Resistance training for Black men with depressive symptoms: a pilot randomized controlled trial to assess acceptability, feasibility, and preliminary efficacy

Abstract

Background Depression is under-recognized in Black men, who are less likely to seek or have access to psychiatric treatment. Resistance training (RT; i.e., weight lifting) can improve depressive symptoms and may be more acceptable to Black men, but its effects have not been examined for Black men with depressive symptoms. Methods Fifty Black men with depressive symptoms were randomized to either (a) 12 weeks of RT (coupled with Behavioral Activation techniques to promote adherence) or (b) an attention-control group (Health, Wellness, and Education; HWE). Both groups met twice/week for 12 weeks, and follow-up assessments were done at end-of-treatment (EOT) and 6 months after enrollment. Changes in physical activity and muscular strength were collected as a manipulation check. The primary outcome was interviewer assessed symptoms of depression using the Quick Inventory of Depression Symptomology (QIDS). Secondary outcomes included self-reported depressive symptoms, anxiety, and stress. The association between change in QIDS from baseline to EOT and concurrent changes in physical activity and muscular strength in the RT group were explored as an initial assessment of mechanism. Longitudinal mixed effects regression models with subject-specific intercepts were used to examine intervention effects. Results A sample with high rates of medical comorbidities (e.g., 44% HIV positive), substance use (e.g., 34% smoking), and negative social determinates of health (e.g., 50% unemployed) was enrolled. Recruitment, engagement, and retention data indicate that the intervention and design were feasible. The RT group showed greater gains in self-reported exercise (b = 270.94, SE = 105.69, p = .01) and muscular strength (b = 11.71, SE = 4.23, p = .01 for upper body and b = 4.24, SE = 2.02, p = .04 for lower body) than the HWE group. The RT group had greater reductions in QIDS scores at both EOT (b = -3.00, SE = 1.34, p = .01) and 6 months (b = -2.63, SE = 1.81, p = .04). The RT group showed a greater reduction in anxiety at EOT (b = -2.67, SE = 1.06, p = .02). Findings regarding self-reported depressive symptoms and stress were non-significant, but in the expected direction with effect sizes in the small to medium range. In the RT group, improvement on the QIDS between baseline and EOT was associated with concurrent improvements in physical activity (b = 21.03, SE = 11.16, p = .02) and muscular strength (b = 1.27, SE = .44, p = .03 for upper body and b = .75, SE = .14, p = .03 for lower body). Conclusions Results suggest that RT is feasible and may be efficacious for reducing depressive symptoms among underserved urban Black men. Trial Registration ClinicalTrial.gov #: NCT03107039 (Registered 11/04/2017).

The development and initial feasibility testing of D-HOMES: a behavioral activation-based intervention for diabetes medication adherence and psychological wellness among people experiencing homelessness

“…Most relevant to the current investigation, BA has been successfully applied to target health behavior change (e.g., smoking cessation, substance use recovery, exercise engagement, etc. ; Busch et al, 2017 ; Ciccolo et al, 2022 ; Adkins-Hempel et al, 2023 ) in various populations with high rates of behavioral comorbidities, psychosocial distress, and psychosocial barriers to change [e.g., those in residential substance abuse treatment, patients with HIV (Pinkston et al, 2022 ), and low income urban Black men (Ciccolo et al, 2022 )]. This literature includes evidence that BA can improve medication adherence among people living with HIV and substance use (Daughters et al, 2010 ) and in other resource-limited settings (Magidson et al, 2019 ) as well as to support diabetes self-management specifically (Egede et al, 2021 ).…”

Participants’ experiences of a counsellor-supported PTSD Coach intervention in a resource-constrained setting

“…Denial about needing support, and stigma (e.g., fear of judgement, and associated concerns about the social acceptability of accessing support) were mentioned as systemic barriers to treatment (Hundt et al, 2019 ; Ciccolo et al, 2022 ; Rice et al, 2020 ). The harmful effects of general stigma associated explicitly with mental illness are well-known (Clement et al, 2015 ; Knettel et al, 2019 ; Booysen et al, 2021 ; Monnapula-Mazabane and Petersen, 2021 ).…”

“…Notably, a systematic review and meta-analysis indicated that stigma is one of the most common barriers to seeking care (Morgan et al, 2018 ). The stigma and fear of social rejection may be further influenced by both cultural and gender-related factors (Venter et al, 2019 ; Rice et al, 2020 ; Ciccolo et al, 2022 ), highlighting the need for sensitivity towards cultural and gender-based concerns when developing and promoting support resources (Ciccolo et al, 2022 ). A PTSD Coach Online (web-based) study describes their process of fully adapting the programme and creating PTSD Coach Online-Arabic (Miller-Graff et al, 2021 ; Ellis et al, 2022 ).…”

Improving mental health in black men through a 24-week community-based lifestyle change intervention: the black impact program

“…In Black American adults, a systematic review of 13 randomized controlled trials, showed that while there was an effect of increasing physical activity in reducing depressive symptoms in Black adults, the majority of the studies analyzed were in Black women [ 29 ]. In a recent pilot RCT, resistance training improved depressive symptoms to a greater extent than health, wellness and education in a pilot of Black men over 12 weeks [ 63 ]. Consistent with these findings, in Black Impact at baseline, individuals with a PHQ-2 score of 0 vs. ≥1 had higher levels of physical activity.…”