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Abstract

Exercise is an evidence-based intervention for treating depression and is now recognised as a frontline treatment for depression in Canada. However, limited research has investigated ways to translate exercise-based interventions for depression to community-settings. Globally, research suggests more women than men are affected by depression. Women are also less likely to meet recommended physical activity guidelines. This dissertation focused on the development, implementation, and evaluation of a community-based exercise intervention for women with major depressive disorder (MDD). The development process was guided by The Obesity-Related Behavioural Intervention Trials: ORBIT Model, Behaviour Change Wheel (BCW), and Behaviour Change Intervention Ontology (BCIO). Study 1 involved interviews and focus groups with various community-partners (e.g., exercise professionals, healthcare providers, women with lived experience of depression) to consider the design, development, and implementation of a potential intervention. Potential barriers and facilitators to successful implementation were explored. Second, an appropriate community-based gym provider was identified as the intervention delivery partner. Study 2 describes the systematic process used to conduct an in-depth review of the community-based gym program guided by the Theoretical Domains Framework (TDF), Behaviour Change Technique Taxonomy v1 (BCTTv1), and BCIO to retrofit the community-based program components and contents. The findings informed the need to supplement the program with behaviour change support through the provision of behaviour change counselling. Study 2 outlines the development of a behaviour change counselling manual. Study 3 was a mixed-method single-arm study to evaluate the acceptability, feasibility, and preliminary efficacy of a 12-week community-based exercise program for women with MDD supplemented with behaviour change counselling (REACH). REACH proved to be feasible and was deemed acceptable with high adherence recorded for the exercise sessions and behaviour change counselling telephone calls. The findings provide support for the plausibility of an antidepressant effect, with most participants reporting clinically significant changes in depression scores. Together, the studies in this dissertation contribute to the development of an effective, accessible exercise intervention that could be integrated into mental healthcare in Canada. Collaborating with a community-based gym provider provides the opportunity for the program to be scaled up in partnership with existing national exercise providers in Canada.