Exercise to Prevent Depression and Anxiety in Older Hispanics

Eligible participants will be randomized to either the Happy Older Latinos are Active (HOLA)
intervention or a psychoeducation condition. Participants randomized to HOLA will participate
in a group exercise, 3 times a week, for 16 weeks. The exercise is a moderate intensity walk
at a centrally located park in Miami-Dade county and will last for an hour (10 minute
warmup/stretching, 30 minute walk, 5 minute cool down). Groups will consist of 6 participants
and be led by a community health worker. During the cool down phase, participants will plan a
pleasant event to be done in between sessions. Participants randomized to the psychoeducation
component will receive a fotonovela and will meet once a month after they receive the
fotonovela to discuss their thoughts on the materials they received. These discussion groups
will last one hour and will consist of 10 participants. A total of 60 participants will be
randomized (30 to HOLA, 30 to fotonovela). Assessments will be conducted at baseline, post
intervention, 6 months post-intervention, and 12 months post-intervention.

Inclusion Criteria:

1. Hispanic (self-identified);

2. Age 60+;

3. Minor depression as defined by a primary DSM-IV Axis I diagnosis of minor depressive
disorder or subthreshold depression defined as a score ≥ 3 on the Patient Health
Questionnaire (PHQ-2), OR subthreshold anxiety as defined as a score ≥ 3 on the
Generalized Anxiety Disorder-2 scale (GAD-2);

4. Absence of episodes of major depression and anxiety disorders for past 12 months (as
determined by the MINI);

5. Voluntary informed consent for participation in the study by the participant or by the
participant's legally designated guardian or conservator;

6. Medical clearance for participation in an exercise program by a physician, physician's
assistant, or nurse practitioner;

7. Expect to be resident in Miami for the subsequent 12 months.

Exclusion Criteria:

1. Currently residing in a nursing or group home;

2. A terminal physical illness expected to result in the death within one year;

3. A diagnosis of dementia, co-morbid diagnosis of dementia, or significant cognitive
impairment as indicated by an MMSE score <24;

4. Presence of any axis 1 psychiatric disorder or substance abuse during preceding 12
months;

5. History of psychiatric disorders other than non-psychotic unipolar major depression or
anxiety disorder;

6. High suicide risk, i.e., intent or plan to attempt suicide in the near future (a
response of "yes" to questions 3, 4, and/or 5 on the Paykel Questionnaire);

7. Participants taking cognitive enhancing medication or psychotropic medications (e.g.
antidepressants);

8. unable to complete 400 m walk test in less than 15 min;

9. if participant heart rate exceeded 170 beats per minute OR systolic blood pressure
exceeds 180 during 400 m walk test;

10. chest or leg pain, dyspnea, dizziness, feeling faint, or other significant symptoms
while completing 400 m walk test;

(i) acute or severe medical illness that would prevent participants from walking at a
moderate pace for 45 minutes, three times a week.