Gait, Depression, and Mind-body Therapy in Seniors
Condition: Major Depressive Disorder
MeSH terms: Depression; Depressive Disorder; Depressive Disorder, Major
Study type: Interventional

Summary: 
      Falls are the leading cause of injury---related hospitalization and death in the elderly. As
      such, fear of falling (FOF) is common among senior populations and often leads to activity
      avoidance, social isolation, and reduced physical and mental health. Risk of falls is
      particularly concerning for individuals suffering from late life depression (LLD) as both
      depression and antidepressant treatment have been shown to be linked to gait impairments, a
      strong predictor of fall risk. Currently, our team is conducting a study to examine the
      effects of a non---pharmacological mind---body therapy commonly known as automatic
      self---transcending meditation (ASTM) on autonomic and mood---related symptoms of LLD. This
      study provides a timely opportunity to explore the intricate relationship between gait
      disturbances and depression severity, as well as the potential benefits of ASTM intervention
      on gait and FOF in seniors. Using a GAITRite® portable walkway, measures of stride length and
      gait velocity will be obtained for seniors in the ASTM and control study arms every four
      weeks for the duration of the ASTM program. The aim of this study is to answer the following
      research questions: are gait impairments and depression severity correlated, and does ASTM
      training have any effect on gait and FOF? The results of this study could not only provide
      insight into the physical manifestations of depression but if ASTM training is found to
      improve gait and reduce FOF then there is potential to use this mind---body meditation
      technique as an adjunct therapy to reduce fall risk in seniors with LLD. Furthermore, future
      research could expand upon these findings to examine the benefits of ASTM on gait impairments
      secondary to other psychiatric illnesses.
    

Detailed description: 
      Falls are the leading cause of injury---related death in senior populations (i.e. 65 years of
      age and older)

        1. ; approximately 30% of community---dwelling seniors suffer a fall at least once per
           year, with this proportion increasing with age

        2. . In Canada, 40% of falls by seniors result in hip fractures which oftentimes leads to
           only partial recovery

        3. , therefore it is not uncommon for older adults to report a fear of falling (FOF). FOF
           is particularly common in community---dwelling older females and those who have
           previously experienced a fall [4,5]. In some individuals, FOF actually leads to activity
           avoidance

      [5]. Moreover, seniors who have suffered a fall report reductions in their quality of life
      [6]. A systematic review by Scheffer et al. [4] has identified the major outcomes of FOF to
      be reductions in physical and mental health, quality of life and an increased risk of fall.
      Older adults suffering symptoms of depression are also more likely to have a severe FOF,
      leading to activity restriction in this group [7, 8]. As such, minimizing the risk of falls
      in older populations has important implications for the physical and mental wellbeing of
      individuals in this cohort. Among the risk factors that increase the likelihood of seniors
      suffering a fall are gait impairments [9] and depression [10---12]. Indeed, measures of gait
      can be used to predict future falls [13] while increases in depressive symptoms are
      associated with increases in fall rate [10]. An association has been established between
      depression and gait deficits, even when confounding variables such as socio---demographic and
      overall health status are controlled; specifically, depression is associated with reductions
      in various gait parameters including gait velocity, stride length and swing time variability
      [14, 15]. At present, antidepressants are the first line of treatment for depression, however
      in seniors the response rate to an antidepressant trial of adequate dose and duration is
      often inadequate and can be as low as 30--- 40% [16]. In addition, antidepressant use is
      often associated with a number of adverse events including increased fall risk [11] and
      impairments in gait [17, 18]. For example, in healthy seniors, a single dose of amitriptyline
      led to gait impairments when subjects were required to walk in the presence of obstructions
      [17]. Therefore the relationship between depression, gait, and fall risk is further
      complicated by standard pharmacological treatment practices for this population. In recent
      years, various non---pharmacological interventions have been embraced by patients with late
      life depression (LLD). Loosely defined as mind---body therapies, these include biofeedback,
      energy healing, meditation, guided imagery, and yoga [19, 20]. Amongst these practices,
      meditation therapy may be of particular benefit for older adults with gait impairments and
      LLD; meditation is non---invasive, easy to learn, has negligible side effects, can be
      practiced from anywhere and has been shown to have multi---organ benefits [see 21 for a
      review]. Whilst relatively few studies have examined the effects of meditation on gait, a
      study of mindfulness---based cognitive therapy (MBCT) found the therapy normalized gait
      patterns in adults with a history of depression [22]. Additionally, a particular type of
      meditation, referred to as automatic self---transcending meditation (ASTM) has been shown to
      reduce symptoms of depression [23]. Currently, our research team is commencing the data
      collection phase of an REB approved study that has received funding by the Academic Medical
      Organization of Southwestern Ontario (AMOSO) Innovation Fund. This study is a single blind
      longitudinal naturalistic randomized control trial targeting individuals with late---life
      depression, and will examine the effects of ASTM on autonomic and mood---related symptoms of
      depression. In the framework of the ASTM study there is an opportunity to more closely
      examine the relationship between gait and depression in elderly populations, as well as the
      potential benefits of this mind---body therapy on gait and FOF. We are kindly requesting
      funding from the Department of Psychiatry to carry out this investigation. Specifically, we
      aim to assess gait parameters such as stride length and gait velocity, which have been shown
      to be affected by depression [14, 15], in LLD patients receiving ASTM training in addition to
      their current treatment schedules (ASTM group) as well as those that continue with their
      treatment as usual (TAU group). A thorough literature and clinical trial registry search
      reveals that no one has previously, or is currently, examining the effects of ASTM training
      on parameters of gait in LLD patients.
    

Intervention name(s): Automatic self-transcending meditation
Intervention type(s): Behavioral
Intervention description(s): ASTM is a category of meditation that helps quiet the mind and induce physiological and mental relaxation while the eyes are shut. It utilizes relaxed attention to a specific sound value (mantra) according to specific criteria, in order to draw attention inward.
Other intervention name(s): ASTM
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Gait; late life depression; mind-body therapies