Testing the Efficacy of a Technology-Supported Lifestyle Physical Activity Intervention Among Women with Depression in Alcohol Treatment

ABSTRACT
Alcohol use disorder (AUD) is a significant and costly public health problem. Women develop AUD more
quickly and suffer a broader range of adverse alcohol-related health consequences than men. Yet, due to
stigma, shame, and child care issues, women are less likely to receive specialty addiction treatment. Moreover,
mounting evidence indicates factors that precipitate relapse differ between men and women. Men are more
likely to relapse in response to positive emotional states and social pressure while negative emotional states
are important precipitators of relapse in women. Indeed, women often report drinking to cope with negative
emotions and express a lack of alternate coping strategies. Given the robust evidence for physical activity (PA)
in decreasing depression, negative affect, and alcohol craving, PA interventions may play an important role as
an alternate coping strategy for women with AUD and a means to decrease relapse. Our team was the first
group to develop and test a lifestyle physical activity (LPA) approach with women with AUD (R34 AA024038).
LPA is a new PA paradigm that emerged as an alternative to the gym-based fitness training interventions that
struggle with high dropout and lack transportability to varied settings. LPA interventions represent simple, low-
cost, and flexible approaches that are supported by brief counseling and activity monitors (e.g., Fitbit) to
facilitate goal-setting and self-monitoring. In our Stage 1a and 1b studies, we developed and demonstrated
initial support for an LPA+Fitbit intervention for women with AUD and depression. The intervention consisted
of 6 brief, phone-based PA counseling sessions focused on increasing PA and strategically using bouts of PA
to cope with affect and alcohol cravings and use of the Fitbit fitness tracker and mobile app. Our preliminary
work established the acceptability and feasibility of this intervention. In addition, results of an initial randomized
controlled trial (RCT; N = 50) showed that, relative to a health education contact (HEC) control, women in the
LPA+Fitbit intervention had higher rates of alcohol abstinence, greater reductions in depression and negative
affect, and increased PA at the 3-month follow-up. We propose to build on our promising preparatory work and
take the next step by conducting a fully powered (N=214), Stage 2 RCT to test the efficacy of the LPA+Fitbit
intervention, compared to a Fitbit Only condition, for women with AUD and depression in alcohol treatment. In
addition, to elucidate mechanisms of treatment effects, we will employ two, 10-day bouts of ecological
momentary assessment (EMA) to obtain multiple daily measures of affect, cravings, drinking, and PA
engagement during early recovery (i.e., first 90 days) coupled with objective assessment of PA (i.e., Fitbit
data). This project will contribute much-needed knowledge on the role of PA in reducing alcohol use,
depressive symptoms and negative mood in women with AUD. If the efficacy of the LPA+Fitbit intervention can
be established, depressed women with AUD will have a valuable adjunct to traditional alcohol treatment that
can server as an alternate coping strategy during early recovery, when relapse risk is highest.

Grant Number: 5R01AA028186-05
NIH Institute/Center: NIH
Principal Investigator: Ana Abrantes