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Depressed individuals are more likely to die from cardiovascular disease (CVD) than those without depression. People with CVD have higher rates of depression than those without and have higher mortality rates if they have comorbid depression. While physical activity (PA) improves both, few people engage in enough. We compared self-guided internet-based cognitive behavior therapy (CBT) + Fitbit or mindfulness-based cognitive therapy (MBCT) + Fitbit, with Fitbit only to increase daily steps for participants with depression who have low PA.Adult participants (N = 340) were recruited from two online patient-powered research networks and randomized to one of three study interventions for 8 weeks with an additional 8 weeks of follow-up. Using linear mixed effects models, we evaluated the effect of the intervention on average daily steps (NCT03373110).Average daily steps increased 2.8 steps per day in MBCT+Fitbit, 2.9 steps/day in CBT + Fitbit, but decreased 8.2 steps/day in Fitbit Only. These changes were not statistically different between the MBCT+Fitbit and CBT + Fitbit groups, but were different from Fitbit Only across the initial 8-week period. Group differences were not maintained across follow-up. Exploratory analyses identified comorbid anxiety disorders, self-reported PA, and employment status as moderators.Changes in daily steps over both 8- and 16-week periods-regardless of intervention group-were minimal. The results emphasize the limits of using self-guided web-based psychotherapy with an activity tracker to increase PA in participants with a history of depression and low PA.

Background Mindfulness can improve overall well-being by training individuals to focus on the present moment without judging their thoughts. However, it is unknown how much mindfulness practice and training are necessary to improve well-being. Objective The primary aim of this study was to determine whether a standard 8-session web-based mindfulness-based cognitive therapy (MBCT) program, compared with a brief 3-session mindfulness intervention, improved overall participant well-being. In addition, we sought to explore whether the treatment effects differed based on the baseline characteristics of the participants (ie, moderators). Methods Participants were recruited from 17 patient-powered research networks, web-based communities of stakeholders interested in a common research area. Participants were randomized to either a standard 8-session MBCT or a brief 3-session mindfulness training intervention accessed on the web. The participants were followed for 12 weeks. The primary outcome of the study was well-being, as measured by the World Health Organization—Five Well-Being Index. We hypothesized that MBCT would be superior to a brief mindfulness training. Results We randomized 4411 participants, 3873 (87.80%) of whom were White and 3547 (80.41%) of female sex assigned at birth. The mean baseline World Health Organization—Five Well-Being Index score was 50.3 (SD 20.7). The average self-reported well-being in each group increased over the intervention period (baseline to 8 weeks; model-based slope for the MBCT group: 0.78, 95% CI 0.63-0.93, and brief mindfulness group: 0.76, 95% CI 0.60-0.91) as well as the full study period (ie, intervention plus follow-up; baseline to 20 weeks; model-based slope for MBCT group: 0.41, 95% CI 0.34-0.48; and brief mindfulness group: 0.33, 95% CI 0.26-0.40). Changes in self-reported well-being were not significantly different between MBCT and brief mindfulness during the intervention period (model-based difference in slopes: −0.02, 95% CI −0.24 to 0.19; P=.80) or during the intervention period plus 12-week follow-up (−0.08, 95% CI −0.18 to 0.02; P=.10). During the intervention period, younger participants (P=.05) and participants who completed a higher percentage of intervention sessions (P=.005) experienced greater improvements in well-being across both interventions, with effects that were stronger for participants in the MBCT condition. Attrition was high (ie, 2142/4411, 48.56%), which is an important limitation of this study. Conclusions Standard MBCT improved well-being but was not superior to a brief mindfulness intervention. This finding suggests that shorter mindfulness programs could yield important benefits across the general population of individuals with various medical conditions. Younger people and participants who completed more intervention sessions reported greater improvements in well-being, an effect that was more pronounced for participants in the MBCT condition. This finding suggests that standard MBCT may be a better choice for younger people as well as treatment-adherent individuals. Trial Registration ClinicalTrials.gov NCT03844321; https://clinicaltrials.gov/ct2/show/NCT03844321

BACKGROUND Mindfulness can improve overall well-being by training individuals to focus on the present moment without judging their thoughts. However, it is unknown how much mindfulness practice and training are necessary to improve well-being. OBJECTIVE The purpose of this study was to compare standard with brief mindfulness training to improve overall well-being. METHODS Participants were recruited from 17 Patient-Powered Research Networks, online communities of stakeholders interested in a common area of research. Participants were randomized to either a standard 8-session mindfulness based cognitive therapy (MBCT) or a brief 3-session mindfulness training intervention accessed online. Participants were followed for 12 weeks. The primary outcome of the study was well-being as measured by the World Health Organization (WHO)-5 Index. We hypothesized that MBCT would be superior to brief mindfulness training. RESULTS We randomized 4,411 participants, 88% of whom were white and 80% female sex assigned at birth. Baseline WHO-5 score mean was 50.3 (SD = 20.7). Average self-reported well-being in each group increased over the intervention period (baseline to 8 weeks) (model-based slope [95% CI] for MBCT group: 0.78 [0.63, 0.93]; brief mindfulness group: 0.76 [0.60, 0.91]) as well as the full study period (i.e., intervention plus follow-up; baseline to 20 weeks) (model-based slope [95% CI] for MBCT group: 0.41 [0.34, 0.48]; brief mindfulness group: 0.33 [0.26, 0.40]). Change in self-reported well-being was not statistically significantly different between MBCT and brief mindfulness during the intervention period (model-based difference in slopes [95% CI]: -0.02 [-0.24, 0.19], P = .80) or during the intervention period plus 12-week follow-up (-0.08 [-0.18, 0.02], P = .10). During the intervention period, younger participants (P = .05) and participants who completed a higher percentage of intervention sessions (P = .005) experienced greater improvements in well-being across both interventions, effects that were stronger for participants in the MBCT condition. CONCLUSIONS Standard MBCT improved well-being but was not superior to a brief mindfulness intervention. Younger patients and those able to complete more training sessions improved the most. CLINICALTRIAL ClinicalTrials.gov, NCT03844321, https://clinicaltrials.gov/ct2/show/NCT03844321