Physical activity and depressive symptoms in older adults: 11-year follow-up

"When I go back to painting, I am 'Alice in Wonderland": older women coping with age-related crises through visual artmaking

BACKGROUND

The creative process of visual artmaking provides an opportunity for older women to express themselves and explore their emotions, thoughts, and experiences. This study examined the roles of visual artmaking in older women's lives in general and in relation to the ongoing challenges of aging.

METHODS

The sample was composed of 21 Israeli women aged 60-90, who indicated that they produced visual artworks on an ongoing basis. The participants' artworks were collected, and semi-structured in-depth interviews were conducted.

RESULTS

A thematic analysis of the interviews revealed 4 themes: visual artmaking to address the challenges of older women's lives, artwork as a framework for doing, visual artmaking to support the wellbeing of older women, artwork as channel of communication and stronger ties with family members.

CONCLUSIONS

The findings contribute to a better understanding of the roles of visual art in older women's lives, especially in times of crisis.

Health Behavior Models and Regular Exercise Levels Among Workers in Taiwan

Purpose

The present study aims to examine the disparate effects of health behavior models, namely exercise self-efficacy (ESE), health belief model (HBM), and planned behavior theory (PBT), applied to clarify the degree of regular exercise among workers in Taiwan.

Methods

A cross-sectional research design was adopted. A questionnaire was distributed to obtain information pertaining to regular exercise level, demographic characteristics, and the scores of ESE, HBM, and PBT. In total, 400 full-time workers voluntarily participated in this study.

Results

The results showed that only 20.5% of the participants exercised regularly, 37.3% exercised irregularly, and 42.3% did not exercise currently. "Perceived benefits" and "perceived barriers" pertaining to HBM; "attitude" and "perceived behavioral control" pertaining to PBT; and ESE were associated with regular exercise level in the multiple linear regression analyses of each health behavior model. When all three models were considered simultaneously, ESE provided the greatest explanation of the variances for regular exercise levels. PBT total made a smaller contribution in the prediction of regular exercise level, while the effect of HBM did not show statistical significance. In order to explore the practicality of moving beyond theoretical models and focusing on the components across health behavior models to enhance workers' exercise behavior, the components showing statistical significance in separate analysis were put into the multiple linear regression simultaneously. The results showed that ESE, perceived barriers of health behavior, attitude, and perceived behavioral control were significantly associated with regular exercise level.

Conclusion

A low percentage of workers exercising regularly should be a notable issue for workplace health promotion. Neither utilizing cues to exercise nor advertising health threats of physical inactivity is sufficient to enable workers to exercise regularly. Enhancing workers' ESE and behavior control and removing the exercise barriers would constitute efficient strategies for maintaining the exercise habit of workers.

The Role of Daily Steps in the Treatment of Major Depressive Disorder: Secondary Analysis of a Randomized Controlled Trial of a 6-Month Internet-Based, Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth

BACKGROUND

Current evidence supports physical activity (PA) as an adjunctive treatment for major depressive disorder (MDD). Few studies, however, have examined the relationship between objectively measured PA and MDD treatment outcomes using prospective data.

OBJECTIVE

This study is a secondary analysis of data from a 24-week internet-based, mindfulness-based cognitive behavioral therapy program for MDD. The purpose of this analysis was twofold: (1) to examine average daily step counts in relation to MDD symptom improvement, and whether pain moderated this relationship; and (2) to examine whether changes in step activity (ie, step trajectories) during treatment were associated with baseline symptoms and symptom improvement.

METHODS

Patients from the Centre for Addiction and Mental Health were part of a randomized controlled trial evaluating the effects of internet-based, mindfulness-based cognitive behavioral therapy for young adults (aged 18-30 years old) with MDD. Data from 20 participants who had completed the intervention were analyzed. PA, in the form of objectively measured steps, was measured using the Fitbit-HR Charge 2 (Fitbit Inc), and self-reported depression severity was measured with the Beck Depression Inventory-II (BDI-II). Linear regression analysis was used to test PA's relationship with depression improvement and the moderating effect of pain severity and pain interference. Growth curve and multivariable regression models were used to test longitudinal associations.

RESULTS

Participants walked an average of 8269 steps per day, and each additional +1000-step difference between participants was significantly associated with a 2.66-point greater improvement (reduction) in BDI-II, controlling for anxiety, pain interference, and adherence to Fitbit monitoring (P=.02). Pain severity appeared to moderate (reduce) the positive effect of average daily steps on BDI-II improvement (P=.03). Higher baseline depression and anxiety symptoms predicted less positive step trajectories throughout treatment (Ps≤.001), and more positive step trajectories early in the trial predicted greater MDD improvement at the end of the trial (Ps<.04). However, step trajectories across the full duration of the trial did not significantly predict MDD improvement (Ps=.40).

CONCLUSIONS

This study used objective measurements to demonstrate positive associations between PA and depression improvement in the context of cognitive behavioral treatment. Pain appeared to moderate this relationship, and baseline symptoms of anxiety and depression predicted PA trajectories. The findings inform future interventions for major depression. Future research with larger samples should consider additional moderators of PA-related treatment success and the extent to which outcomes are related to PA change in multimodal interventions.

TRIAL REGISTRATION

Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/11591.

Prevalence of early and late onset of chronic diseases and multimorbidity and its association with physical, mental and functional health among older Indian adults

BACKGROUND

Identifying people with early and late onset of chronic conditions might help target the subpopulations that are more vulnerable to negative mental, physical and functional health outcomes. The current study aimed to examine the association of early and late onset of chronic single and multiple morbidities with self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults.

METHODS

Cross-sectional study was conducted using data from the Longitudinal Ageing Study in India (LASI) Wave 1 (2017-2018). The total sample size for the present study was 31,386 older adults age 60 years or older. Multivariable binary logistic regression analysis was used to establish the association between the outcomes (poor perceived physical/mental health, functional difficulty and physical inactivity) and explanatory variables (early [ = < 50 years of age] and late [> 50 years]) onset of chronic illnesses such as hypertension, diabetes, heart attack, heart disease, stroke, cancer, lung disease, arthritis, osteoporosis and psychiatric disease).

RESULTS

Overall, 24.21% of the sample population had poor self-perceived physical health, whereas 8.67% of participants had poor self-perceived mental health. The prevalence of difficulty in ADL, difficulty in IADL, and physical inactivity was 23.77%, 48.36%, and 68.9%, respectively. Odds of poor perceived mental health were higher for the respondents with early as well as late onset of hypertension, stroke, and arthritis; while individuals with late onset of diabetes, and heart disease had higher odds of poor perceived mental health than those without chronic disease. Individuals with early onset of single morbidity were more likely to report ADL difficulty (adjusted odds ratio [AOR]: 1.33, confidence interval [CI]: 1.06-1.67); while those with late onset of single (AOR: 1.34, CI: 1.17-1.53) and multimorbidity (AOR: 1.91, CI: 1.63-2.24) were more likely to report ADL difficulty compared with individuals without morbidity. Individuals with early as well as late-onset of multimorbidity had more than two times higher odds of reporting poor physical health, poor mental health and IADL difficulty compared with individuals without chronic disease.

CONCLUSIONS

The present study revealed that early and/or late onset of chronic single and/or multiple morbidities significantly predicted poor self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults. The findings further suggest that late onset of chronic diseases such as cancer and stroke and multi-morbidity had stronger associations with physical inactivity that may help identify high risk groups for screening and support.

Age-varying association between depression symptoms and executive function among older adults: Moderation by physical activity

OBJECTIVES

This study assessed trends in depression symptoms, executive function, and their association across age among older adults. Subgroup comparisons were made between older adults meeting and not meeting physical activity guidelines on variables and associations of interest.

METHODS

Participants (n = 2473) were older adults ages 60 to 79 from the 2011-2014 National Health and Nutrition Examination Survey. Depression symptoms, executive function, and physical activity were assessed, and weighted time-varying effect modeling was used for analyses.

RESULTS

Depression symptoms were most severe at age 62 followed by a modest decline before a second peak around age 67. Executive function was highest at age 60 and declined steadily through age 77. Depression symptoms and executive function were negatively associated, but the strength and significance of this association varied with age. Older adults meeting physical activity guidelines had increased executive function and less severe depression symptoms, and meeting physical activity guidelines buffered the association between depression symptoms and executive function at key ages during older adulthood.

CONCLUSIONS

Differences by age should be considered when designing and implementing health programs and treatments focusing on mental health and cognition in older adulthood. Encouraging moderate-intensity physical activity may help protect older adults from depression-related cognitive decline.

Behavioral and Brain Correlates of Emotional Distress in Older Adults During COVID-19 Quarantine

COVID-19 led to unprecedented lockdowns and changes in older adults' lives, especially those with type 2 diabetes who have high risk of complications and mortality. We investigated the associations of cognitive and motor function and gray matter volumes (GMVs) with COVID-19 lockdown-related emotional distress of type 2 diabetes older adults, participating in the Israel Diabetes and Cognitive Decline Study. We administered a questionnaire to obtain information about anxiety, depression, general well-being, and optimism during a mandated lockdown. Lower grip strength before lockdown was associated with increased sadness, anxiety, and less optimism. Slower gait speed was associated with greater sadness. Lower GMV was related to greater anxiety during the lockdown when compared with anxiety levels before the COVID-19 outbreak. Yet, global cognition was not associated with any emotional distress measure. These results support the role of good motor function on emotional well-being during acute stress and GMV as a potential underlying mechanism.

Accelerometer-Assessed Physical Activity and Cognitive Performance among European Adults Aged 50+: The Mediating Effects of Social Contacts and Depressive Symptoms

BACKGROUND

Cognitive decline is a major public health concern worldwide and it is vital to identify and better understand effective population-based means to improve cognitive performance in old age. The current study set out to examine the links between accelerometer-based physical activity with cognitive performance in later life, as well the indirect pathways through one's social network contacts and depression.

METHOD

We used data from 855 participants aged 50 and above who took part in a cross-sectional accelerometer study as part of the Survey of Ageing, Retirement and Health (SHARE). Cognitive function was measured as an average score of fluency, immediate and delayed recall tests, social contacts were the average contact frequency with members of the social support network, and depression was the Euro-D summary score of depressive symptoms. A multiple mediation analysis was conducted to test the direct and indirect associations between total physical activity (intensity gradient) and cognitive function, as well as the mediation of this association by social contacts and depressive symptoms.

RESULTS

Intensity of physical activity was directly related to better cognitive performance (B = 0.170, p = 0.007). The association was partially mediated by social contacts (B = 0.022, 95% CI 0.005, 0.046) and depressive symptoms (B = 0.009, 95% CI 0.009, 0.025), such that total physical activity was linked to cognitive health via more frequent contacts with network members and low depressive symptoms.

CONCLUSIONS

Practitioners might consider encouraging a physically active lifestyle that involves social interactions to support better cognitive aging and mental health.

Depression among Older Adults in Indonesia: Prevalence, Role of Chronic Conditions and Other Associated Factors

Background

Depression is one of the most common illnesses worldwide, with a prevalence of 5.7% among older adults aged over 60. Depression is a severe health condition that can significantly affect the quality of life.

Objective

The objective of this study is to investigate the determinant factors of depression among older adults in Indonesia.

Methods

Data of 4236 adults of 60 years old and over were taken from the fifth wave of the Indonesian Family Life Survey (IFLS-5). Sociodemographic and multiple health-related variables collected through interviews and measurements were analyzed. Multivariate logistic regression was used to evaluate depression and its associated factors.

Results

The prevalence of depression assessed using ten questions from the Center for Epidemiologic Studies Depression Scale (CES-D 10) was 16.3%. Significant associated factors for depression were moderate and low subjective economic status, living in Java or other regions outside Sumatra and Java, no life satisfaction, self-perceived as having poor health, having dependency (IADL scores), and experienced falls and insomnia. Among chronic conditions, stroke, arthritis, and hearing impairment were also more common in depressed older adults.

Conclusion

Predictors of depression identified in this study may be used to help prevent and improve depression in Indonesian older adults, especially those who live on Java. Improvement in healthcare, especially in the prevention and rehabilitation of stroke, arthritis, possible frailty (falls and dependency), hearing impairment, and insomnia, concurrent with early detection of depression in these chronic conditions, may help create a better quality of life among Indonesian older adults.

Prevalence and associated factors of physical inactivity among middle-aged and older adults in India: results of a national cross-sectional community survey

OBJECTIVE

This study aimed to determine the prevalence and associated factors of physical inactivity in middle-aged and older adults in India.

DESIGN

Population-based cross-sectional study.

SETTING

Nationally representative sample of general community-dwelling middle-aged and older adult population in India.

PARTICIPANTS

The sample included 72 262 adults (45 years and older, mean age 58.8 years, SD=11.8), from the longitudinal ageing study in India wave 1 in 2017-2018.

PRIMARY AND SECONDARY OUTCOME MEASURES

Self-reported physical activity, along with physical measurements, health status and health behaviour, and sociodemographic covariates. Multivariable logistic regression calculated OR with 95% CI for physical inactivity.

RESULTS

Overall, 36.7% were physically inactive, 42.6% among men, and 32.4% among women (p<0.001). In the adjusted logistic regression analysis, among both men and women, older age (70 years and older), being Sikh, impaired vision and depressive symptoms were positively and cognitive functioning, current tobacco use and social participation were negatively associated with physical inactivity. In addition, among men, higher socioeconomic status, urban residence, functional disability and heart disease or stroke were positively associated with physical inactivity, and among women being married and higher education were negatively, and insomnia symptoms and poor or fair self-rated health status were positively associated with physical inactivity.

CONCLUSIONS

Almost 4 in 10 middle-aged and older adults in India had inadequate physical activity. Overall and gender specific risk factors for physical inactivity were identified. Interventions may operate at multiple levels and consider gender-related physical inactivity patterns.

Cross-sectional associations of personal efforts and beliefs and depressive symptoms among older adults in India

Whilst there is growing evidence on the increased vulnerability of older adults to depression, there is limited research on potentially mitigative factors against symptoms of depression at a population level. This research examined associations of possible protective factors (personal efforts and beliefs) and depressive symptoms among older adults in India. This cross-sectional study used data from the Longitudinal Aging Study in India with 31,464 respondents aged 60 years and above. Depressive symptoms were assessed using the 10-item Centre for Epidemiologic Studies Depression Scale. Multivariable linear regression was used while exploring the associated factors of depressive symptoms. The mean score of depressive symptoms was 2.94 (CI 2.92, 2.96). Older adults who engaged in moderate [aCoef: −0.11, CI −0.18, −0.05], vigorous [aCoef: −0.09, CI −0.16, −0.03], or both types of physical activity [aCoef: −0.10, CI −0.19, −0.02] had lower likelihood of depressive symptoms in comparison to those who were physically inactive. Older adults who participated in social activities were less likely to have depressive symptoms [aCoef: −0.44, CI −0.50, −0.39] compared to their socially inactive counterparts. Further, older adults who perceived religion as very important [aCoef: −0.29, CI −0.41, −0.17], who had high life satisfaction [aCoef: −0.78, CI −0.82, −0.73], who had good self-perceived health [aCoef: −0.29, CI −0.33, −0.25] and those who had high self-perceived social standing [aCoef: −0.39, CI −0.47, −0.31] had lower likelihood of depressive symptoms in comparison to their respective counterparts. Physical activity, social participation, voluntary work and financial contribution to family, religiosity, life satisfaction, self-perceived health and self-perceived social standing are associated with lower likelihood of depressive symptoms among community-dwelling older adults in this study. Future longitudinal studies should explore these factors that can guide interventions against depression in old age.

Physical activity and depressive symptoms among community-dwelling older adults in the COVID-19 pandemic era: A three-wave cross-lagged study

The aim of the study is to determine the trajectories of physical activity and depressive symptoms and their reciprocal relationship among community-dwelling older adults in the COVID-19 pandemic era. The study population consisted of a cohort of 511 participants aged 60 years and over, who were recruited from eight community health centers in Ya'an, China. The Physical Activity Scale for the Elderly and the Patient Health Questionnaire were respectively used to measure physical activity and depressive symptoms at three time points: before the COVID-19 outbreak (T₀), during the outbreak period (T₁), and after the subsidence of COVID-19 (T₂). The results revealed that physical activity and depressive symptoms fluctuated substantially across T₀, T₁, and T₂. In addition, more severe depressive symptoms at T₀ and T₁ were significantly associated with lower levels of physical activity at T₁ and T₂, but the obverse direction of physical activity being associated with subsequent depressive symptoms was not observed in the current study. These findings highlight the importance of supporting old people to remain physically active and combat mental distress early in a pandemic, and prevention and management of depressive symptoms may also be beneficial to promote physical activity.

Depressive Symptoms Among Older Adults Pre- and Post-COVID-19 Pandemic

OBJECTIVES

It is a concern that public health measures to prevent older people contracting COVID-19 could lead to a rise in mental health problems such as depression. The aim of this study therefore is to examine trends of depressive symptoms before and during the COVID-19 pandemic in a large cohort of older people.

DESIGN

Observational study with 6-year follow-up.

SETTING & PARTICIPANTS

More than 3000 community-dwelling adults aged ≥60 years participating in The Irish Longitudinal Study on Ageing (TILDA).

METHODS

Mixed effects multilevel models were used to describe trends in depressive symptoms across 3 waves of TILDA: wave 4 (2016), wave 5 (2018), and a final wave conducted July-November 2020. Depressive symptoms were measured using the 8-item Center for Epidemiologic Studies Depression Scale (CES-D), with a score ≥9 indicating clinically significant symptoms.

RESULTS

The prevalence of clinically significant depressive symptoms at waves 4 and 5 was 7.2% [95% confidence interval (CI) 6.5, 7.9] and 7.2% (95% CI 6.5, 8.0), respectively. This more than doubled to 19.8% (95% CI 18.5, 21.2) during the COVID-19 pandemic. There was no change in CES-D scores between waves 4 and 5 (β = 0.09, 95% CI -0.04, 0.23), but a large increase in symptoms was observed during the pandemic (β = 2.20, 95% CI 2.07, 2.33). Age ≥70 years was independently associated with depressive symptoms (β = 0.45, 95% CI 0.18, 0.72) during the pandemic but not from wave 4 to 5 (β = 0.09, 95% CI -0.18, 0.36). Living with others was associated with a lower burden of symptoms during the pandemic (β = -0.40, 95% CI -0.71, -0.09) but not between waves 4 and 5 (β = -0.40, 95% CI -0.71, -0.09).

CONCLUSIONS AND IMPLICATIONS

This study demonstrates significant increases in the burden of depressive symptoms among older people during the COVID-19 pandemic, particularly those aged ≥70 years and/or living alone. Even a small increase in the incidence of late life depression can have major implications for health care systems and societies in general. Improving access to age-attuned mental health care should therefore be a priority.

Effects of Urban Park Quality, Environmental Perception, and Leisure Activity on Well-Being among the Older Population

Previous studies have shown that natural environments and leisure activities can reduce depression and increase well-being. Urban parks are important for the psychological well-being of middle-aged and older adults. However, it remains unknown whether the relationship between environmental perceptions, leisure activity, and well-being is affected by the quality of park environments. This study uses a cross-level framework to examine the effects of urban park quality on middle-aged and older adults’ environmental perceptions, leisure activity, and well-being. The Neighborhood Green Space Tool was used to assess the environmental quality of 19 parks, and 380 individuals aged 55 years and older were interviewed in each park using an on-site questionnaire. The results reveal that the associations between environmental perception and well-being were moderated by the quality of park accessibility, amenities, and incivilities; the effect of environmental perception on depression was moderated by the quality of incivilities in parks; and the effect of frequency of leisure activities on depression was moderated by the quality of park accessibility.

Bi-directional relationships between physical activity and mental health among a large sample of Canadian youth: a sex-stratified analysis of students in the COMPASS study

OBJECTIVE

The aim of this research was to examine the bidirectional association between self-reported symptoms of mental disorder and physical activity among a large sample of Canadian secondary school students over time.

METHODS

Linked survey data were obtained from 28,567 grade 9 to 12 students across Canada participating in two waves of the COMPASS Study (2017-18; 2018-19). Autoregressive cross-lagged models were run to examine the reciprocal relationships between self-reported moderate-to-vigorous physical activity (MVPA) and symptoms of depression (CESD-10) and anxiety (GAD-7). Models were stratified by gender, and accounted for grade, ethno-racial identity, and school-level clustering.

RESULTS

Autoregressive associations show that neither symptoms of anxiety nor depression, at baseline, were predictive of mean MVPA at follow-up - consistent for the full sample and among both males and females. Higher MVPA among males at baseline was associated with lower symptoms of both anxiety (β = - 0.03, p = 0.002) and depression (β = - 0.05, p < 0.001) at follow-up. However, among females, higher MVPA at baseline was associated with greater symptoms of anxiety (β = 0.03, p < 0.001), but not symptoms of depression (β = 0.01, p = 0.073), at follow-up.

CONCLUSION

In our large sample of Canadian secondary school students, associations between physical activity and symptoms of mental disorder were not bi-directional, and these relationships differed in males and females. This study illustrates the complex nature of the relationship between physical activity and symptoms of mental disorder among youth. While results support the benefits of promoting physical activity among males to prevent or manage internalizing symptoms, the relationship among females warrants further investigation.

Regular Physical Activities and Related Factors among Middle-Aged and Older Adults in Jinan, China: A Cross-Sectional Study

The objective of this study was to investigate the prevalence of regular physical activity (RPA) among middle-aged and older adults in urban communities in Jinan, China, and to identify the factors related to RPA. A cross-sectional survey was conducted among middle-aged and elderly urban residents. A total of 1406 participants were included in the final data analysis. The results of the four models consistently showed that the relevant factors of RPA were educational level, previously diagnosed hypertension (PDH) and depression. In terms of educational level, compared with illiteracy, from the first model to the fourth model, the odds ratios (ORs) and 95% confidence intervals (CIs) of senior middle school were 2.072 (1.418, 3.026), 2.072 (1.418, 3.026), 1.905 (1.289, 2.816) and 1.926 (1.302, 2.848), respectively, and the ORs and 95% CIs of college or above were 2.364 (1.462, 3.823), 2.364 (1.462, 3.823), 2.001 (1.208, 3.312) and 2.054 (1.239, 3.405). In terms of PDH, compared with those with PDH, from the first model to the fourth model, ORs and 95% CIs of non-PDH were 1.259 (1.003, 1.580), 1.259 (1.003, 1.580), 1.263 (1.006, 1.585) and 1.261 (1.004, 1.584), respectively. For depression, compared with those without depression, also from the first model to the fourth model, ORs and 95% CIs of depression were 0.702 (0.517, 0.951), 0.702 (0.517, 0.951), 0.722 (0.532, 0.981) and 0.719 (0.529, 0.977), respectively. In conclusion, the results of this study showed that participation in RPA among middle-aged and older adults in Jinan urban communities was significantly associated with education level, PDH and depression.

Gender-specific factors associated with risk of depression among Lebanese older adults

BACKGROUND

Depression among older adults is a frequent and underdiagnosed condition. However, there is a paucity of research on mental health problems among elderly people in Arab countries. The purpose of this study was to describe the risk of depression among a representative sample of older Lebanese adults living in rural areas and to identify gender-specific factors associated with depression risk.

METHODS

This study included a randomly selected sample of 823 rural elderly people aged ≥65 years without cognitive decline. Data, including sociodemographic characteristics, living condition, health and functional status, were collected during face-to-face interviews. Depression was assessed by the five-item Geriatric Depression Scale.

RESULTS

Risk for depression was significantly higher in women than in men (39.5% vs 26.2%, P < 0.001). Among men, reporting a higher versus a lower income (adjusted odds ratio (AOR) = 0.299) and being physically active significantly decreased the odds of depressive symptoms. In addition, physical disability (AOR = 3.03) and a high level of loneliness (AOR = 41.76) were significantly related to an increased risk of depression. Among women, daily or occasional physical activity was related to a reduced risk of depression compared to sedentary lifestyles (AOR = 0.35; AOR = 0.50). Furthermore digestive symptoms (AOR = 1.98), poor nutritional status (AOR = 1.99), and strong feelings of loneliness (AOR = 10.86) were significantly related to an increased odds of depression.

CONCLUSION

Elderly Lebanese people, especially women, were at high risk for depression. Among other gender-specific factors, loneliness was strongly associated with depressive disorders in both genders, with a four times greater odds ratio in men than in women.

Physical activity and depression in older adults: the knowns and unknowns

This study provides a comprehensive and updated review of the literature with respect to the relationship between physical activity and depression in older adults. The evidence from both observational studies and experimental studies are collected to present a discussion on the type and dose of physical activity, as well as the underlying mechanisms of physical activity and depression in older adults. Overall, the results from previous studies support a solid inverse relationship between physical activity and depression in older adults, while the dose-effect relationship between them, as well as different effects among different types of physical activities, remains largely unexplored. Depression in older adults is related to an array of negative health outcomes and is more chronic compared to that in younger adults. Physical activity has been regarded as a promising non-pharmaceutical method in treating and preventing depression in older adults. Further experimental work and research need to be done to develop theoretically grounded and evidence-based interventions to better advance our knowledge of this topic and effectively promote physical activity in older adults.

A dose response relationship between accelerometer assessed daily steps and depressive symptoms in older adults: a two-year cohort study

OBJECTIVES

this study investigated the prospective associations of accelerometer assessed daily steps with subsequent depressive symptoms in older adults.

METHODS

a 2-year prospective study was performed in the community. A total of 285 older adults ≥65 years (mean age = 74.5) attended the baseline assessment in 2012. The second wave of assessment was carried out in 2014 including 274 (96.1%) participants. Daily step counts were measured with a triaxial accelerometer (ActiGraph GT3X+), and participants were divided into three categories (<3,500, 3,500-6,999 and ≥ 7,000 steps/day). The 15-item Geriatric Depression Scale was used to measure depressive symptoms. Negative binomial regression models with multivariable adjustment for covariates (baseline depressive symptoms, accelerometer wear time, age, gender, education, chronic disease, activities of daily living) were conducted to examine the association between daily steps and subsequent depressive symptoms.

RESULTS

each 1,000-step increase in daily walking was linearly associated with a reduced rate of subsequent depressive symptoms (rate ratio [RR] = 0.95, 95% confidence interval [CI] = 0.92-0.98). Participants with daily step count in 3,500-6,999 (RR = 0.84, 95% CI = 0.70-0.99) and ≥7,000 steps (RR = 0.71, 95% CI = 0.55-0.92) per day had fewer depressive symptoms at follow-up. Sensitivity analyses assessing confounding and reverse causation provided further support for the stability of our findings.

CONCLUSION

older adults engaging in more daily steps had fewer depressive symptoms after 2 years. Even as few as 3,500-6,999 steps a day was associated with a protecting effect. Accumulating ≥7,000 steps a day could provide the greatest protection against depressive symptoms.

The Cross-Lagged Panel Analysis between Frailty and Physical Activity among Community-Dwelling Older Adults by Age Groups

Objectives: This study was to investigate the reciprocal relationship between frailty and physical activity among older adults by age group (middle-old: 70-79 years; oldest-old: 80-84 years) within 2 years using cross-lagged panel analysis. Methods: The study data were derived from the Korean Frailty and Aging Cohort Study, and a total of 1092 participants were included. Results: Frailty and high physical activity had significant reciprocal relationships in the middle-old group, which indicates that frailty was associated with less high physical activity, and high physical activity predicts less frailty after 2 years. In the oldest-old group, there was no statistically significant reciprocal relationship between frailty and any level of physical activity reference to low physical activity and vice versa after 2 years. Discussion: Further studies on the relationship between frailty and physical activity of the oldest-old population and specific physical activity guidelines for older adults are needed.

Relationship Between Physical Activity, Depressive Symptoms and Low Back Pain Related Disability in Older Adults With Low Back Pain: A Cross-Sectional Mediation Analysis

Low back pain (LBP) can be less disabling in those who are physically active. This study analyzed the association between physical activity (PA)- and LBP-related disability in older people with LBP, exploring if this association was mediated by depressive symptoms. The authors analyzed the relationship between PA levels and disability using the short version of the International Physical Activity Questionnaire and the Roland-Morris Disability Questionnaire, respectively, collected at baseline from the Brazilian Back Complaints in the Elders study. The authors investigated depressive symptoms as a mediator of this association using the Center of Epidemiologic Studies Depression scale. PA was inversely associated with disability. This association was smaller when considering the indirect effect through depressive symptoms. Thus, depressive symptoms partially mediated the association between PA and disability in older adults with LBP, and higher levels of PA were associated with less depressive symptoms and disability.

A cross-lagged model of depressive symptoms and mobility disability among middle-aged and older Chinese adults with arthritis

AIM

To examine the reciprocal and longitudinal associations between depressive symptoms and mobility disability in middle-aged and older Chinese adults with arthritis.

METHODS

We used three waves of the China Health and Retirement Longitudinal Study. The analytic sample included 4682 community-dwelling adults aged ≥45 years with arthritis who completed the self-report measurement of depressive symptoms and mobility disability every 2 years over a 4-year study period. Analysis involved an autoregressive cross-lagged model.

RESULTS

The prevalence rates of comorbid depressive symptoms and mobility disability were 38.9%, 33.2% and 38.9%, respectively across three waves. There was a significant bidirectional and longitudinal relationship between depressive symptoms and mobility disability among middle-aged and older Chinese adults with arthritis. A higher level of depressive symptoms in previous waves was associated with a subsequent increase in mobility disability over time. A similar pattern was also shown in the opposite direction from mobility disability to depressive symptoms over time.

CONCLUSIONS

This study demonstrates that depressive symptoms and mobility disability are reciprocally related in Chinese adults with arthritis over time. In addition, it highlights the importance of early interventions aimed at reversing the downward spiral of depressive symptoms and mobility disability to improve the health of Chinese adults with arthritis. Geriatr Gerontol Int 2020; 20: 873-877.

Relationships among Leisure Physical Activity, Sedentary Lifestyle, Physical Fitness, and Happiness in Adults 65 Years or Older in Taiwan

The purpose of this study is to understand the relationship among leisure physical activity, sedentary lifestyle, physical fitness, and happiness in healthy elderly adults aged over 65 years old in Taiwan. Data were recruited from the National Physical Fitness Survey in Taiwan, which was proposed in the Project on the Establishment of Physical Fitness Testing Stations by the Sports Administration of the Ministry of Education. Participants were recruited from fitness testing stations set up in 22 counties and cities from October 2015 to May 2016. A total of 20,111 healthy older adults aged 65-102 years were recruited as research participants. The fitness testing procedure was described to all participants, who were provided with a standardized structured questionnaire. Participants' data included sex, city or county of residence, living status (living together with others or living alone), education level, and income. Physical fitness testing was conducted in accordance with The Fitness Guide for Older Adults published by the Sports Administration of the Ministry of Education. The testing involved cardiorespiratory endurance, muscle strength, muscle endurance, flexibility, balance, and body composition. The t-test was used to evaluate the differences between continuous and grade variables under the two classification variables of sex, city or county of residence, and living status. We used the MARS (multivariate adaptive regression splines) model to analyze the effects of physical fitness variables and leisure physical activity variables on happiness. Among healthy elderly adults, sex, age, living status, body mass index, and leisure physical activity habits proved to be related to happiness. Aerobic endurance (2-min step test), muscular strength and endurance (30-s arm curl and 30-s chair stand tests), flexibility (back stretch and chair sit-and-reach tests), and balance ability (8-foot up-and-go tests and one-leg stance with eyes open tests) were found to be related to happiness. The results of this study indicate that increased physical activity and intensity, as well as physical fitness performance, are associated with improved happiness.

Examination of the Correlation Between Physical and Psychological Measures in Community-Dwelling Older Adults

INTRODUCTION

The purpose of this study was to determine if correlations exist between strength and mobility and psychological measures of anxiety and depression in community-dwelling older adults.

METHODS

One hundred and eleven participants randomly completed trials of grip strength (GS), the Timed Up and Go (TUG), the 10-meter walk test (10MWT), the Geriatric Anxiety Scale (GAS), and the Geriatric Depression Scale (GDS) in a prospective, correlational study.

RESULTS

This study found significant correlations between and within physical measures of strength and mobility and psychological measures. Age, GS, GDS, and education were significant predictors of gait speed (10MWT). Age, GS, and GDS were predictors of TUG scores. Grip strength was found to be a significant predictor of fall status; fallers had significantly weaker GS than non-fallers. Symptoms of anxiety (GAS) were predictive of symptoms of depression.

DISCUSSION

Objective measures of physical performance can provide information regarding an individual's symptoms of anxiety and depression. Health professionals should understand the correlations between mood and physical ability to better treat their patients.

Cultural adaptation and psychometric adequacy of the Persian version of the physical activity scale for the elderly (P-PASE)

OBJECTIVE

This cross sectional study was conducted to investigate cultural adaption and validation of the Persian version of the PASE among the elderly community dwellers in Iran. Out of 278 elderly people, 65% of them were female. After translation and cultural adaption, the PASE was evaluated with respect to the validity and reliability. Regarding the construct validity, the concurrent validity was assessed between the PASE and ADL, IADL, self-rated health, and TUG test.

RESULTS

The mean score of P-PASE was equal to 153.73 ± 48.47. P-PASE scores were significantly and negatively correlated with TUG (r = - 0.691, P < 0.001) and age (r = - 791, P > 0.001), and were also significantly correlated with ADL (r = 0.775, P < 0.001), and IADL (r = 0.161, P < 0.001). The ICC was obtained as 0.92 (95% CI 0.90-0.94), 0.86 (95% CI 0.82-0.87), and 0.91 (95% CI 0.90-0.94) for the leisure time activity, household activity, and work-related activity scores, respectively. The Cronbachs̓ alpha coefficient was equal to 0.74, 0.74, and 0.79, respectively for leisure time activity, household activity, and work-related activity domains.

Intensity, frequency, duration, and volume of physical activity and its association with risk of depression in middle- and older-aged Chinese: Evidence from the China Health and Retirement Longitudinal Study, 2015

Background

The general benefit of physical activity (PA) to one’s mental health has been widely acknowledged. Nevertheless, the specific type and amount of PA that associates with lower risk of depression in China awaits further investigation. The present study was conducted on middle- and older-aged Chinese population with two objectives: 1) to understand the patterns of PA; 2) to measure the associations between depression and PA at different levels from various aspects.

Methods

Using data from the China Health and Retirement Longitudinal Study (CHARLS, 2015), we selected 9118 community residents aged 45 years and older. Depressive symptoms were measured by 10-item Center for Epidemiologic Studies (CES-D 10). Multivariate logistic regression model was performed to examine the association between risk of depression and PA from four aspects including intensity, frequency, duration, and volume.

Results

Spending 1–2 days/week (OR = 0.58, 95% CI: 0.36, 0.91), less than 30 minutes each time (OR = 0.66, 95% CI: 0.42, 1.03) or 150–299 min/week (OR = 0.49, 95% CI: 0.28, 0.87) on Moderate Physical Activity (MPA) was associated with lower odds of depression in women. Spending 3–5 days/week (OR = 1.98, 95% CI: 1.29, 3.05) or 6–7 days/week (OR = 1.50, 95% CI: 1.07, 2.11), 4 hours and longer each time (OR = 1.65, 95% CI: 1.18, 2.32), 300 min/week or longer (OR = 1.65, 95% CI: 1.22, 2.24) on Vigorous Physical Activity (VPA) in total, or 2250 Metabolic Equivalent of Task (OR = 1.73, 95% CI: 1.26, 2.38) on Moderate-to-Vigorous PA was associated with higher risk of depression in men.

Conclusions

The association between depression and PA depended largely on intensity and gender. Lower frequency, shorter duration, and moderate amount of MPA was associated with lower risk of depression in women. Risk of depression was higher in men who spent higher frequency, longer duration, and overlong time on VPA.

Engagement in physical activity, suicidal thoughts and suicide attempts among older people in five developing countries

BACKGROUND

Suicide causes rising economic costs and public health risks for communities in the worldwide. Physical activity (PA) is considered a potentially feasible approach to reduce risk of suicide with low cost and high accessibility, and therefore attracting increasing attention. However, current literature on the association between PA and suicidal behavior amongst elderly people in low- and middle-income countries (LMICs) are scarce. Therefore, in this study we aimed to examine the relationship between suicidal thoughts (ST) and suicidal attempts (SA) with PA among elderly people in five LMICs.

METHODS

Cross-sectional data were collected from WHO's Study of Global Ageing and Adult Health (SAGE) with 2,861 participants aged 50 years or above. Variables included: self-reported occurrence of ST and SA during past 12 months and four types of PA (vigorous physical activity (VPA), moderate physical activity (MPA), walking/bike riding, moderate leisure time physical activity (MLPA)).

RESULTS

The overall prevalence of taking >75 min of VPA/week, >150 min/week, MLPA and walking/bike riding were, respectively, 85.4% (95% CI [81.3-88.7]), 61.6% (95% CI [52.9-69.6]), 9.6% (95% CI [7.2-12.6]) and 75.1% (95% CI [68.7-80.6]). Respectively, 31.0% (95% CI [24.3-38.7]) and 5.5% (95% CI [3.9-7.5]) of the respondents reported having morbid thoughts and SA during last 12 months. In adjusted multivariable regression analysis, not engaging in PA revealed positive association with higher odds of having morbid thoughts and SA, however, with varying degrees for different types of PA among men and women and across countries. The adjusted odds ratio among elderly who encountered ST increased significantly with PA levels (1.265 in male and 1.509 in female with VPA, 1.292 in male and 1.449 in female with MPA, 1.669 in female with LMPA and 3.039 in women with walk/bike); similarly, with SA (1.526, 1.532, 1.474 and 1.392 in women with VPA, MPA, LMPA and Walk/bike, respectively). The degree of adjusted odds ratio varied between genders and among countries.

CONCLUSION

Although the data were cross-sectional, and no linear dose-response relationship was observed between PA and morbid thought and suicide ideation, the findings provide important indications of potential harmful effects of no/inadequate PA on psychological morbidities among older individuals. Promoting adequate PA among older individuals through community-based suicide prevention programs can potentially contribute to reduction in the burden of PA in LMICs.

Association between health behaviors and mood disorders among the elderly: a community-based cohort study

BACKGROUND

According to a WHO report, nearly 15% of adults aged 60 and over suffer from a mental disorder, constituting 6.6% of the total disability for this age group. Taipei City faces rapid transformation towards an aging society, with the proportion of elderly in the total population rising from 12% in 2008 to 16% in 2016. The aim of this study is to identify the prevalence of mental disorders among the elderly in Taipei City and to elucidate risk factors contributing to mental disorders.

METHODS

The elderly health examination database was obtained from the Department of Health, Taipei City government, from 2005 to 2012. A total of 86,061 people underwent publicly funded health examinations, with 348,067 visits. Each year, there are around 43,000 elderly persons in Taipei City using this service. We used a mental health questionnaire including five questions to estimated relative risks among potential risk factors with the generalized estimating equations (GEE) model to measure the mental health status of the elderly. Mood disorders were measured with the Brief Symptom Rating Scale (BSRS-5) questionnaire. Age, education level, gender, marital status, living alone, drinking milk, eating vegetables and fruits, long-term medication, smoking status, frequency of alcohol consumption, frequency of physical activity, BMI, and number of chronic diseases were included as covariates.

RESULTS

The results show that being male (odds ratio (OR) 0.57; 95% CI = 0.56, 0.59), higher education (OR 0.88; 95% CI = 0.82, 0.95), no long-term medication (OR 0.57; 95% CI = 0.56, 0.58), and exercising three or more times per week (OR 0.94; 95% CI = 0.91, 0.98) were all positively correlated with better emotional status. However, being divorced (OR = 1.22, 95% CI = 1.09, 1.36), not drinking milk (OR = 1.12, 95% CI = 1.09, 1.14), not eating enough vegetables and fruits every day (OR = 1.78, 95% CI = 1.73, 1.83), daily smoking (OR = 1.15, 95% CI = 1.01, 1.32), and having more chronic diseases (OR = 1.02, 95% CI = 1.01, 1.03) were all correlated with poor mental status among the elderly.

CONCLUSIONS

The findings of this research can both estimate the prevalence of mood disorders at the community level, and identify risk factors of mood disorders at the personal level.

Leisure time activities as mediating variables in functional disability progression: An application of parallel latent growth curve modeling

Objectives

The aims of this study were to investigate (1) whether and (2) the extent to which Taiwanese older adults’ leisure time activity (LTA) trajectories mediated the potential association between their sociodemographic factors and their functional disability trajectories.

Methods

Longitudinal data from four waves of the Taiwan Longitudinal Study on Aging (TLSA), collected between 1996 and 2007, were used for analysis (N = 3,429). Parallel-process latent growth curve modeling was adopted to evaluate the process by which LTA mediated between sociodemographic factors (age, gender, education, self-rated health, comorbidities, and depression) and the outcome process of functional disabilities.

Results

When mediated by baseline level of LTA, five sociodemographic factors—age, gender, education level, self-rated health, and number of comorbidities—had significant and negative mediating effects on baseline or change in functional disability, thus improving disability outcomes. However, four of the sociodemographic factors (age, education level, and number of comorbidities), when mediated through the rate of change in LTA, were found to have significant and positive mediating effects, which increased disability levels. The proportion of effects mediated by the LTA trajectory ranged from 0% to 194%.

Discussion

The large proportion of effects mediated through the LTA process underlines the importance of LTA to public health policy and health programs for older adults. The study’s findings shed light on how to better target populations of older adults to promote an active lifestyle and achieve more successful aging in late life in Asian countries.

Designing programmes of physical activity through sport: learning from a widening participation intervention, 'City of Football'

Background

Implementation profoundly influences how well new audiences engage with sport-based physical activity programmes. Recognising that effective implementation relies on concurrently generating supportive contexts, systems and networks for the least engaged ‘target’ groups; this paper aims to address what underpins children’s (non) engagement with football-based physical activity.

Methods

An observational research design, using a non-probability sample of N = 594 primary and secondary schoolchildren assessed outcomes of a three-year ‘City of Football’ (CoF) programme. Pupils self-reported football participation, personal friendship networks and exposure to six concurrent sources of influence (SoI). A 2-step hierarchical cluster analysis and univariate analyses assessed between-cluster differences.

Results

Girls played football least regularly (χ² [4] = 86.722, p = 0.000). Overall, participation was significantly associated with personal networks engaged in football. Boys’ personal networks were more stable and structurally effective. Football participation was also positively and linearly association with SoI scores. Girls and pupils with no personal networks around football reported the lowest SoI scores. Three clusters emerged, dominated by social network influences. The Traditional Market (n = 157, 27.7%) comprised 81.7% boys; they regularly played football, had the most effective network structure and scored highly across all six domains of SoI. The Sporadically Engaging Socialisers (n = 190, 33.5%) comprised 52.9% girls who rarely played football, reported low SoI scores and an inferior network structure. In the Disconnected cluster (n = 220, 38.8%), 59.3% were non-footballing girls who reported the lowest motivation and ability SoI scores; and no personal networks engaged in football.

Conclusions

This study reveals new insights about the primacy of social network effects for engaging children in football-based physical activity programmes. With little or no attention to these social-oriented issues, such interventions will struggle to attract ‘target’ children, but will readily engage already well-connected, experienced football-playing boys. The challenge for drawing non-footballing children into football-based interventions lies with engaging children – especially girls - whose social networks are not football-focused, while they also find football neither personally motivating nor easy to do.

Change in health and social factors in mid-adulthood and corresponding changes in leisure-time physical inactivity in a prospective cohort

Background

To identify whether changes in adult health and social factors are associated with simultaneous changes in inactivity.

Methods

Health, social factors and leisure-time inactivity (activity frequency < 1/week) were self-reported at 33y and 50y in the 1958 British birth cohort (N = 12,271). Baseline (33y) health and social factors and also patterns of change in factors 33y-to-50y were related to inactivity 33y-to-50y (never inactive, persistently inactive, deteriorating to inactivity, or improving from inactivity) using multinomial logistic regression.

Results

Approximately 31% were inactive at 33y and 50y; 35% changed status 33y-to-50y (17% deteriorating to inactivity, 18% improving from inactivity). Baseline poor health and obesity were associated with subsequent (33y-to-50y) inactivity; e.g. for poor health, relative risk ratios (RRRs) for deteriorating to inactivity (vs never inactive) and improving from inactivity (vs persistently inactive) were 1.38(1.16,1.64) and 0.77(0.63,0.94) respectively. Adverse changes in health and weight were associated with simultaneous adverse changes in inactivity; e.g. worsening health (vs always good/excellent health) was associated with higher risk of deteriorating to inactivity (RRR:2.20(1.85,2.62)) and lower risk of improving from inactivity (RRR:0.61(0.49,0.77)). However, improving health and weight loss were not associated with improving from inactivity. Worsening self-efficacy 33y-to-50y was associated with lower risk of improving from inactivity; there was no association between improving self-efficacy and inactivity change. Downward social mobility was not associated with deteriorating to or improving from inactivity. Changes in depression symptom level, marriage/co-habitation or parenthood 33y-to-50y were not associated with inactivity changes. No associations were observed for employment.

Conclusions

Associated changes in mid-life health factors with deleterious inactivity changes, highlight the importance of maintaining health, weight and self-efficacy across adulthood to deter inactivity.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0723-z) contains supplementary material, which is available to authorized users.

Sedentary behaviors, physical activity, and changes in depression and psychological distress symptoms in older adults

BACKGROUND

Television (TV) viewing and computer use have been associated with higher risk of depression, but studies specifically assessing the impact of these and other types of sedentary behaviors (SBs) on the mental health of older adults are scarce and their results are inconclusive. Similarly, the association between specific types of recreational physical activity (rPA) and mental health in older adults is poorly understood.

METHODS

In 2012, information on SBs, rPA, and other health behaviors was collected with validated questionnaires from community-dwelling older adults participating in the Seniors-ENRICA cohort. In 2012 and 2015, symptoms of depression and mental distress were assessed using the GDS-10 and the General Health Questionnaire-12 (GHQ-12), respectively.

RESULTS

Time spent watching TV was prospectively associated with higher (worse) GDS-10 scores in women (β [95% confidence interval (CI)] comparing the second and third tertiles of TV viewing to the first: 0.21 [-0.04 to 0.46] and 0.37 [0.13-0.62], respectively; P-trend: < 0.01), but not in men (-0.11 [-0.35 to 0.13] and -0.18 [-0.44 to 0.08]; P-trend: 0.16). Women, but not men, who spent more time in other SBs, including reading, using the computer and commuting, showed a lower number of depressive symptoms (-0.19 [-0.44 to 0.06] and -0.34 [-0.60 to -0.08]; P-trend: 0.01) and lower (better) GHQ-12 scores (-0.33 [-0.67 to -0.00] and -0.35 [-0.69 to -0.00]; P-trend: 0.05) at follow-up. Both in men and women, higher levels of rPA, such as walking, practicing sports, and do-it-yourself activities, were associated with lower GDS-10 scores (-0.07 [-0.25 to 0.11] and -0.19 [-0.36 to -0.01]; P-trend: 0.04) and with lower GHQ-12 scores (-0.02 [-0.26 to 0.22] and -0.23 [-0.47 to -0.00]; P-trend: 0.06).

CONCLUSIONS

Older women who spent more time watching TV and less time in other SBs showed a higher number of depressive symptoms. Data suggest that increasing rPA may improve mental health in older adults, particularly among women.

Factors associated with physical activity of women aged over 75 in South Korea

Physical activity (PA) and the activity-related factors of aged women dwelling in a city community of Korea were examined for 253 participants aged over 75, regarding their socio-demographic characteristics, health status, physical performance, depression, cognitive function, self-efficacy, outcome expectations, and PA. Descriptive statistics, analysis of covariance, Pearson correlation, and multiple regressions were performed to analyze cross-sectional data. The data indicated the participants carry out low-intensity physical activities, such as house chores, light gardening, and walking for pleasure. Moderate and vigorous-intensity physical activities were performed rare. The frequency per week was 15.62±8.60 for all listed activities. Frequency of PA decreased significantly in participants aged over 80, of poor perceived health, depression, and cognitive decline. There was a negative correlation between PA and the figure 8 walks (r=−0.20, P=0.002). PA showed significantly positive correlation with self-efficacy (r=0.34, P=0.001) and outcome expectations (r=0.36, P=0.001). In a regression analysis, explanation rate of factors influencing PA was 21.9 % (P=0.001). Outcome expectations (β=0.23), cognitive function (β= −0.20), and self-efficacy (β=0.19) influenced the PA. These findings indicate that interventions stimulating cognitive function and enhancing positive expectation and self-confidence should be included for PA promotion of older women aged 75 years and over.

Self-Perceived Health and Sleep Quality of Community Older Adults after Acupunch Exercises

OBJECTIVES

To test the long-term effects of the 12-month Healthy Beat Acupunch (HBA) exercise program on the self-perceived health and sleep quality of older adults in community care centers, and to compare the effects of two delivery methods: instructor-led HBA for the first 6 months and DVD-guided HBA for another 6 months.

DESIGN

Cluster-randomized controlled trial.

SETTING

Eight community care centers.

PARTICIPANTS

In total, 232 participants were recruited from eight community care centers, and cluster-randomized to the experimental (4 centers, N = 113) and control (4 centers, N = 119) groups.

INTERVENTION

The experimental group received the instructor-led HBA program 3 times weekly for the first 6 months, followed by the DVD-guided HBA program for another 6 months.

MEASUREMENTS

Self-perceived health and sleep quality were assessed using the Short Form Health Survey and the Pittsburgh Sleep Quality Index, respectively, at baseline and every 3 months for 1 year.

RESULTS

The experimental group reported more favorable self-perceived physical and mental health, higher subjective sleep quality, and less daytime dysfunction than did the control group. Effect sizes of physical health and sleep quality increased from the instructor-led stage to the DVD-guided stage; the effect size of physical health showed the most significant change, increasing from 0.38 in the instructor-led stage to 0.55 in the DVD-guided stage.

CONCLUSIONS

The exercise program consisting of the instructor-led class, followed by the DVD-guided class, was an effective and feasible longitudinal program for older adults in community care centers.

The reciprocal relationship between physical activity and depression: Does age matter?

BACKGROUND

The level of physical activity (PA) and the prevalence of depression both change across the lifespan. We examined whether the association between PA and depression is moderated by age. As sense of mastery and functional limitations have been previously associated with low PA and depression in older adults, we also examined whether these are determinants of the differential effect of age on PA and depression.

METHODS

1079 patients with major depressive disorder (aged 18-88 years) were followed-up after two-years; depression diagnosis and severity as well as PA were re-assessed. Linear and logistic regression analyses were used to test reciprocal prospective associations between PA and depression outcomes. In all models the interaction with age was tested.

RESULTS

PA at baseline predicted remission of depressive disorder at follow-up (OR = 1.43 [95% CI: 1.07-1.93], p = .018). This effect was not moderated by age. PA predicted improvement of depression symptom severity in younger (B = -2.03; SE = .88; p = .022), but not in older adults (B = 2.24; SE = 1.48; p = .128) (p = .015 for the interaction PA by age in the whole sample). The level of PA was relatively stable over time. Depression, sense of mastery and functional limitation were for all ages not associated with PA at follow-up.

CONCLUSIONS

Age did not moderate the impact of PA on depressive disorder remission. Only in younger adults, sufficient PA independently predicts improvement of depressive symptom severity after two-year follow-up. Level of PA rarely changed over time, and none of the determinants tested predicted change in PA, independent of age.

Behavioral protective factors of increased depressive symptoms in community-dwelling older adults: A prospective cohort study

BACKGROUND

It remains unclear what kinds of behavior prevent the development of geriatric depression. This study aimed to elucidate behavioral predictors of increased depressive symptoms in older adults focusing on gender differences.

METHODS

A total of 3106 community-dwelling older people aged older than or equal to 65 years without depressive symptoms at baseline participated. The 15-item Geriatric Depression Scale was used to assess depressive symptoms with a score of 6 or more at baseline and 15 month follow-up. Behavioral status was investigated by using dichotomous questions about the aspects of physical, cognitive, and social activities. Each category included 3 specific items. Demographic data and other potential confounding factors were also assessed.

RESULTS

In the 15 month follow-up survey, 239 participants (7.7%) reported increased depressive symptoms. Multiple logistic regression analysis indicated that engagement in light physical exercise (odds ratio = 0.74, 95%, CI = 0.56-0.98), taking enrichment lessons (0.62, 0.46-0.85), using a personal computer (0.68, 0.48-0.97), participation in events at the community center (0.54, 0.40-0.72), and attending a community meeting (0.69, 0.52-0.92) were independently associated with lower risk of increased depressive symptoms. In a separate analysis for each gender, significant odds ratios of using a personal computer were observed in men, whereas significant odds ratios of light physical exercise, participation in events at the community center, and attending a community meeting were observed in women.

CONCLUSIONS

Light physical exercise, taking lessons, usage of a computer, and participation in community events showed protective effects against depressive symptoms. However, the significance of each behavioral factor may vary according to gender.

Weight Status, Physical Activity, and Depression in Korean Older Adults

Background

This study aimed to explore the associations between weight status, physical activity, and depression in Korean older adults.

Methods

We used the baseline data drawn from the 2008 baseline survey utilized in the Living Profiles of Older People Survey, comprised of 15,146 community-dwelling older people (42.6% men and 57.4% women) aged 60 years and older residing in the Republic of Korea. After excluding respondents with missing data on height, weight, and physical activity (PA), data on 10,197 samples (43.3% men and 56.7% women) were analyzed in this study.

Results

Underweight and completely inactive individuals had poorer sociodemographic and health behavioral characteristics and increased risks of late-life depression compared with normal weight and sufficiently active individuals, respectively. In terms of the aerobic PA guidelines, completely inactive individuals had a significantly higher risk of late-life depression (odds ratio 1.730; 95% confidence interval, 1.412–2.120) compared with sufficiently active individuals, even after adjustments for age, education, household income, night sleeping, living status, marital status, smoking, number of comorbidities, nutritional status, self-reported health status, and cognitive performance as covariates. In addition, those who did not meet the PA guidelines and were underweight or overweight/obese were more likely to have late-life depression compared to those who were active and normal weight.

Conclusions

The current findings of the study suggest that modifiable, lifestyle risk factors, such as physical inactivity, underweight, and overweight/obesity, are positively associated with late-life depression in Korean older adults.

Understanding temporal relationships between depression, falls, and physical activity in a cohort of post-hospitalized older adults - a breakthrough or a conundrum?

BACKGROUND

Clinical depression affects approximately 15% of community-dwelling older adults, of which half of these cases present in later life. Falls and depressive symptoms are thought to co-exist, while physical activity may protect an older adult from developing depressive symptoms. This study investigates the temporal relationships between depressive symptoms, falls, and participation in physical activities amongst older adults recently discharged following extended hospitalization.

METHODS

A prospective cohort study in which 311 older adults surveyed prior to hospital discharge were assessed monthly post-discharge for six months. N = 218 completed the six-month follow-up. Participants were recruited from hospitals in Melbourne, Australia. The survey instrument used was designed based on Fiske's behavioral model depicting onset and maintenance of depression. The baseline survey collected data on self-reported falls, physical activity levels, and depressive symptoms. The monthly follow-up surveys repeated measurement of these outcomes.

RESULTS

At any assessment point, falls were positively associated with depressive symptoms; depressive symptoms were negatively associated with physical activity levels; and, physical activity levels were negatively associated with falls. When compared with data in the subsequent assessment point, depressive symptoms were positively associated with falls reported over the next month (unadjusted OR: 1.20 (1.12, 1.28)), and physical activity levels were negatively associated with falls reported over the next month (unadjusted OR: 0.97 (0.96, 0.99) household and recreational), both indicating a temporal relationship.

CONCLUSION

Falls, physical activity, and depressive symptoms were inter-associated, and depressive symptoms and low physical activity levels preceded falls. Clear strategies for management of these interconnected problems remain elusive.

Longitudinal Association Between Objectively Measured Walking and Depressive Symptoms Among Estonian Older Adults

Although an inverse correlation between physical activity and depressive symptoms among older adults has been found in research, this relation has seldom been examined prospectively. Accordingly, the current study examined the reciprocal relations between physical activity and depressive symptoms in Estonian older adults over a 2-year period. A three-wave longitudinal model was tested using cross-lagged analysis for 195 individuals aged over 70 years (mean = 72.1, SD = 2.1; 145 females). Results indicated that a cross-lagged model in which depressive symptoms predicted walking at subsequent time points (higher depressive symptoms were related to fewer walking steps), and walking predicted depressive symptoms at subsequent time points (higher walking steps were related to lower depressive symptoms) was most parsimonious and provided acceptable model fit. These results suggest that reduced physical activity may be a long-term consequence of depressive symptoms in older adults.

Is the link between movement and mental health a two-way street? Prospective associations between physical activity, sedentary behaviour and depressive symptoms among women living in socioeconomically disadvantaged neighbourhoods

This study aimed to investigate the bi-directional relationship between different domains of physical activity (PA), sedentary behaviour (SB) and depressive symptoms among women living in socioeconomically disadvantaged neighbourhoods in Victoria, Australia. Women (n=1033), aged 18-46years at Wave 1 (2007/08), completed self-report measures of PA (leisure-time, transport, occupational, domestic), SB (TV viewing, computer use, overall sitting time) and depressive symptoms (CES-D 10) at each study time-point (Wave 2: 2010/11, Wave 3: 2012/13). Separate linear mixed models were fitted to examine if change in depressive symptoms differed dependent on each of the baseline PA or SB measures. Similarly, baseline depressive symptoms were used as a predictor of change in PA and SB. In secondary analyses, associations between baseline PA or SB and odds of becoming 'at risk' of depression among those not 'at risk' at baseline were examined using logistic regression. There was no evidence that change in depressive symptoms differed depending on PA or SB at baseline. In general, there was also no evidence that change in PA or SB differed depending on baseline depressive symptoms. One exception was change in leisure-time PA, which declined more among those with heightened depressive symptoms at baseline (Interaction: β=-0.003, 95% CI=-0.007, -0.0003). Transport-related PA (adjusted OR=1.06, 95% CI=1.013, 1.101) and domestic PA (adjusted OR=1.02, 95% CI=1.003, 1.040) were associated with greater odds of becoming at risk of depression at wave 3. There was limited evidence of a bi-directional relationship between PA, SB and depressive symptoms in women living in socioeconomically disadvantaged neighbourhoods.

Effects of different amounts of exercise on preventing depressive symptoms in community-dwelling older adults: a prospective cohort study in Taiwan

OBJECTIVES

To compare the effects of four different amounts of exercise for preventing depressive symptoms in community-dwelling older adults.

DESIGN

Prospective cohort study.

SETTING

A nationally representative sample in Taiwan.

PARTICIPANTS

Four waves of the survey 'Taiwan Longitudinal Study on Aging (TLSA)' from 1996 to 2007 were analysed. A total of 2673 older adults aged 65 years and over were recruited.

PRIMARY AND SECONDARY OUTCOME MEASURES

Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CESD). Four different types/amounts of exercise were examined including: (1) 3 times/week, 15 min/time; (2) 3 times/week, 30 min/time; (3) 6 times/week, 15 min/time; and (4) 6 times/week, 30 min/time. All exercise types were required to have at least moderate intensity. The impacts of different amounts of exercise on depressive symptoms were analysed using generalised linear mixed models.

RESULTS

More than one-fifth of the elder individuals under consideration had depressive symptoms (CESD ≥10). About 38.6% of older adults met the lowest criteria for exercise type 1, and fewer (28.0%) met the highest criteria for type 4. Only exercise type 4 in the current survey was initially related to lower depressive symptoms (OR=0.8, 95% CI 0.66 to 0.95). However, after considering the interaction between time and changes in exercise patterns, the results showed that all persistent exercise models, even if a very low amount (3 times/week, 15 min/time), had significantly preventive effects on depressive symptoms (OR=0.56~0.67).

CONCLUSION

Consistent exercise with at least 15 min per time, three times a week of moderate intensity is significantly associated with lower risk of depressive symptoms. This low amount of exercise may be easier to promote at the community and population level than other alternatives.

TRIAL REGISTRATION

Registry number 104040 of the Institutional Ethics Committee of Chia-Yi Christian Hospital.

Lifestyles and Mortality in Taiwan: An 11-Year Follow-up Study

The associations of modifiable lifestyle-related factors with cardiovascular and all-cause mortality were examined in a population-based sample of older Taiwanese people. A total of 4176 individuals aged 50 years and older, with 11 years of follow-up, were analyzed. Current and former smokers had a higher risk of all-cause mortality compared with never smokers ([HR = 1.33; 95% CI = 1.12, 1.58], [HR = 1.39; 95% CI = 1.16, 1.68]). Low intake of vegetables and fruits was associated with a significantly higher risk of 1.43 (95% CI = 1.13, 1.81) for cardiovascular mortality and 1.22 (95% CI = 1.09, 1.38) for all-cause mortality. The low physical activity group at baseline who became part of the low, moderate, and high physical activity groups during follow-up had the following risks of cardiovascular mortality: ([HR = 2.89; 95% CI = 1.91, 4.36], [HR = 2.17; 95% CI = 1.29, 3.63], [HR = 1.59; 95% CI = 0.90, 2.82]). Similarly, the moderate physical activity group at baseline who became part of the low, moderate, and high physical activity groups during follow-up had the following risks of cardiovascular mortality: ([HR = 3.52; 95% CI = 2.14, 5.80], [HR = 2.25; 95% CI = 1.34, 3.80], [HR = 1.44; 95% CI = 0.78, 2.66]). The same tendencies were found in all-cause mortality. Smoking, diet, and physical activity were significantly modifiable lifestyle-related factors for mortality.Besides, individuals who decreased their physical activity had a significantly higher risk, whereas those who increased their physical activity had a significantly lower risk.

Combined Associations of Physical Activity and Sedentary Behavior With Depressive Symptoms in Older Adults

The aim of this study was to analyze the association of combined physical activity (PA)/sedentary behaviour (SB) with depressive symptoms (DS) in older adults. A cross-sectional study was conducted with 622 individuals ≥ 60 years old. After adjusting for gender, years of study, and monthly household income, prevalence ratios for presence of DS were statistically significant for older adults with <150 min/week in PA and ≥75th percentile of SB on weekdays (PR = 2.11,95%CI: 1.54-2.90) and on weekends (PR = 2.20,95%CI:1.57-3.09). Older adults who do not meet the PA guidelines and spend more time in SB on weekdays or weekend days are more likely to present with DS compared to those who meet the recommendations of PA and spend less time in SB during the day.

Psychological prognosis after newly diagnosed chronic conditions: socio-demographic and clinical correlates

BACKGROUND

This study was aimed toward discerning depressive symptom trajectories associated with different chronic conditions and toward finding modifiable factors associated with those trajectories.

METHODS

Data were drawn from the 1996-2007 Taiwan Longitudinal Study on Aging. Nine chronic conditions were selected, and mood trajectories were measured with the Center of Epidemiological Studies-Depression scale.

RESULTS

Among the nine chronic conditions we examined, four patterns of depressive symptom trajectories were identified: (1) elevated depressive symptoms and worsened over time after diagnosed with heart disease (n = 681), arthritis (n = 850), or hypertension (n = 1,207); (2) elevated depressive symptoms without worsening over time after diagnosed with stroke (n = 160), lung diseases (n = 432), gastric conditions (n = 691), or liver diseases (n = 234); (3) no elevated depressive symptoms after diagnosis but an increase in depressive symptoms over time for participants with diabetes (n = 499); and (4) no significant patterns after diagnosed with cancer (n = 57). Cumulative psychological burden over time was significant for participants with hypertension, diabetes, heart diseases, or arthritis. However, these effects disappeared after controlling for comorbidities and physical limitations. Moreover, psychiatric condition was found to play an important role in baseline depressive symptoms among participants diagnosed with lung diseases, arthritis, or liver diseases.

CONCLUSIONS

Findings from this study provide information in addressing psychological burden at different times for different conditions. In addition, minimizing the incidence of comorbidities, physical limitations, or psychiatric conditions may have the prospective effect of avoiding the trend of increased depressive symptoms, especially when adults diagnosed with hypertension, diabetes, heart diseases, arthritis, lung diseases, arthritis, or liver diseases.

Examining the bidirectional relationship between physical activity, screen time, and symptoms of anxiety and depression over time during adolescence

More physical activity (PA) and less screen time (ST) are positively associated with mental health in adolescents; however, research is limited by short-term designs and the exclusion of ST when examining PA. We examined: (a) changes in PA, ST, symptoms of depression, and symptoms of anxiety over four assessments spanning 11years, and (b) bidirectional relationships between initial PA, ST, and symptoms of depression and anxiety as predictors of change in each other during adolescence. Between 2006 and 2010, participants from Ottawa Canada (Time1; N=1160, Mean age=13.54years) completed questionnaires at four points covering the ages from 10 to 21years. Latent growth modeling was used. PA decreased over time whereas ST and symptoms of depression and anxiety increased over time. Controlling for sex, ethnicity, school location, zBMI, birth year, and parents' education, initially higher anxiety was associated with initially higher ST (covariance=.88, p<.05) and initially lower PA (covariance=-6.84, p=.07) independent of initial symptoms of depression. Higher initial depression was associated with higher initial ST (covariance=2.55, p<.05). Increases in anxiety were associated with increases in ST (covariance=.07, p=.06) and increases in depression (covariance=.41, p<.05). Examining bidirectional relationships, higher initial symptoms of depression predicted greater decreases in PA (b=-.28, p<.05). No other significant findings between initial PA, ST, anxiety, or depression were found as predictors of change in each other. Interventions targeting depression around age 13 may be useful to prevent further declines in PA. Similarly, interventions to reduce ST may be beneficial for concurrent reductions in symptoms of depression and anxiety, irrespective of PA.

Depression statuses and related predictors in later life: A 10-year follow-up study in Israel

The aim of the current study was to investigate the factors associated with depression statuses in a 10-year follow-up of community-dwelling older adults in Israel. Longitudinal data were used from the Israeli sample of the Survey of Health, Aging and Retirement in Europe, assessing the depressive symptoms in 1042 respondents, aged 50 or above, at three time points: 2004/2005 (Wave I); 2009/2010 (Wave II); and 2014/2015 (Wave III). Multinomial logistic regression was used to determine the relationships among explanatory variables and depression statuses (no-depression, intermittent depression, or persistent depression). Some 46.5 % of the participants suffered from intermittent or persistent depression. Five factors were associated with increasing the probability of both intermittent and persistent depression: being female, unemployed, less educated, physically disabled, and in poor health. Five other explanatory variables were associated only with a higher risk for persistent depression: low family income, widowhood, physical inactivity, more than two chronic diseases, and cognitive dysfunction. According to these findings, depression is common among older people in Israel. Low socio-economic status and poor subjective and physical health are significant determinants of depression statuses over time, underlining the importance of taking measures to improve these conditions in order to reduce the risk of depression in old age.

Prevalence of Depression among Older Adults—Results from the Well-being of the Singapore Elderly Study

Introduction: Depression is a significant public health issue across all sociodemographic groups and is identified as a common and serious mental health problem particularly among the older adult population. The aims of the current study were to determine the prevalence of depression and subsyndromal depression among older adults in Singapore. Materials and Methods: The Well-being of the Singapore Elderly (WiSE) study was a comprehensive single phase, cross-sectional survey. Stage 1 Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) depression syndrome was used for this analysis. Association of depression and subsyndromal depression with sociodemographic characteristics, social support as well as comorbidity with chronic physical illnesses and quality of life was assessed. Results: The prevalence of GMS-AGECAT depression and subsyndromal depression was 3.7% and 13.4%, respectively. The odds of depression were significantly higher among those aged 75 to 84 (2.1) as compared to those aged 60 to 74 years and in those who had a history of depression diagnosis by a doctor (4.1). The odds of depression were higher among those of Indian and Malay ethnicities (5.2 and 3.2 times, respectively) as compared to those of Chinese ethnicity. Those with depression and subsyndromal depression were associated with more disability, poorer life satisfaction, and medical comorbidities. Conclusion: Our study suggests that the prevalence of depression seems to have decreased as compared to a decade ago wherein the prevalence of depression was estimated to be 5.5%. This positive trend can be ascribed to concerted efforts across various disciplines and sectors, which need to be continually strengthened, monitored and evaluated. Key words: Comorbidity, GMS-AGECAT, Social support, Subsyndromal depression