The article “Effects of a self-regulation intervention on exercise are moderated by depressive symptoms: A quasi-experimental” was published in the Journal of International Psychology in 2012 and covers the pages 1-8 of the 13 th volume. As the title suggests, the publication followed an experimental study by Sarah Pompa, Lena Fleiga, Ralf Schwarzera, and Sonia Lippke, all specialists in the field of psychology and members of health psychology departments at the Freie University Berlin and Jacobs University of Bremen. Therefore, one can argue that the article is credible because the study was conducted by specialist researchers in the respective field with deep knowledge and understanding of the concepts being studied.
Conceptualization of the Study
The objective of the article was to “investigate the possibility of a computer-based intervention to increase physical exercise in individuals with or without depressive symptoms” (Pomp, Fleig, Schwarzer et al. , 2013, p. 2). The objective is captured in the title of the article and restated in the aims sections, where the hypothesis is also presented: “the effectiveness of the intervention is moderated by depressive symptoms” (p. 3). It is evident that the study was conceptualized based on cumulating evidence on the correlation between exercise and management of depressive symptoms. Daley (2008) through a meta-analysis of reviews on exercise and depression established that exercise is widely reported as an effective therapy compared to not treatment, equally effective as traditional therapy in some cases, and a promising approach in developing areas such as postnatal depression management.
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Despite growing evidence of the need for physical exercise to promote long-term recovery in depressed patients under rehabilitative care, empirical evidence suggests lack of adherence. Pomp, Fleig, Schwarzer et al. (2013) identified the lack of research as to why there was lack of adherence, and bridge the gap through this study, which established that exercise was only effective in non-depressed patients. The findings open a whole new chapter because they suggest that depression, which is a target for treatment through exercise, acts as a barrier in uptake of exercise by depressed patients. Pomp, Fleig, Schwarzer et al. (2013) refer to this development as “a conflict of resources”, and offer a detailed explanation of why depressive symptoms may interfere with self-regulated exercise. It is clear from the abstract of the article that the concept under study poses a dilemma to psychologists and opens new avenues for exploration of behavior change programs that yield effective outcomes for patients with depression.
Appropriateness of the Methodology
According to Delay (2008), concerns have been raised regarding the methodological qualities of trials, the possibility to overestimate treatment outcomes, and lack of long-term data on the benefits of exercise in depressed patients. Therefore, there is need to rely on available evidence as the wait for high quality trials continues. A similar approach is adopted by Pomp, Fleig, Schwarzer et al. (2013) in adopting a quasi-experimental approach for the study. In a study conducted by Aussems, Boomsma, and Snijders (2011) examining the use of various research designs in the field of social sciences, it was established that quasi-experiments are not often used and in instances where they are employed, the design and analysis falls short of expectations because of the difficulty in dealing with selection bias. Taking Pomp, Fleig, Schwarzer et al. (2013) study into this context, it is evident that sections of the study that do not involve data analysis and discussion are clearly understandable because they capture the key issues by highlighting the objective of the study and presenting the findings and conclusion. However, the data analysis part is rather confusing to a lay person with no comprehensive knowledge of statistical analysis.
The use of quasi experiment was suited to answering the study question, which sought to establish the existence of causality between exercise and its outcomes as treatment for depression, and the role of depression in inhibiting uptake of exercise. Such a research question can be addressed using an empirical method that estimates the causal impact of an intervention in a target population. Concerns raised in the study by Aussems, Boomsma, and Snijders (2011) in relation to quasi experiment as a research design are due to bias created by its lack of random assignment of sample or participants. Experimental purists have criticized quasi experiments for its “queasy” feeling due to inferiority of its internal validity compared to randomized experiments. However, the ease with which quasi experiments are implemented as a group justifies its choice by the researchers.
The researchers fail to clearly state their experimental design, but it is evident from the article that Pomp, Fleig, Schwarzer et al. (2013) adopted a nonequivalent groups design, one of the classic quasi experimental designs. The design is used by the researchers in its simplest form where it requires pretest and posttest for the control and treated groups. In the context of the study, having depression was the treatment and the two groups consisted of depressed and non-depressed patients, though they were not randomly selected. In the sample and procedure section of the paper, participants’ recruitment process is explained in detail. One can decipher that recruitment was at the onset of admission to orthopedic rehabilitation center, and a longitudinal design was necessary as the experiment was conducted for six weeks. The researchers mention the total sample assessed for eligibility to be 714, but data from only 381 was used after a series of inclusion and exclusion criteria, which are clearly illustrated, were employed. Methods used in the collection of data including use of computer-assisted telephone interviews and online questionnaires are stated in the paper, and conformity to research guidelines in relation to ethical requirement is evident as emphasis was placed on informed consent.
The analytical procedure adopted by the researchers is a complex one due to existence of numerous variables whose correlations needed to be determined. Analysis of covariance (ANCOVA) was used to test the effects of the intervention and depressive symptoms and their interaction with exercise. A number of statistical tools such as randomization check and attrition analysis were also employed to determine difference in groups’ demographics and differences between the original sample and longitudinal sample respectively with the objective to address issues of bias. Overall, the organization of the methodological section of the article is easier to follow even though detailed explanation of tools used is not provided for clarity.
Discussion of Findings
It is important to emphasize on the relevance of the discussion of the article to the objective of the study, which the researchers handle exceptionally well. The researcher revisits the aim of the study by discussing the “correlation between depressive symptoms and effectiveness of an exercise self-regulated intervention” (Pomp, Fleig, Schwarzer et al. , 2013, p. 4). There is evident causality relationship in the discussion of the findings, which the researchers identify to be consistent with those in previous meta-analytical studies regarding the negative effects of depressive symptoms on exercise. Pomp, Fleig, Schwarzer et al. (2013) use a comparative line graph to illustrate the effects of depression on outcomes of self-regulated exercise intervention between the onset of the study and conclusion, and the difference starkly stands out for interpretation without the need to go through other parts of the article. Perhaps the most notable aspect of Pomp, Fleig, Schwarzer et al. (2013) discussion is the use of relevant literature to back up the findings of the study to ensure not only relevance, but also credibility.
Pomp, Fleig, Schwarzer et al. (2013) re-explored factors leading to conceptualization of the study by providing an outlook section in the discussion where the two fold role of exercise namely, promotion of physical health and alleviation of depressive symptoms, are discussed. In light of this knowledge, implications and recommendations for practice and future studies are offered with emphasis placed on the need for targeted exercise programs for depressive patients. Practitioners are informed of the need for integrated approaches that address exercise behavior and depressive symptoms among patients to ensure the two are counterproductive. Modes of administration of self-regulated interventions are also proposed. However, it can be argued that Pomp, Fleig, Schwarzer et al. (2013) bring forward a number of conflicting issues that cannot be addressed at once as each needs to be studied independently before integration into the comprehensive management framework. The limitations of the study highlighted in the paper include the marginality in significance of the interaction effect and use of low number of participants with depressive symptoms. These limitations can be attributed to the use of quasi experiment that lack randomization, and suggestions by the researchers for future studies to employ larger sample and replicate the studies is evidence that the design used lacks in rigor.
References
Aussems, M. C. E., Boomsma, A., & Snijders, T. A. (2011). The use of quasi-experiments in the social sciences: a content analysis. Quality & Quantity , 45 (1), 21-42.
Daley, A. (2008). Exercise and depression: a review of reviews. Journal of Clinical Psychology in Medical Settings , 15 (2), 140.
Pomp, S., Fleig, L., Schwarzer, R., & Lippke, S. (2013). Effects of a self-regulation intervention on exercise are moderated by depressive symptoms: A quasi-experimental study. International Journal of Clinical and Health Psychology , 13 (1), 1-8.
