||5R21CA214102-02 Interpret this number
||Butler Hospital (Providence, Ri)
||Tdcs for Increasing Exercise Adherence in Individuals with Elevated Depressive Symptoms
Regular exercise protects against overweight/obesity as well numerous chronic diseases. Yet, less than
half of Americans exercise sufficiently. Elevated levels of depressive symptoms have been identified as an
important correlate of physical inactivity as well as poor adherence to exercise programs. Individuals with
depression are less sensitive to rewards, demonstrate an attentional bias toward negative stimuli, and have
lower baseline levels of activation of the left frontal cortex – which may place them at increased risk for
effectively managing the affective experience of exercise. Indeed, engagement in bouts of exercise
consistently results in changes in affect and, importantly, these affective experiences (especially positive
affect) predict current and long-term levels of physical activity. Whether an individual is able to manage the
interoceptive cues associated with increased levels of physical exertion or shift attention away from the
negative aspects of exercise appears to influence the affective experience during exercise. Yet, relatively little
attention has been given toward improving the affective experience of exercise in the general population, much
less among individuals with affective vulnerabilities who are at greater risk for insufficient activity levels.
Transcranial direct current stimulation (tDCS) is a relatively safe form of noninvasive brain stimulation,
which has shown promise in impacting a variety of cognitive and affective processes in a large number of
individuals, including those with depression. tDCS uses low current electricity to modulate neuronal activity in
targeted brain areas via two electrodes placed on the head. tDCS targeting the left dorsolateral prefrontal
cortex (DLPFC), specifically, has shown promise in improving emotion regulation. Experimental studies of
tDCS targeting DLPFC have resulted in lower perceived emotional valence toward negative stimuli, improved
frustration tolerance and decreases in attentional bias to negative emotional stimuli. When paired with
exercise, those receiving tDCS experience a slower rate of perceived exertion (RPE) during exercise. There is
also increased interest in testing neuromodulation approaches such as brain stimulation techniques in obesity
prevention efforts (see PA-15-163). We propose to conduct a pilot randomized controlled trial of tDCS versus
sham delivered 3x/week for 8 weeks in the context of supervised aerobic exercise (AE) program among 60
low-active individuals with elevated depressive symptoms. Follow-up assessments will be conducted at end of
treatment, 3-, and 6-months to examine changes in levels objective-measured moderate-to-vigorous physical
activity (MVPA). Therefore, tDCS would be a highly novel and potentially promising approach toward improving
the affective experience of exercise and thereby increase exercise adherence among individuals with
depressive symptoms. This, in turn, would have high public health impact on preventing obesity and chronic
diseases among these at-risk individuals.
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