A randomised controlled trial of energetic activity for depression in young people (READY): a multi-site feasibility trial protocol

BACKGROUND

Prevalence of depression is increasing in young people, and there is a need to develop and evaluate behavioural interventions which may provide benefits equal to or greater than talking therapies or pharmacological alternatives. Exercise could be beneficial for young people living with depression, but robust, large-scale trials of effectiveness and the impact of exercise intensity are lacking. This study aims to test whether a randomised controlled trial (RCT) of an intervention targeting young people living with depression is feasible by determining whether it is possible to recruit and retain young people, develop and deliver the intervention as planned, and evaluate training and delivery.

METHODS

The design is a three-arm cluster randomised controlled feasibility trial with embedded process evaluation. Participants will be help-seeking young people, aged 13-17 years experiencing mild to moderate low mood or depression, referred from three counties in England. The intervention will be delivered by registered exercise professionals, supported by mental health support workers, twice a week for 12 weeks. The three arms will be high-intensity exercise, low-intensity exercise, and a social activity control. All arms will receive a 'healthy living' behaviour change session prior to each exercise session and the two exercise groups are energy matched. The outcomes are referral, recruitment, and retention rates; attendance at exercise sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data; adverse events, all measured at baseline, 3, and 6 months; resource use; and reach and representativeness.

DISCUSSION

UK National Health Service (NHS) policy is to provide young people with advice about using exercise to help depression but there is no evidence-based exercise intervention to either complement or as an alternative to medication or talking therapies. UK National Institute for Health and Care Excellence (NICE) guidelines suggest that exercise can be an effective treatment, but the evidence base is relatively weak. This feasibility trial will provide evidence about whether it is feasible to recruit and retain young people to a full RCT to assess the effectiveness and cost-effectiveness of an exercise intervention for depression.

TRIAL REGISTRATION

ISRCTN, ISRCTN66452702 . Registered 9 April 2020.

The effect of carbohydrate mouth rinse on a 30-minute arm cranking performance

The aim of this study was to examine the effect of carbohydrate mouth rinse on 30-min arm cranking performance. Twelve healthy, active males (age 21.6, standard deviation (SD)=3.1 years; mass 76.2, SD=12.2 kg) volunteered in a single-blind, randomised crossover design. Firstly they completed an incremental exercise test to exhaustion (VO2max test) on an arm crank (50W for 2 min, increasing by 10W every min). During visit 2 and 3 they arm cranked for maximal distance over 30 min at a resistance equivalent to 50% of their peak power, mouth rinsing for 5 s with either 25 ml of a tasteless 6.4% maltodextrin solution (CHO) or 25 ml of water (placebo) every 6 min. A letter cancellation test was performed pre and post exercise to measure cognitive function. The result showed that cognitive function was not significantly different between trials (P=0.874). There was no significant difference in distance arm cranked between trials (P=0.164) even though 9 out of 12 participants had improved performance on the CHO trial. In conclusion, further research is needed to determine the ergogenic effect of CHO mouth rinsing on upper body exercise performance.

Sex differences on the acute effects of caffeine on maximal strength and muscular endurance

The aim of this study was to look at the effects of caffeine on strength performance and to examine any differences between sexes. Sixteen moderately active, resistance-trained individuals (10 males and 8 females) performed 2 trials (excluding a familiarisation trial). The effect of 5 mg/kg body mass (BM) caffeine or a placebo on bench press (BP) one repetition maximum (1RM), squat 1RM, the number of BP reps to failure at 40% 1RM (total weight lifted; TWL), pain rating (0-10) were recorded after each final successful lift. BP 1RM was significantly greater (P=0.016), with an increase of 5.91% for males and an increase of 10.69% for females. However, there was no sex difference in squat 1RM with males producing 130.3±27.8 and 134.0±28.9 kg and females producing 66.9±6.2 and 65.3±7.0 kg for placebo and caffeine, respectively. TWL tended to increase with caffeine for males from 1,246.8±704.9 to 1,545.5±920.3 kg; with females having no effect of caffeine (397.8±245.1 to 398.8±182.7kg; P=0.06). Caffeine had no effect on pain perception. This study found that 5 mg/kg BM caffeine improved BP 1RM in resistance-trained males and females. However, for TWL there was a tendency towards improvement in males only, suggesting a sex difference to caffeine ingestion for TWL.

Gender differences in patellofemoral load during the epee fencing lunge

Clinical analyses have shown that injuries and pain linked specifically to fencing training/competition were prevalent in 92.8% of fencers. Patellofemoral pain is the most common chronic injury in athletic populations and females are considered to be more susceptible to this pathology. This study aimed to examine gender differences in patellofemoral contact forces during the fencing lunge. Patellofemoral contact forces were obtained from eight male and eight female club level epee fencers using an eight-camera 3D motion capture system and force platform data as they completed simulated lunges. Independent t-tests were performed on the data to determine whether gender differences in patellofemoral contact forces were present. The results show that females were associated with significantly greater patellofemoral contact force parameters in comparison with males. This suggests that female fencers may be at greater risk from patellofemoral pathology as a function of fencing training/competition.

The effect of caffeine mouth rinse on self-paced cycling performance

The aim of the study was to determine whether caffeine mouth rinse would improve 30 min self-paced cycling trial. Twelve healthy active males (age 20.5±0.7 years, mass 87.4±18.3 kg) volunteered for the study. They attended the laboratory on 3 separate occasions performing a 30 min self-paced cycling trial. On one occasion water was given as a mouth rinse for 5 s (PLA), on another occasion a 6.4% maltodextrin (CHO) solution was given for 5 s and finally a caffeine solution (containing 32 mg of caffeine dissolved in 125 ml water; CAF) was given for 5 s. Distance cycled, heart rate, ratings of perceived exertion, cadence, speed and power output were recorded throughout all trials. Distance cycled during the CAF mouth rinse trial (16.2±2.8 km) was significantly greater compared to PLA trial (14.9±2.6 km). There was no difference between CHO and CAF trials (P=0.89). Cadence, power and velocity were significantly greater during the CAF trial compared to both PLA and CHO (P<0.05). There were no differences between trials for heart rate and perceived exertion (P>0.05). Caffeine mouth rinse improves 30 min cycling performance by allowing the participant to increase cadence, power and velocity without a concurrent increase in perceived exertion and heart rate.

The effects of carbohydrate ingestion on 30 minute rowing time trial performance

The aim of the study was to determine whether ingestion of 6.4% carbohydrate solution prior to 30 min rowing had any effect on distance rowed. Twelve male participants (aged 22.21±2.47 years) volunteered to take part. Participants ingested either 500 ml of 6.4% flavourless maltodextrin solution (CHO) or water (PLA) prior to exercise. During 30 min of self-paced rowing heart rate (HR), ratings of perceived exertion (RPE), stroke rate, power output and distance covered were recorded every 6-min throughout. Participants rowed significantly (P<0.05) further during the CHO trial (6,714.2±409.9 m) compared to the PLA trial (6,390.8±448.1 m). Power also increased during the CHO trial compared to the PLA (P<0.05). However, there was no difference in RPE. In conclusion, from the current investigation rowers who wish to improve their time trial performance in longer duration events may benefit from the ingestion of CHO prior to competition.