BACKGROUND There is a lack of knowledge about internet-based cognitive behavioural therapy in patients with cardiovascular disease, and its effects on depressive symptoms and physical activity. AIM To examine trajectories of depressive symptoms and physical activity, and to explore if these trajectories are linked with the delivery of internet-based cognitive behavioural therapy. METHODS A secondary-analysis of data collected in a randomised controlled trial that evaluated the effects of a 9-week internet-based cognitive behavioural therapy programme compared to an online discussion forum on depressive symptoms in cardiovascular disease patients. Data were collected at baseline, once weekly during the 9-week intervention period and at the 9-week follow-up. The Montgomery Åsberg depression rating scale - self-rating (MADRS-S) was used to measure depressive symptoms. Two modified items from the physical activity questionnaire measuring frequency and length of physical activity were merged to form a physical activity factor. RESULTS After 2 weeks the internet-based cognitive behavioural therapy group had a temporary worsening in depressive symptoms. At 9-week follow-up, depressive symptoms (P<0.001) and physical activity (P=0.02) had improved more in the internet-based cognitive behavioural therapy group. Only in the internet-based cognitive behavioural therapy group, was a significant correlation (r=-0.39, P=0.002) between changes in depressive symptoms and changes in physical activity found. Structural equation analyses revealed that internet-based cognitive behavioural therapy decreased depressive symptoms, and that a decrease in depression, in turn, resulted in an increase in physical activity. CONCLUSIONS Internet-based cognitive behavioural therapy was more effective than an online discussion forum to decrease depressive symptoms and increase physical activity. Importantly, a decrease in depressive symptoms needs to precede an increase in physical activity.

中文翻译：

---

心血管疾病患者参与基于互联网的认知行为治疗项目期间抑郁与身体活动之间的轨迹和关联

背景对于心血管疾病患者的基于互联网的认知行为疗法及其对抑郁症状和身体活动的影响缺乏相关知识。目的检查抑郁症状和身体活动的轨迹，并探讨这些轨迹是否与基于互联网的认知行为疗法的提供有关。方法 对在一项随机对照试验中收集的数据进行二次分析，该试验评估了为期 9 周的基于互联网的认知行为治疗计划与心血管疾病患者抑郁症状在线讨论论坛的效果。在基线、9 周干预期间每周一次和 9 周随访时收集数据。Montgomery Åsberg 抑郁评定量表 - 自评 (MADRS-S) 用于测量抑郁症状。将测量身体活动频率和长度的身体活动问卷中的两个修改项目合并为身体活动因素。结果 2 周后，基于互联网的认知行为治疗组的抑郁症状暂时恶化。在 9 周的随访中，基于互联网的认知行为治疗组的抑郁症状 (P<0.001) 和身体活动 (P=0.02) 改善更多。只有在基于互联网的认知行为治疗组中，抑郁症状的变化与身体活动的变化之间存在显着相关性（r=-0.39，P=0.002）。结构方程分析显示，基于互联网的认知行为疗法减少了抑郁症状，而抑郁症的减少反过来又导致身体活动的增加。结论 基于互联网的认知行为疗法比在线讨论论坛更有效地减少抑郁症状和增加身体活动。重要的是，抑郁症状的减少需要先于体力活动的增加。