inMotion Clinical Study: Using Motivational Interviewing to Increase Physical Activity to Treat Depression in People Aging With MS or SCI

People aging with disabilities such as spinal cord injury (SCI) or multiple sclerosis (MS)
report high rates of major depression. Depression frequently adds to the disabilities and
suffering in these populations. Few definitive studies of depression treatments have been
done in people with MS and none in SCI. There are several reasons to explore novel
treatments for major depression in these groups. First, standard treatments, such as
antidepressant medications, may not be as effective in people with neurological
disabilities. Next, people with physical disabilities tend to be inactive. Lack of physical
activity has been positively correlated with higher levels of depression. Longitudinal data
and treatment trials suggest that increased physical activity is related to improved mood.
Controlled trials show that increased exercise and physical activity can be effective
treatments for major depression in nondisabled older adults. Previous research by the
investigators' group suggests that people with MS are quite interested in exercise and that
exercise is a safe and effective treatment for depression in younger, less disabled people
with MS. Exercise may have widespread benefits for people with MS or SCI. Finally, exercise
or increased physical activity represents a low cost, non-stigmatizing, highly accessible
potential treatment for depression in people with physical disabilities. In this study the
investigators will determine whether a relatively brief telephone-based intervention to
promote physical activity is an effective treatment for major depression in people aging
with MS or SCI. The investigators define "aging" as chronological age greater than 45 years
old.

Inclusion Criteria:

- aged at least 45 years old

- self-report diagnosis of MS or SCI

- meeting SCID requirements for Major Depressive Disorder (MDD) or dysthymia

- MS: EDSS between 4.0 and 8.0

- SCI: ASIA A-D injury level at or below C4 and they have upper extremity function
sufficient to propel a manual wheelchair

- meeting PHQ-9 measure cut-off for depression by scoring more than 10 on the measure

- currently inactive (exercising less than 150 minutes per week)

- response form received from participants' doctor declaring exercise safe for the
subject.

Exclusion Criteria:

- significant cognitive impairment

- pressure ulcers on sitting surfaces (or another condition that precludes sitting

- significant obesity (>160% of ideal body weight)

- significant risk factors for beginning moderate physical activity measured with the
PAR-Q

- response form received from participants' doctor declaring exercise unsafe for the
subject

- a self-reported history of significant Uthoff's effect for those with MS

- psychiatric contraindications such as bipolar disorder, psychosis, active suicidal
ideation with intent or plan, or current alcohol or drug dependence. We will include
people who remain depressed but are on stable doses of antidepressant medications.