost-effectiveness of a physical activity intervention as a treatment for depression: the TREAting Depression with physical activity (TREAD) trial. Health Technol Assess. 2012;16. 10.3310/hta16100.
    1. Rosenbaum S, Newby J, Steel Z, Andrews G, Ward PB. Online physical activity interventions for mental disorders: a systematic review. Internet Interv. 2015;2:214–220. doi: 10.1016/j.invent.2015.04.001.
    1. Haskell WL, Blair SN, Hill JO. Physical activity: health outcomes and importance for public health policy. Prev Med. 2009;49:280–282. doi: 10.1016/j.ypmed.2009.05.002.
    1. Haskell WL, Lee IM, Pate RR, Powell WW, Blair SN, Franklin BA, et al. Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sport Exerc. 2007;39:1423–1434. doi: 10.1249/mss.0b013e3180616b27.
    1. Hillsdon M, Foster C, Thorogood M. Interventions for promoting physical activity. Cochrane Db Syst Rev. 2005;25:CD003180.
    1. Foster C, Richards J, Thorogood M, Hillsdon M. Remote and web 2.0 interventions for promoting physical activity. Cochrane Database Syst Rev. 2013;9:CD010395.
    1. Stubbs B, Vancampfort D, Rosenbaum S, Ward PB, Richards J, Soundy A, et al. Dropout from exercise randomized controlled trials among people with depression: a meta-analysis and meta regression. J Affect Disord. 2016;190:457–466. doi: 10.1016/j.jad.2015.10.019.
    1. Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967;6:278–296. doi: 10.1111/j.2044-8260.1967.tb00530.x.
    1. Williams JB. A structured interview guide for the Hamilton Depression Rating scale. Arch Gen Psychiatry. 1988;45:742–747. doi: 10.1001/archpsyc.1988.01800320058007.
    1. Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988;8:77–100. doi: 10.1016/0272-7358(88)90050-5.
    1. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–571. doi: 10.1001/archpsyc.1961.01710120031004.
    1. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International Physical Activity Questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB.
    1. Thomas S, Reading J, Shephard RJ. Revision of the Physical Activity Readiness Questionnaire (PAR-Q) Can J Sport Sci. 1992;17(4):338–345.
    1. SGAD, SGBP, SGPP Die somatische Behandlung der unipolaren depressiven Störungen: Update 2016. Swiss Medical Forum. 2016;16:716–724.
    1. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46:81–95. doi: 10.1007/s12160-013-9486-6.
    1. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6. 10.1186/748-5908-6-42.
    1. Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009;28:690–701. doi: 10.1037/a0016136.
    1. Samdal GB, Eide GE, Barth T, Williams G, Meland E. Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults: systematic review and meta-regression analyses. Int J Behav Nutr Phys Act. 2017;14(42). 10.1186/s12966-017-0494-y.
    1. Howlett Neil, Trivedi Daksha, Troop Nicholas A, Chater Angel Marie. Are physical activity interventions for healthy inactive adults effective in promoting behavior change and maintenance, and which behavior change techniques are effective? A systematic review and meta-analysis. Translational Behavioral Medicine. 2018;9(1):147–157. doi: 10.1093/tbm/iby010.
    1. Olander EK, Fletcher H, Williams S, Atkinson L, Turner A, French DP. What are the most effective techniques in changing obese individuals’ physical activity self-efficacy and behaviour: a systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2013;10(29). 10.1186/479-5868-10-29.
    1. Krämer L, Helmes AW, Bengel J. Understanding activity limitations in depression: integrating the concepts of motivation and volition from health psychology into clinical psychology. Eur Psychol. 2014;19:278–288. doi: 10.1027/1016-9040/a000205.
    1. Marcus DK, O'Connell D, Norris AL, Sawaqdeh A. Is the Dodo bird endangered in the 21st century? A meta-analysis of treatment comparison studies. Clin Psychol Rev. 2014;34(7):519–530. doi: 10.1016/j.cpr.2014.08.001.
    1. Wampold BE, Mondin GW, Moody M, Stich F, Benson K, Ahn H-N. A meta-analysis of outcome studies comparing bona fide psychotherapies: empiricially, “all must have prizes”. Psychol Bull. 1997;122(3):203–215. doi: 10.1037/0033-2909.122.3.203.
    1. Rowlands AV. Accelerometer assessment of physical activity in children: an update. Pediatr Exerc Sci. 2007;19:252–266. doi: 10.1123/pes.19.3.252.
    1. Freedson PS, Melanson E, Sirard J. Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc. 1998;30:777–781. doi: 10.1097/00005768-199805000-00021.
    1. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of Physical Sctivities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(9):S498–S516.
    1. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR, Tudor-Locke C, et al. 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43:1575–1581. doi: 10.1249/MSS.0b013e31821ece12.
    1. Trost SG, Pate RR, Freedson PS, Sallis JF, Taylor WC. Using objective physical activity measures with youth: how many days of monitoring are needed? Med Sci Sport Exerc. 2000;25:426–431. doi: 10.1097/00005768-200002000-00025.
    1. Herrmann SD, Barreira TV, Kang M, Ainsworth BE. How many hours are enough? Accelerometer wear time may provide bias in daily activity estimates. J Phys Act Health. 2013;10:742–749. doi: 10.1123/jpah.10.5.742.
    1. Herman Hansen B, Børtnes I, Hildebrand M, Holme I, Kolle I, Anderssen SA. Validity of the Actigraph GT1M during walking and cycling. J Sports Sci. 2014;32:510–516. doi: 10.1080/02640414.2013.844347.
    1. Rosenbaum Simon, Ward Philip B. The Simple Physical Activity Questionnaire. The Lancet Psychiatry. 2016;3(1):e1. doi: 10.1016/S2215-0366(15)00496-4.
    1. Schilling René, Schärli Eveline, Fischer Xenia, Donath Lars, Faude Oliver, Brand Serge, Pühse Uwe, Zahner Lukas, Rosenbaum Simon, Ward Philip B., Carraro Attilio, Gerber Markus. The utility of two interview-based physical activity questionnaires in healthy young adults: Comparison with accelerometer data. PLOS ONE. 2018;13(9):e0203525. doi: 10.1371/journal.pone.0203525.
    1. Åstrand P-O, Rodahl K. Textbook of work physiology: physiological bases of exercise. Champaign: Human Kinetics; 2003. pp. 1–92.
    1. Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med. 1970;2:92–98.
    1. Macsween A. The reliability and validity of the Astrand nomogram and linear extrapolation for deriving VO2max from submaximal exercise data. J Sports Med Phys Fitness. 2001;41:312–317.
    1. Ernst G. Hidden signals—the history and methods of heart rate variability. Front Public Health. 2017;5. 10.3389/fpubh.2017.00265.
    1. Tarvainen MP, Niskanen JP, Lipponen JA, Ranta-Aho PO, Karjalainen PA. Kubios HRV—heart rate variability analysis software. Comput Methods Prog Biomed. 2014;113:210–220. doi: 10.1016/j.cmpb.2013.07.024.
    1. Giles D, Draper N, Neil W. Validity of the Polar V800 heart rate monitor to measure RR intervals at rest. Eur J Appl Physiol. 2016;116:563–571. doi: 10.1007/s00421-015-3303-9.
    1. Bassi D, Santos-de-Araujo AD, Camargo PF, Dibai-Filho AV, da Fonseca MA, Mendes RG, et al. Inter and intra-rateer reliability of short-term measurement of heart rate variability on rest in diabetic type 2 patients. J Med Syst. 2018:42. 10.1007/s10916-018-1101-8, 10.1007/s10916-018-1101-8.
    1. Plante TG, LeCaptain SE, McLain HC. Perceived fitness predicts daily coping better than physical activity. J Appl Biobehav Res. 2000;5:66–79. doi: 10.1111/j.1751-9861.2000.tb00064.x.
    1. Plante TG, Lantis A, Checa G. The influence of perceived versus aerobic fitness on psychological health and physiological stress responsitivity. Int J Stress Manag. 1998;5:141–156. doi: 10.1023/A:1022936930992.
    1. Gerber M, Brand S, Holsboer-Trachsler E, Pühse U. Fitness and exercise as correlates of sleep complaints. Is it all in our minds? Med Sci Sports Exerc. 2010;43:893–901. doi: 10.1249/MSS.0b013e3181c0ea8c.
    1. Fuchs R. Aufbau eines körperlich-aktiven Lebensstils im Kontext der medizinischen Rehabilitation: Ein motivational-volitionales Interventionskonzept (MoVo-LISA Projekt). Unveröffentlichter Endbericht. Freiburg: Universität Freiburg; 2008.
    1. Gerber M, Fuchs R, Pühse U. Follow-up of a short motivational and volitional exercise-intervention trial with overweight and obese individuals. Schweizerische Zeitschrift für “Sportmedizin und Sporttraumatologie”. 2010;58:108–114.
    1. Fuchs R. Psychologie und körperliche Bewegung [Psychology and physical activity] Göttingen: Hogrefe; 1997.
    1. Seelig H, Fuchs R. Messung der sport- und bewegungsbezogenen Selbstkonkordanz [Measurement of sport and exercise related self-concordance] Z Sportpsychol. 2006;13:121–139. doi: 10.1026/1612-5010.13.4.121.
    1. Gerber M, Mallett C, Pühse U. Beyond intentional processes: the role of action and coping planning in explaining exercise behaviour among adolescents. Int J Sport Exerc Psychol. 2011;9:209–226. doi: 10.1080/1612197X.2011.614846.
    1. Sheldon KM, Elliot AJ. Goal striving, need-satisfaction, and longitudinal well-being: the self-concordance model. J Pers Soc Psychol. 1999;76:482–497. doi: 10.1037/0022-3514.76.3.482.
    1. Sniehotta FF, Schwarzer R, Scholz U, Schüz B. Action planning and coping planning for long-term lifestyle change: theory and assessment. Eur J Soc Psychol. 2005;35:565–576. doi: 10.1002/ejsp.258.
    1. Krämer L, Göhner W, Seelig H, Fuchs R. Barrieren und Barrierenmanagement im Prozess der Sportteilnahme. In: Sudeck G, Conzelmann A, Lehnert K, Gerlach E, editors. Differentielle Sportpsychologie—Sportwissenschaftlich Persönlichkeitsforschung 40 Jahrestagung der Arbeitsgemeinschaft für Sportpsychologie (asp) vom 1-3 Mai in Bern. Hamburg: Czwalina; 2008. p. 81.
    1. Krämer L, Fuchs R. Barrieren und Barrierenmanagement im Prozess der Sportteilnahme: Zwei neue Messinstrumente. Zeitschrift für Gesundheitspsychologie. 2010;18:170–182. doi: 10.1026/0943-8149/a000026.
    1. Fava GA, Kellner R, Munari F, Pavan L. The Hamilton Depression Rating Scale in normals and depressives. Acta Psychiatr Scand. 1982;66:26–32. doi: 10.1111/j.1600-0447.1982.tb00911.x.
    1. Endicott J, Cohen J, Nee J, Fleiss J, Sarantakos S. Hamilton Depression Rating Scale extracted from regular and change versions of the Schedule for Affective Disorders and Schizophrenia. Arch Gen Psychiatry. 1981;38:98–103. doi: 10.1001/archpsyc.1981.01780260100011.
    1. Richter P, Werner J, Heerlein A, Kraus A, Sauer H. On the validity of the Beck Depression Inventory. Psychopathology. 1998;31:160–168. doi: 10.1159/000066239.
    1. Wollmer MA, de Boer C, Kalak N, Beck J, Gotz T, Schmidt T, et al. Facing depression with botulinum toxin: a randomized controlled trial. J Psychiatr Res. 2012;46:574–581. doi: 10.1016/j.jpsychires.2012.01.027.
    1. Button KS, Kounali D, Thomas L, Wiles NJ, Peters TJ, Welton NJ, et al. Minimal clinically important difference on the Beck Depression Inventory—II according to the patient's perspective. Psychol Med. 2015;45:3269–3279. doi: 10.1017/S0033291715001270.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–396. doi: 10.2307/2136404.
    1. Cohen S, Williamson GM. Perceived stress in a probability sample of the united states. In: Spacapan S, Oskamp S, editors. The social psychology of health. Newbury Park: Sage; 1988. pp. 31–67.
    1. Klein EM, Brähler E, Dreier M, Reinecke L, Müller KW, Schmutzer G, et al. The German version of the Perceived Stress Scale—psychometric characteristics in a representative German community sample. BMC Psychiatry. 2016;16. 10.1186/s12888-016-0875-9.
    1. Bullinger M, Kirchberger I. SF-36 Fragebogen zum Gesundheitszustand. Göttingen: Hogrefe; 2011.
    1. Rejeski WJ, Brawley LR, Shumaker SA. Physical activity and health-related quality of life. Exerc Sport Sci Rev. 1996;24:71–108. doi: 10.1249/00003677-199600240-00005.
    1. Salyers MP, Bosworth HB, Swanson JW, Lamb-Pagone J, Osher FC. Reliability and validity of the SF-12 Health Survey among people with severe mental illness. Med Care. 2000;38:1141–1150. doi: 10.1097/00005650-200011000-00008.
    1. Luo X, George ML, Kakouras I, Edwards CL, Pietrobon R, Richardson W, et al. Reliability, validity, and responsiveness of the short form 12-item survey (SF-12) in patients with back pain. Spine. 2003;28:1739–1745.
    1. Díaz-Arribas MJ, Fernández-Serrano M, Royuela A, Kovacs FM, Gallego-Izquierdo T, Ramos-Sánchez M, et al. Minimal clinically important difference in quality of life for patients with low back pain. Spine. 2017;42:1908–1916. doi: 10.1097/BRS.0000000000002298.
    1. Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index (ISI) as an outcome measure for insomnia research. Sleep Med. 2001;2:297–307. doi: 10.1016/S1389-9457(00)00065-4.
    1. Morin CM, Belleville G, Belanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34:601–608. doi: 10.1093/sleep/34.5.601.
    1. Gerber M, Lang C, Lemola S, Colledge F, Kalak N, Holsboer-Trachsler E, et al. Validation of the German version of the Insomnia Severity Index in adolescents, young adults and adult workers: results from three cross-sectional studies. BMC Psychiatry. 2016;16. 10.1186/s12888-016-0876-8.
    1. Chan RC, Shum D, Toulopoulou T, Chen EY. Assessment of executive functions: review of instruments and identification of critical issues. Arch Clin Neuropsychol. 2008;23:201–216. doi: 10.1016/j.acn.2007.08.010.
    1. Huettel SA, McCarthy G. What is odd in the oddball task? Prefrontal cortex is activated by dynamic changes in response strategy. Neuropsychologia. 2004;42:379–386. doi: 10.1016/j.neuropsychologia.2003.07.009.
    1. Mackworth JF. Paced memorizing in a continuous task. J Exp Psychol. 1959;58:206. doi: 10.1037/h0049090.
    1. Eriksen BA, Eriksen CW. Effects of noise letters upon the identification of a target letter in a nonsearch task. Percept Psychophys. 1974;16:143–149. doi: 10.3758/BF03203267.
    1. García-Larrea L, Lukaszewicz AC, Mauguiére F. Revisiting the oddball paradigm. Non-target vs neutral stimuli and the evaluation of ERP attentional effects. Neuropsychologia. 1992;30:723–741. doi: 10.1016/0028-3932(92)90042-K.
    1. Diamond A. Executive functions. Annu Rev Psychol. 2013;64:135–168. doi: 10.1146/annurev-psych-113011-143750.
    1. Soveri A, Lehtonen M, Karlsson LC, Lukasik K, Antfolk J, Laine M. Test–retest reliability of five frequently used executive tasks in healthy adults. Appl Neuropsychol. 2018;25:155–165. doi: 10.1080/23279095.2016.1263795.
    1. Wöstmann NM, Aichert DS, Costa A, Rubia K, Möller HJ, Ettinger U. Reliability and plasticity of response inhibition and interference control. Brain Cogn. 2013;81:82–94. doi: 10.1016/j.bandc.2012.09.010.
    1. Williams LM, Simms E, Clark CR, Paul RH, Rowe D, Gordon E. The test-retest reliability of a standardized neurocognitive and neurophysiological test battery:“neuromarker”. Int J Neurosci. 2005;115:1605–1630. doi: 10.1080/00207450590958475.
    1. Ostchega Y, Nwankwo T, Sorlie PD, Wolz M, Zipf G. Assessing the validity of the Omron HEM-907XL oscillometric blood pressure measurement device in a national survey environment. J Clin Hypertens. 2009;12:22–28. doi: 10.1111/j.1751-7176.2009.00199.x.
    1. Cook NR, Cohen J, Hebert PR, Taylor JO, Hennekens CH. Implications for small reductions in diastolic blood pressure for primary prevention. Arch Intern Med. 1995;155:701–709. doi: 10.1001/archinte.1995.00430070053006.
    1. Cifkova R, Erdine S, Fagard R, Farsang C, Heagerty AM, Kiowski W. Hypertension Guidelines Committee. Practice guidelines for primary care physicians: 2003 ESH/ESC hypertension guidelines. J Hypertens. 2003;21:1779–1786. doi: 10.1097/00004872-200310000-00001.
    1. WHO . Obesity. Preventing and managing the global epidemic. Technical Report Series No. 894. Geneva: World Health Organization; 2000.
    1. Jensen MG, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129:139–140. doi: 10.1161/.
    1. Bacchi E, Cavendon V, Zancanaro C, Moghetti P, Milanese C. Comparison between dual-energy X-ray absorptiometry and skinfold thickness in assessing body fat in overweigh/obese adult patients with type-2 diabetes. Sci Rep. 2017;17424. 10.1038/s41598-017-17788-y.
    1. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143–3421. doi: 10.1161/circ.106.25.3143.
    1. Abbai NS, Nyirenda M, Reddy T, Ramjee G. Good correlation between the Afinion AS100 analyser and the ABX Pentra 400 analyser for the measurement of glycosylated haemoglobin and lipid levels in older adults in Durban, South Africa. S Afr Med J. 2018;108:50–55. doi: 10.7196/SAMJ.2017.v108i1.12548.
    1. Foerster V, Severn M. Point-of-care glycated hemoglobin testing to diagnose type 2 diabetes. CADTH Issues in Emerging Health Technologies. 2016;156:1–8.
    1. Rodondi N, Gencer B, Collet TH, Battegay E. Ab welchem Cholesterinwert soll in der Schweiz eine Behandlung erfolgen? Swiss Med Forum. 2011;11:467–472.
    1. Magno S, Ceccarini G, Pelosini C, Jaccheri R, Vitti J, Fierabracci P, et al. LDL-cholesterol lowering effect of a new dietary supplement: an open label, controlled, randomized, cross-over clinical trial in patients with mild-to-moderate hypercholesterolemia. Lipids Health Dis. 2018;17. 10.1186/s12944-018-0775-8.
    1. Nathan DM. Diabetes: Advances in diagnosis and treatment. JAMA. 2015;314:1052–1062. doi: 10.1001/jama.2015.9536.
    1. World Health Organization . Use of glycated haemoglobin (HbA1c) in the diagnosis of diabetes mellitus. Geneva: WHO; 2011.
    1. Little RR, Rohlfing CL, Sacks DB. Status of hemoglobin A1c measurement and goals for improvement: from chaos to order for improving diabetes care. Clin Chem. 2011;57:205–214. doi: 10.1373/clinchem.2010.148841.
    1. Giese M, Unternahrer E, Huttig H, Beck J, Brand S, Calabrese P, et al. BDNF: an indicator of insomnia? Mol Psychiatry. 2014;19:151–152. doi: 10.1038/mp.2013.10.
    1. Giese Maria, Unternaehrer Eva, Brand Serge, Calabrese Pasquale, Holsboer-Trachsler Edith, Eckert Anne. The Interplay of Stress and Sleep Impacts BDNF Level. PLoS ONE. 2013;8(10):e76050. doi: 10.1371/journal.pone.0076050.
    1. LeRoith D, McGuinness M, Shemer J, Stannard B, Lanau F, Faria TN, et al. Insulin-like growth factors. Biol Signals. 1992;1:173–181. doi: 10.1159/000109323.
    1. Karg K, Burmeister M, Shedden K, Sen S. The serotonin transporter promoter variant (5-HTTLPR), stress, and depression meta-analysis revisited: evidence of genetic moderation. Arch Gen Psychiatry. 2011;68:444–454. doi: 10.1001/archgenpsychiatry.2010.189.
    1. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–1288. doi: 10.1177/1049732305276687.
    1. Cohen J. Statistical power analysis for the behavioral sciences. Mahwah: Erlbaum; 1988.
    1. Gupta SK. Intention-to-treat concept: a review. Perspect Clin Res. 2011;2:109–112. doi: 10.4103/2229-3485.83221.
    1. White I. R., Horton N. J., Carpenter J., statistics r. i. m. a. s., Pocock S. J. Strategy for intention to treat analysis in randomised trials with missing outcome data. BMJ. 2011;342(feb07 1):d40–d40. doi: 10.1136/bmj.d40.

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