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People who stay even moderately fit as they age may live longer than those who are out-of-shape, a new study suggests.

The study, of nearly 4,400 healthy U.S. adults, found that the roughly 20 percent with the lowest physical fitness levels were twice as likely to die over the next nine years as the 20 percent with the next-lowest fitness levels.

That was with factors like obesity, high blood pressure and diabetes taken into account — underscoring the importance of physical fitness itself, researchers report in the journal Medicine and Science in Sports and Exercise.

“Our findings suggest that sedentary lifestyle, rather than differences in cardiovascular risk factors or age, may explain (the) two-fold higher mortality rates in the least-fit versus slightly more fit healthy individuals,” lead researcher Dr. Sandra Mandic, of the University of Otago in Dunedin, New Zealand, noted in an email to Reuters Health.

She pointed out that nearly two-thirds of the least-fit study participants were not getting the minimum recommended amount of exercise — at least 30 minutes of moderate activity, like brisk walking, on five or more days a week.

“These results emphasize the importance of improving and maintaining high fitness levels by engaging in regular physical activity,” Mandic said, “particularly in poorly fit individuals.”

The study included 4,384 middle-aged and older adults whose fitness levels were assessed during exercise treadmill tests sometime between 1986 and 2006; they were then followed for an average of about nine years.

When Mandic’s team separated the participants into five groups based on fitness levels, they found that one-quarter of the least-fit men and women had died during the study period, versus 13 percent of those who were slightly more in shape.

Among adults in the most-fit group, only 6 percent died during the follow-up period.

Overall, the five groups showed little difference in their reported exercise habits over their adult lives. Where they did differ was their activity levels in recent years.

“Since it is recent physical activity that offers protection,” Mandic said, “it is important to maintain regular physical activity throughout life.”

And since fitness is linked to longevity regardless of weight and health conditions like high blood pressure and high cholesterol, exercise is important for all, according to Mandic.

That, she said, includes people who are thin and in generally good health.

Online psychotherapy with patient and therapist texting each other in real-time can be effective, potentially giving thousands or even millions of patients new access to much-needed treatment, researchers say.

The new study adds to a growing body of research and practice involving technology-based treatments for depression and other mental health issues. In this case, the specific type of therapy used was cognitive-behavioral therapy (CBT).

“There is a role for this, it’s exciting,” said one expert, Dr. Kathryn J. Kotrla, chairwoman and associate professor of psychiatry and behavioral science at Texas A&M Health Science Center College of Medicine. “CBT is tremendously underutilized.”

This and other computer-based treatment could benefit people in rural or remote areas who need psychotherapy, including traumatized veterans returning from Iraq and Afghanistan.

Cognitive therapy “is proven [effective] for trauma-related issues,” said Kotrla, who is also associate dean of the Texas A&M Health Science Center College of Medicine, Round Rock campus. And providing it online means that “it’s discreet, it’s time-related. It avoids the issue of stigma,” she said.

The new findings, by a team at the University of Bristol in the United Kingdom, are published Aug. 22 in a special Global Mental Health edition of the journal The Lancet.

According to an accompanying commentary article, prescription rates for antidepressant medications have soared over the past two decades, alongside a decline in the number of people receiving in-person psychotherapy.

Meanwhile, the commentary states, a good proportion of people for whom therapy is recommended never show up and half of those who do show up don’t last through to the fourth appointment.

So, “people are looking at different ways of delivering psychotherapy other than the traditional go-to-the-therapist’s-office-and-meet-for-50-minutes,” said Dr. Gregory E. Simon, co-author of the commentary and a psychiatrist and researcher with Group Health Cooperative in Seattle. “On the far extreme are completely computerized or completely automated programs that don’t have to have a human being involved. On the other end, people may communicate with a therapist through a Web site or telephone but there’s a real live therapist there they’re communicating with.”

For this study, nearly 300 British patients with depression were randomly assigned to receive online CBT or were put on an eight-month waiting list for online CBT while they received usual care from their general practitioner.

The online therapy, which consisted of 10 weekly 55-minute sessions, essentially involved instant messages back and forth. About two-thirds of participants “showed up” for five or more sessions.

After four months of follow-up, 38 percent of patients in the CBT group recovered from depression compared with 24 percent in the control group, the study found.

At eight months, recovery rates were 42 percent in the intervention group and 26 percent in the control group, the researchers found. That’s an improvement on recovery rates seen in conventional therapy.

The authors hypothesized that the heightened success rate might be due to the fact that people are writing rather than speaking their feelings and thoughts. “This approach could enhance metacognitive awareness, a term applied to changing the patient’s relationship with negative thoughts and feelings, rather than changing their belief in the content of the negative thoughts,” they wrote in the report.

Virtual therapy sessions with a real person do not save much in costs (except for gas) and there may be a trade-off in terms of quality of communication. But the real benefits come in access and convenience, experts said.

“When you make the therapy much more convenient, people will be more likely to stick with it,” Simon said. “I don’t think anyone would argue that you don’t lose something. Communicating in person is richer and communication over phone is richer than just typing text, but balance that with convenience and the person is more likely to stick with it . . . You may be reaching people you wouldn’t reach otherwise.”