Behaviour change interventions that promote physical activity have major implications for health and well-being. Measuring intervention fidelity is crucial in determining the extent to which an intervention is delivered as intended, therefore increasing scientific confidence about effectiveness. However, we lack a clear overview of how well intervention fidelity is typically assessed in physical activity trials. A systematic literature search was conducted to identify peer - reviewed physical activity promotion trials that explicitly measured intervention fidelity. Methods used to assess intervention fidelity were categorised, narratively synthesised and critiqued using assessment criteria from NIH Behaviour Change Consortium (BCC) Treatment Fidelity Framework (design, training, delivery, receipt and enactment). Twenty eight articles reporting of twenty one studies used a wide variety of approaches to measure intervention fidelity. Delivery was the most common domain of intervention fidelity measured. Approaches used to measure fidelity across all domains varied from researcher coding of observational data (using checklists or scales) to participant self-report measures. There was considerable heterogeneity of methodological approaches to data collection with respect to instruments used, attention to psychometric properties, rater-selection, observational method and sampling strategies. In the field of physical activity interventions, fidelity measurement is highly heterogeneous both conceptually and methodologically. Clearer articulation of the core domains of intervention fidelity, along with appropriate measurement approaches for each domain are needed to improve the methodological quality of fidelity assessment in physical activity interventions. Recommendations are provided on how this situation can be improved.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Physical activity (PA) is a potentially effective treatment for depression and depressive relapse. However, promoting PA in people with depression is challenging. Interventions informed by theory and evidence are therefore needed to support people with depression to become more physically active. eMotion is a web-based intervention combining behavioural activation and PA promotion for people in the community with symptoms of depression. Objective: The objectives were to assess the feasibility and acceptability of delivering eMotion to people with depression in the community, and to explore outcomes. Methods: Participants with elevated depressive symptoms were recruited from the community through a variety of methods (e.g. social media) and randomised to eMotion or a waiting list control group for eight weeks. eMotion is an administratively supported weekly modular programme aiming to help people use key behaviour change techniques (e.g. graded tasks, action planning and self-monitoring) to re-engage in routine, pleasurable or necessary activities, with a focus on physical activities. Feasibility data were collected which included: recruitment and trial retention rates, the fidelity of intervention delivery, receipt and enactment, and the acceptability of the intervention and data collection procedures. Data were collected for the primary (depression) and secondary outcomes (e.g. anxiety, PA, fidelity and client satisfaction) at baseline and two months post-randomisation using self-reported online questionnaires and accelerometers. Fidelity of delivery (logins, modules accessed, time spent) was tracked using web usage statistics. Exploratory analyses were conducted on the primary and secondary outcomes. Results: Of the 183 people who made contact, 62 were recruited and randomised with a mean PHQ-8 score of 14.6 (SD = 3.2). Of those randomised, 52 provided accelerometer recorded PA data at baseline which showed a baseline median of 35.8 (Interquartile Range (IQR) = 0.0 to 98.6) minutes of moderate to vigorous physical activity (MVPA) recorded in at least 10-minute bouts per week, with only seven people (13%) achieving guideline levels (150 minutes of MVPA per week). Eighty-one percent of participants provided follow-up data for the primary outcome (PHQ-8), but only 42% provided follow-up accelerometer data. Within the intervention group, the median number of logins, modules accessed and total minutes spent on eMotion was 3 (IQR = 2.0 to 8.0), 3 (IQR = 2.0 to 5.0) and 41.3 (IQR = 18.9 to 90.4) respectively. Acceptability was mixed. Exploratory data analysis showed that PHQ-8 levels were lower for the intervention group than the control group at two months post-randomisation (adjusted mean difference: -3.6, 95% CI: -6.1 to -1.1). Conclusions: It is feasible to deliver eMotion in UK communities to inactive populations. eMotion has the potential to be effective and is ready for testing in a full-scale trial. Further work is needed to improve engagement with both the intervention and data collection procedures. Clinical Trial: ClinicalTrials.gov NC-T03084055

Depression is associated with physical inactivity, which may mediate the relationship between depression and a range of chronic physical health conditions. However, few interventions have combined a psychological intervention for depression with behaviour change techniques, such as behavioural activation (BA), to promote increased physical activity. To determine procedural and clinical uncertainties to inform a definitive randomised controlled trial (RCT), a pilot parallel-group RCT was undertaken within two Improving Access to Psychological Therapies (IAPT) services in South West England. We aimed to recruit 80 adults with depression and randomise them to a supported, written self-help programme based on either BA or BA plus physical activity promotion (BAcPAc). Data were collected at baseline and 4 months post-randomisation to evaluate trial retention, intervention uptake and variance in outcomes to inform a sample size calculation. Qualitative data were collected from participants and psychological wellbeing practitioners (PWPs) to assess the acceptability and feasibility of the trial methods and the intervention. Routine data were collected to evaluate resource use and cost. Sixty people with depression were recruited, and a 73 % follow-up rate was achieved. Accelerometer physical activity data were collected for 64 % of those followed. Twenty participants (33 %) attended at least one treatment appointment. Interview data were analysed for 15 participants and 9 study PWPs. The study highlighted the challenges of conducting an RCT within existing IAPT services with high staff turnover and absences, participant scheduling issues, PWP and participant preferences for cognitive focussed treatment, and deviations from BA delivery protocols. The BAcPAc intervention was generally acceptable to patients and PWPs. Although recruitment procedures and data collection were challenging, participants generally engaged with the BAcPAc self-help booklets and reported willingness to increase their physical activity. A number of feasibility issues were identified, in particular the under-use of BA as a treatment for depression, the difficulty that PWPs had in adapting their existing procedures for study purposes and the instability of the IAPT PWP workforce. These problems would need to be better understood and resolved before proceeding to a full-scale RCT. ISRCTN74390532 . Registered on 26 March 2013.

Background: Self-Practice/Self-Reflection (SP/SR) is increasingly beginning to feature as a central component of CBT training programmes (Bennett-Levy et al., 2001). Programmes including a reflective element, however, are not unproblematic and it has been documented that simply setting time aside for reflection does not necessarily result in trainees using such time to reflect. Such limitations may be overcome by including a requirement to post reflections on reflective blogs. Aim: To examine the effect that a requirement to contribute to a reflective blog had upon a SP/SR approach to CBT training. Method: A focus group methodology was adopted with data analyzed using a general inductive qualitative approach. Results: The requirement to use blogs to reflect upon the self-practice of CBT techniques enhanced SP/SR, established a learning community, and improved course supervision, although some technical difficulties arose. Conclusions: Consideration should be given towards using reflective blogs to support a SP/SR approach to CBT training. Benefits afforded by the use of reflective blogs further establish SP/SR as a valid and flexible training approach.

Cognitive behaviour therapy (CBT) is an effective treatment for depression. However, CBT is a complex therapy that requires highly trained and qualified practitioners, and its scalability is therefore limited by the costs of training and employing sufficient therapists to meet demand. Behavioural activation (BA) is a psychological treatment for depression that may be an effective alternative to CBT and, because it is simpler, might also be delivered by less highly trained and specialised mental health workers. COBRA is a two-arm, non-inferiority, patient-level randomised controlled trial, including clinical, economic, and process evaluations comparing CBT delivered by highly trained professional therapists to BA delivered by junior professional or para-professional mental health workers to establish whether the clinical effectiveness of BA is non-inferior to CBT and if BA is cost effective compared to CBT. Four hundred and forty patients with major depressive disorder will be recruited through screening in primary care. We will analyse for non-inferiority in per-protocol and intention-to-treat populations. Our primary outcome will be severity of depression symptoms (Patient Health Questionnaire-9) at 12 months follow-up. Secondary outcomes will be clinically significant change and severity of depression at 18 months, and anxiety (General Anxiety Disorder-7 questionnaire) and health-related quality of life (Short-Form Health Survey-36) at 12 and 18 months. Our economic evaluation will take the United Kingdom National Health Service/Personal Social Services perspective to include costs of the interventions, health and social care services used, plus productivity losses. Cost-effectiveness will explored in terms of quality-adjusted life years using the EuroQol-5D measure of health-related quality of life. The clinical and economic outcomes of this trial will provide the evidence to help policy makers, clinicians and guideline developers decide on the merits of including BA as a first-line treatment of depression. Current Controlled Trials ISRCTN27473954