Research Spotlights January 2018

Research Spotlights January 2018

Online game increases family physical activity levels

Gamification of physical activity interventions results in greater increases in physical activity levels in families according to a recently published NHBLI-funded study.

The study included 200 adults enrolled in the Framingham Heart Study, comprising 94 families. All participants tracked daily steps, established goals for increasing steps, and received daily feedback on goal performance during the 12-week intervention. Families randomized to the intervention were also entered into a game designed using insights from behavioral economics to enhance social incentives. Specifically, each family was given 70 points per week with 10 points lost on days when the family representative (chosen at random) did not meet their step goal.

Results indicated the proportion of participant-days in which step goals were met were significantly greater in the gamification arm compared to the control arm (0.53 vs. 0.32).   Participants in the gamification arm also increased their daily steps over 2.5 times as much as those in the control arm during the intervention (1661 vs. 636 steps/day).

This is the first randomized clinical trial testing the effectiveness of gamification to increase family physical activity levels.  These results suggest that gamification with game design features leveraging insights from behavioral economics is potentially effective interventional approach to increase physical activity levels.

Patel MS, Benjamin EJ, Volpp KG, Fox CS, Small DS, Massaro JM, Lee JJ, Hilbert V, et al. 2017. Effect of a game-based intervention designed to enhance social incentives to increase physical activity among families: The BE FIT randomized clinical trial. JAMA Intern Med. 177(11):1586-93.

Obesity Gene: Thinking you don’t have it can increase unhealthy eating behaviors

Could being told you are not genetically susceptible to obesity cause you to eat more unhealthy foods and exercise less? The answer is yes, according to a recent NHGRI-funded study.

The study’s participants, U.S. adults recruited through a platform, were given a saliva test and were randomly assigned to being told there was either a very high or very low chance they carried the obesity gene based on this screening.

The people who thought they did not carry the genes that cause obesity questioned the importance of maintaining healthy eating behaviors and exercise habits, and were more likely to select unhealthy meals such as a cheeseburger or meatloaf and mashed potatoes from the menu options when prompted.

The results of this study have significant public health implications. The “genetic invincibility effect” could make people more vulnerable to weight gain. As genetic testing and risk analysis becomes more accessible, further research to explore how obtaining this information impacts behavior in negative as well as positive ways.

Ahn WK, Lebowitz MS. 2018. An experiment assessing effects of personalized

Cognitive Behavior Therapy Treats Depressive Symptoms as well as Antidepressant Medications

Should those being treated for Major Depressive Disorder (MDD) receive either cognitive-behavioral therapy (CBT) or antidepressant medications depending on which depressive symptoms they have? Although prior research suggested differential symptom effects for imipramine vs. CBT, a large randomized controlled trial funded by the National Institute of Mental Health (NIMH) found that CBT was as effective as two antidepressant medications on symptom clusters of depression.

Previously, the Treatment of Depression Collaborative Research Program (TDCRP) found that imipramine was superior to CBT on sleep, cognitive-affective, and somatic clusters of MDD symptoms, but these findings clustered symptoms from a single scale.  Continuing this precision medicine line of research, the Genome-based Therapeutic Drugs for Depression (GENDEP) study generated symptom factors from multiple depression scales and found that escitalopram was superior to nortriptyline for mood and cognitive symptoms while the reverse was found for neurovegetative symptoms (e.g., sleep and appetite).

The current project (Emory Predictors of Remission to Individual and Combined Treatments; PReDICT) sought to replicate the depression symptom clusters found in GENDEP across multiple depression scales, and extend the findings to include CBT.  In a randomized trial of over 300 patients, they found symptom clusters like those found in the GENDEP study (cognitive despair, mood and interest, sleep, and appetite).  At the end of the 12-week treatment period, CBT and the two antidepressant conditions showed similar improvements for each of the symptom clusters. The antidepressant conditions produced a more rapid effect on cognitive despair and on mood and interest symptom clusters than did CBT, but no significant differences were found by the end of treatment.

While these findings are disappointing for researchers seeking to find reliable indicators of which treatments will work for which depressed patients with which symptom constellations, these findings indicate CBT works less rapidly than antidepressants for some symptom clusters but that over a 12-week treatment period the effects are comparable.

Dunlop BW, Cole, SP, Nemeroff CB, Mayberg HS, Craighead WE. 2017.   Differential change on depressive symptom factors with antidepressant medication and cognitive behavior therapy for major depressive disorder. J Affect Disord. 229:111-119.