Exercise to Prevent Depression and Anxiety in Older Hispanics

The study is a randomized pilot trial of a health promotion intervention in the prevention of anxiety and depression in older Hispanics.

Eligible participants will be randomized to either the Happy Older Latinos are Active (HOLA) intervention or a psychoeducation condition. Participants randomized to HOLA will participate in a group exercise, 3 times a week, for 16 weeks. The exercise is a moderate intensity walk at a centrally located park in Miami-Dade county and will last for an hour (10 minute warmup/stretching, 30 minute walk, 5 minute cool down). Groups will consist of 6 participants and be led by a community health worker. During the cool down phase, participants will plan a pleasant event to be done in between sessions. Participants randomized to the psychoeducation component will receive a fotonovela and will meet once a month after they receive the fotonovela to discuss their thoughts on the materials they received. These discussion groups will last one hour and will consist of 10 participants. A total of 60 participants will be randomized (30 to HOLA, 30 to fotonovela). Assessments will be conducted at baseline, post intervention, 6 months post-intervention, and 12 months post-intervention.

Eligibility Criteria:
Inclusion Criteria:

1. Hispanic (self-identified);
2. Age 60+;
3. Minor depression as defined by a primary DSM-IV Axis I diagnosis of minor depressive disorder or subthreshold depression defined as a score ≥ 3 on the Patient Health Questionnaire (PHQ-2), OR subthreshold anxiety as defined as a score ≥ 3 on the Generalized Anxiety Disorder-2 scale (GAD-2);
4. Absence of episodes of major depression and anxiety disorders for past 12 months (as determined by the MINI);
5. Voluntary informed consent for participation in the study by the participant or by the participant's legally designated guardian or conservator;
6. Medical clearance for participation in an exercise program by a physician, physician's assistant, or nurse practitioner;
7. Expect to be resident in Miami for the subsequent 12 months.

Exclusion Criteria:

1. Currently residing in a nursing or group home;
2. A terminal physical illness expected to result in the death within one year;
3. A diagnosis of dementia, co-morbid diagnosis of dementia, or significant cognitive impairment as indicated by an MMSE score \<24;
4. Presence of any axis 1 psychiatric disorder or substance abuse during preceding 12 months;
5. History of psychiatric disorders other than non-psychotic unipolar major depression or anxiety disorder;
6. High suicide risk, i.e., intent or plan to attempt suicide in the near future (a response of "yes" to questions 3, 4, and/or 5 on the Paykel Questionnaire);
7. Participants taking cognitive enhancing medication or psychotropic medications (e.g. antidepressants);
8. unable to complete 400 m walk test in less than 15 min;
9. if participant heart rate exceeded 170 beats per minute OR systolic blood pressure exceeds 180 during 400 m walk test;
10. chest or leg pain, dyspnea, dizziness, feeling faint, or other significant symptoms while completing 400 m walk test;

(i) acute or severe medical illness that would prevent participants from walking at a moderate pace for 45 minutes, three times a week.