ReviewActivity monitoring in patients with depression: A systematic review
Introduction
Altered physical activity has long been recognised as a feature of depression (Parker and Brotchie, 1992). Psychomotor retardation is argued to be a cardinal feature of melancholia (Parker et al., 1995) but other forms of altered physical activity in depression include agitation and withdrawal from normal activities of daily living. Reports of activity, either observed or self reported, are features of many validated depression assessment tools (Hamilton, 1960, Kroenke et al., 2001).
Objective measurement of activity (actigraphy) using body-worn accelerometers has been available in research settings for over 20 years and accelerometers have been used extensively in research in a wide range of situations to measure both daytime activity (Matthews et al., 2012) and sleep (Martin and Hakim, 2011). In recent years devices incorporating these technologies have become widely available, and – in the case of smartphones – ubiquitous. Much of their use is currently driven by the health and lifestyle market. While research and commercial applications are beginning to use activity monitoring in patients with depression (Help4 Mood Consortium,, ICT4 Depression Consortium, 2012, Monarca Project.,, Optimi Consortium, 2012), we were unable to find a recent systematic review of the extent to which actigraphic measures of activity correspond to clinically meaningful changes in depression. We were also unable to find any guidelines for the use of activity monitoring in depression in order to recommend, for instance, how long patients should wear the actigraphy device or what is the best way of characterising activity patterns during the measurement period.
We carried out a systematic review of published studies in which actigraphy was used to monitor day or night time activity in people with a depressive disorder. We included both case-control studies which examined the difference between people with depression and healthy controls and longitudinal (pre-post) treatment studies to investigate changes over time. The review had two aims:
- (1)
to examine the association between activity levels and depression;
- (2)
to identify areas of research that need to be addressed before guidelines for the use of actigraphy in people with depression can be developed.
Section snippets
Methods
The study was conducted in accordance with PRISMA statement (Moher et al., 2009) and the protocol was agreed by all authors in advance of data collection. As the study included no direct involvement with patients or identifiable data no ethical review was necessary.
Search results
The initial search returned 1267 titles. From these and subsequent following of references, we reviewed 81 abstracts and obtained full texts for 24 publications from 20 studies. In addition data from two papers which were no longer available (Foster et al., 1978; 9) were extracted from an earlier review (Teicher, 1995) resulting in a total of 26 papers for data extraction. This is summarised in Fig. 1. Following data extraction eight papers were excluded: three for having no interpretable data (
Summary of principal findings
Actigraphy confirms the clinical impression that patients with depression display less day-time motor activity than healthy controls and that this activity increases over the course of treatment. Depressed patients appear to have increased night-time activity although this is not apparent in standard actigraphic measures of sleep duration or sleep efficiency. Studies to date have used a wide range of protocols and most have been confined to hospital inpatients.
Strengths and limitations
This is the first review of
Conclusions
Actigraphy is a potentially valuable source of additional information in patients with depression. Guidelines for use of actigraphy in studies of patients with depression are needed and further studies should investigate patients treated in the community and create analysis methods for differentiating relevant behaviour patterns.
Role of funding source
The Help4Mood project is funded by the European Union FP7 Programme (FP7-ICT-2009-4: 248765). The funder had no involvement in the conduct or reporting of the study.
Conflict of interest
None of the authors have any commercial or financial interest in the manufacture or distribution of actigraphy devices. The Help4Mood project includes actigraphy as one element of the patient monitoring system.
Acknowledgements
We thank Javier Rossel for commenting on an earlier draft of the manuscript.
References (46)
- et al.
Methodological challenges when using actigraphy in research
Journal of Pain and Symptom Management
(2008) - et al.
Use of actigraphy for monitoring sleep and activity levels in patients with fibromyalgia and depression
Journal of Psychosomatic Research
(2002) - et al.
Wrist actigraphy Chest
(2011) Circadian pattern of motor activity in major depressed patients undergoing antidepressant therapy: relationship between actigraphic measures and clinical course
Psychiatry Research
(1994)- et al.
24-Hour motor activity after treatment with imipramine or fluvoxamine in major depressive disorder
European Neuropsychopharmacology
(2002) - et al.
Motor activity and autonomic cardiac functioning in major depressive disorder
Journal of Affective Disorders
(2003) - et al.
Actigraphy in patients with seasonal affective disorder and healthy control subjects treated with light therapy
Biological Psychiatry
(2005) - et al.
How many days was that? We're still not sure, but we're asking the question better!
Medicine & Science in Sports & Exercise
(2008) - et al.
A case series on the development of rest–activity rhythm and quality of sleep in patients hospitalized for treatment of uni- or bipolar depression: a potential role for quetiapine
International Journal of Psychiatry in Clinical Practice
(2006) - et al.
Effects of adjunctive antidepressant therapy with quetiapine on clinical outcome, quality of sleep and daytime motor activity in patients with treatment-resistant depression
Human Psychopharmacology
(2007)