A cohort study of leisure time physical activity and depression

Relationship between fear of falling and quality of life in nursing home residents: The role of activity restriction

This study investigates the mediating role of activity restriction in the relationship between the fear of falling and health outcomes. This was a cross-sectional study with convenience sampling of 316 nursing home residents. Generalized structural equation modeling was conducted to test the mediating role. The results showed that residents with fear of falling were more likely to restrict their activities and residents who often or always restricted activities reported lower levels of quality of life and higher levels of depression. Severe activity restriction accounted for 75 % of the total effect of fear of falling on quality of life and 69 % of the total effect of fear of falling on depression. Fall prevention efforts should focus on strategies or interventions to reduce residents' excessive fear of falling and promote activity engagement. Physical and social activities will not only prevent future falls but also improve residents' quality of life and mental health.

The longitudinal relationship between leisure activities and depressive symptoms among older Chinese adults: an autoregressive cross-lagged analysis approach

BACKGROUND

Existing studies have shown a correlation between leisure activities and depressive symptoms in older adults, but the direction of the longitudinal relationship is inconsistent. This study used an autoregressive cross-lagged model to examine the longitudinal relationship between leisure activity participation and geriatric depression.

METHODS

A total of 7,138 participants aged 60 years or older from the 2nd to the 4th wave of the China Health and Retirement Longitudinal Study (CHARLS) were analysed.

RESULTS

First, present depressive symptoms were significantly associated with future depressive symptoms (β2013-2015 = .893, p < .001; β2015-2018 = .946, p < .001), and the same rule applied to leisure activities (β2013-2015 = .402, p < .001; β2015-2018 = .404, p < .001). Second, current depressive symptoms negatively predicted future leisure activities (β2013-2015 = -.071, p < .001; β2015-2018 = -.085, p < .001), but the inverse relationship was not statistically significant (β2013-2015 = -.003, p > .05; β2015-2018 = -.003, p > .05).

CONCLUSION

These findings underscore the importance of interventions targeting depressive symptoms to potentially enhance engagement in leisure activities among older adults. The results contribute to the understanding of the complex dynamics between mental health and lifestyle choices in older populations, highlighting the potential of proactive mental health interventions to improve overall well-being.

The relationship between physical activity and depressive symptoms in males: A systematic review and meta-analysis

BACKGROUND

The prevalence of depressive symptoms (DS) among physically active individuals tends to be lower compared to sedentary controls. This association seems to be moderated by gender and level of physical activity (PA). The objective of this meta-analysis was to assess the relationship between PA and DS in males based on different levels of PA.

METHODS

A systematic review and meta-analyses were conducted following the PRISMA Statement for Systematic Reviews. The literature search was conducted from January 1, 2003 to February 20, 2023. Cross-sectional and cohort studies including male participants aged 18 years or older were included in the analysis. Evidence from selected studies was synthesised as differences between odds ratios to assess whether DS were exhibited among those who were engaged in low, moderate, and high PA via random-effects meta-analyses. This study is registered on PROSPERO, number CRD42023417219.

RESULTS

Out of 1737 records identified, 5 eligible studies were included with a total of 35,811 participants. Results indicated significant effects of moderate PA on DS (OR = 0.68; 95 % C.I. 0.50-0.93). No effect of low and high PA on DS was found (OR = 0.79; 95 % C.I. 0.52-1.20 and OR = 0.78; 95 % C.I. 0.47-1.30).

CONCLUSION

Males who engage in moderate PA present lower prevalence of DS compared to no-PA reference. Such associations were not found for low or high PA. Hence, mental health benefits of PA could possibly be achieved at appropriate levels of PA. High heterogeneity between the studies should be considered when interpreting the results.

Physical activity, physical frailty and depressive symptoms among Chinese male and female older adults: do different indicators make a difference?

Objectives

Older adults become more inactive and frailer with aging. Physical status is closely linked to mental health, but it is unclear which physical indicator is more strongly associated with depressive symptoms in older adults. The present study aimed to compare relationships between self-reported physical activity, physical frailty (muscle mass, muscle strength, and gait ability) and depressive symptoms in community male and female older adults.

Methods

A total of 1,180 adults aged 60 years and older were recruited to participate in this study from a Chinese community receiving annual check-up service from September 2018 to May 2019. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ). The Bio-electrical Impedance Analyzer was used to determine the muscle mass. As the indicators of muscle function, grip strength and gait ability were assessed by the dynamometer and Timed Up and Go Test (TUGT), respectively. The 15-item version of Geriatric Depression Scale (GDS-15) was used to examine depressive symptoms. Demographic variables, health status and sleep quality were collected using questionnaire.

Results

11.8% men and 11.9% women reported depressive symptoms. Logistic regression showed that depressive symptoms was associated with low grip strength (OR = 2.42, 95% CI: 1.04-5.63), slow gait ability (OR = 3.60, 95% CI: 1.28-10.13) in older males, and associated with low level of self-reported physical activity (OR = 3.85, 95% CI: 2.00-7.42) in older females. No significant association was found between muscle mass and depressive symptoms.

Conclusion

There were gender differences in the relationship between physical activity, physical frailty, and depressive symptoms. Grip strength and gait ability may be a better indicator of frailty for predicting depressive symptoms in older men while physical activity may be useful in predicting depressive symptoms in older women.

Prediction of Incident Depression in Middle-aged and Older Adults Using Digital Gait Biomarkers Extracted From Large-Scale Wrist Sensor Data

OBJECTIVES

To determine if digital gait biomarkers captured by a wrist-worn device can predict the incidence of depressive episodes in middle-age and older people.

DESIGN

Longitudinal cohort study.

SETTING AND PARTICIPANTS

A total of 72,359 participants recruited in the United Kingdom.

METHODS

Participants were assessed at baseline on gait quantity, speed, intensity, quality, walk length distribution, and walk-related arm movement proportions using wrist-worn accelerometers for up to 7 days. Univariable and multivariable Cox proportional-hazard regression models were used to analyze the associations between these parameters and diagnosed incident depressive episodes for up to 9 years.

RESULTS

A total of 1332 participants (1.8%) had incident depressive episodes over a mean of 7.4 ± 1.1 years. All gait variables, except some walk-related arm movement proportions, were significantly associated with the incidence of depressive episodes (P < .05). After adjusting for sociodemographic, lifestyle, and comorbidity covariates; daily running duration, steps per day, and step regularity were identified as independent and significant predictors (P < .001). These associations held consistent in subgroup analysis of older people and individuals with serious medical conditions.

CONCLUSIONS AND IMPLICATIONS

The study findings indicate digital gait quality and quantity biomarkers derived from wrist-worn sensors are important predictors of incident depression in middle-aged and older people. These gait biomarkers may facilitate screening programs for at-risk individuals and the early implementation of preventive measures.

Association between handgrip strength and depression among Chinese older adults: a cross-sectional study from the China Health and Retirement Longitudinal Study

BACKGROUND

Muscle strength and depression have been identified as independent risk factors for mortality in the elderly population. This study aimed to quantify the association between handgrip strength (HGS) and depression in community-dwelling older adults.

METHODS

Research data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CESD) with a cut-off score of 20 or more. HGS was assessed with a dynamometer. Binary logistic regression and multiple linear regression models were used to test the association between HGS and depression.

RESULTS

The sample consisted of 7,036 CHARLS participants, with an average age of 68.9 ± 7.2. After adjusting for gender, age, marriage, body mass index, comorbidities, smoking, drinking, and sleep time, compared with participants in the lowest quartile of HGS, those in the second to the fourth quartile group had a 0.84- (95% CI 0.72 to 0.98), 0.70- (95% CI 0.58 to 0.84) and 0.46- (95% CI 0.35 to 0.61) fold risk of depression, respectively.

CONCLUSIONS

There were a negative association between HGS and depression in community-dwelling older adults. It is critical to assess muscle strength in community older adults through accessible and valid objective measures to enhance depression screening.

Physical activity domains and incident clinical depression: A 4-year follow-up analysis from the ELSA-Brasil cohort

AIM

To analyze the prospective dose-response relationships between total and domain-specific physical activity (PA) with incident clinical depression.

METHODS

We used data from two waves (Wave 1: August/2008-December 2010; Wave 2: September/2012-December/2014) of the Brazilian Longitudinal Health Study (ELSA-Brasil) cohort study. Self-reported PA (total, transport, and leisure-time) was the main exposure. Incident clinical depression (new cases of depression between waves) was assessed through the Clinical Interview Schedule-Revised (CIS-R). Poisson regression models, adjusting for potential confounders, were used for data analysis.

RESULTS

In 12,709 adults (53.8 % women, mean age: 51.9 ± 9.0), moderate and high volumes of total PA (1-149 min/week: RR = 0.81, 0.58-1.13, 150-299 min/week: RR = 0.55, 95%CI: 0.40-0.76; ≥300 min/week: RR = 0.64, 95%CI: 0.52-0.80), and any volume of leisure-time PA (1-149 min/week: RR = 0.65, 95%CI: 0.50-0.83; 150-299 min/week: RR = 0.67, 95%CI: 0.52-0.88; RR = 0.61, 95%CI: 0.45-0.82) were associated with a lower risk of incident clinical depression. Transport PA protective only in the lower category (0.1-4.4 mMET-h/wk) (RR = 0.71, 95%CI: 0.54-0.94).

LIMITATIONS

Other PA domains such as occupational and domestic were not assessed; the use of self-report measures for PA which may be subject to bias and recall issues; lack of assessment of additional potential confounders, such as sedentary behavior and family history of depression.

CONCLUSION

Total and leisure-time PA were associated with lower incidence of clinical depression, even at lower doses. Low, moderate, and high volumes of total and leisure-time PA were associated with lower risk of incident clinical depression. Public health PA interventions aiming to prevent development of clinical depression should consider focusing on leisure-time PA.

Association Between Physical Activity and Risk of Depression: A Systematic Review and Meta-analysis

Importance

Depression is the leading cause of mental health-related disease burden and may be reduced by physical activity, but the dose-response relationship between activity and depression is uncertain.

Objective

To systematically review and meta-analyze the dose-response association between physical activity and incident depression from published prospective studies of adults.

Data Sources

PubMed, SCOPUS, Web of Science, PsycINFO, and the reference lists of systematic reviews retrieved by a systematic search up to December 11, 2020, with no language limits. The date of the search was November 12, 2020.

Study Selection

We included prospective cohort studies reporting physical activity at 3 or more exposure levels and risk estimates for depression with 3000 or more adults and 3 years or longer of follow-up.

Data Extraction and Synthesis

Data extraction was completed independently by 2 extractors and cross-checked for errors. A 2-stage random-effects dose-response meta-analysis was used to synthesize data. Study-specific associations were estimated using generalized least-squares regression and the pooled association was estimated by combining the study-specific coefficients using restricted maximum likelihood.

Main Outcomes and Measures

The outcome of interest was depression, including (1) presence of major depressive disorder indicated by self-report of physician diagnosis, registry data, or diagnostic interviews and (2) elevated depressive symptoms established using validated cutoffs for a depressive screening instrument.

Results

Fifteen studies comprising 191 130 participants and 2 110 588 person-years were included. An inverse curvilinear dose-response association between physical activity and depression was observed, with steeper association gradients at lower activity volumes; heterogeneity was large and significant (I2 = 74%; P < .001). Relative to adults not reporting any activity, those accumulating half the recommended volume of physical activity (4.4 marginal metabolic equivalent task hours per week [mMET-h/wk]) had 18% (95% CI, 13%-23%) lower risk of depression. Adults accumulating the recommended volume of 8.8 mMET hours per week had 25% (95% CI, 18%-32%) lower risk with diminishing potential benefits and higher uncertainty observed beyond that exposure level. There were diminishing additional potential benefits and greater uncertainty at higher volumes of physical activity. Based on an estimate of exposure prevalences among included cohorts, if less active adults had achieved the current physical activity recommendations, 11.5% (95% CI, 7.7%-15.4%) of depression cases could have been prevented.

Conclusions and Relevance

This systematic review and meta-analysis of associations between physical activity and depression suggests significant mental health benefits from being physically active, even at levels below the public health recommendations. Health practitioners should therefore encourage any increase in physical activity to improve mental health.

Physical multimorbidity and depression: A mediation analysis of influential factors among 34,129 adults aged ≥50 years from low- and middle-income countries

BACKGROUND

There is a scarcity of literature on the association between physical multimorbidity (i.e., ≥2 chronic physical conditions) and depression among older adults, especially from low- and middle-income countries (LMICs). In addition, the mediators in this association are largely unknown. Therefore, we aimed to examine this association among adults aged ≥50 years from six LMICs (China, Ghana, India, Mexico, Russia, and South Africa), and to identify potential mediators.

METHODS

Cross-sectional, nationally representative data from the Study on Global Ageing and Adult Health were analyzed. Depression was defined as past-12 months DSM-IV depression or receiving depression treatment in the last 12 months. Information on 11 chronic physical conditions were obtained. Multivariable logistic regression and mediation analyses were conducted.

RESULTS

Data on 34,129 individuals aged ≥50 years were analyzed [mean (SD) age 62.4 (16.0) years; maximum 114 years; 52.1% females]. Compared to no chronic conditions, 2, 3, 4, and ≥5 chronic conditions were associated with 2.55 (95% CI = 1.90-3.42), 3.12 (95% CI = 2.25-4.34), 5.68 (95% CI = 4.02-8.03), and 8.39 (95% CI = 5.87-12.00) times higher odds for depression. Pain/discomfort (% mediated 39.0%), sleep/energy (33.2%), mobility (27.5%), cognition (13.8%), perceived stress (7.3%), disability (6.7%), loneliness (5.5%), and food insecurity (1.5%) were found to be significant mediators in the association between physical multimorbidity and depression.

CONCLUSIONS

Older adults with physical multimorbidity are at increased odds of depression in LMICs. Future studies should assess whether addressing the identified potential mediators in people with physical multimorbidity can lead to reduction in depression in this population.

Interaction Effect between Physical Activity and the BDNF Val66Met Polymorphism on Depression in Women from the PISMA-ep Study

The relationship between depression and the Val66Met polymorphism at the brain-derived neurotrophic factor gene (BDNF), has been largely studied. It has also been related to physical activity, although the results remain inconclusive. The aim of this study is to investigate the relationship between this polymorphism, depression and physical activity in a thoroughly characterised sample of community-based individuals from the PISMA-ep study. A total of 3123 participants from the PISMA-ep study were genotyped for the BDNF Val66Met polymorphism, of which 209 had depression. Our results are in line with previous studies reporting a protective effect of physical activity on depression, specifically in light intensity. Interestingly, we report a gene-environment interaction effect in which Met allele carriers of the BDNF Val66Met polymorphism who reported more hours of physical activity showed a decreased prevalence of depression. This effect was observed in the total sample (OR = 0.95, 95%CI = 0.90–0.99, p = 0.027) and was strengthened in women (OR = 0.93, 95%CI = 0.87–0.98, p = 0.019). These results highlight the potential role of physical activity as a promising therapeutic strategy for preventing and adjuvant treatment of depression and suggest molecular and genetic particularities of depression between sexes.

Sport and Recreational Physical Activities Attenuate the Predictive Association of Multimorbidity With Increased Geriatric Depressive Symptoms: A 14-Year Follow-Up Study of Community-Dwelling Older Adults

Multimorbidity is associated with increased depression risks. Little research examines how physical exercise moderates this association. From an existing cohort of community-dwelling older adults in Hong Kong recruited in 2001-2003, the authors included participants who were successfully interviewed after 14 years (2015-2017). Geriatric depressive symptoms were used as the primary outcome and measured by the 15-item Geriatric Depression Scale, while multimorbidity was operationalized using a list of 19 conditions. Subscores of the Physical Activity Scale for the Elderly measuring light, moderate, and strenuous sport/recreational activities were included as moderators. In total, 1,056 participants were included, of whom 50.7% were multimorbid. Multimorbidity was associated with 12% more geriatric depressive symptoms, but strenuous physical activities were associated with a smaller risk elevation only among multimorbid patients (adjusted relative risk = 0.99, 95% confidence interval [0.98, 0.99]; p = .001). In conclusion, strenuous sport and recreational activities may attenuate the association between multimorbidity and geriatric depressive symptoms.

The longitudinal effect of leisure time physical activity on reduced depressive symptoms: The ARIRANG Study

BACKGROUND

Depression is a serious mental condition and physical activity is known to be effective in alleviating it. This study for rural residents of South Korea investigated whether meeting the recommended amount of physical activity during leisure time (LTPA) can reduce the depressive symptoms.

METHODS

A prospective study was conducted with 5,178 participants aged 20 years and over, and we analyzed 1,888 participants excluding those diagnosed with depression at baseline and those with insufficient data after an average of 5.3 years of follow-up. LTPA was quantified by the MET (metabolic equivalent of task) and categorized according to whether the recommended physical activity was met (0, 0.1 to < 7.5, ≥ 7.5 MET h/wk). The relationship with depressive symptoms (CES-D ≥ 41) was generated by adjusted relative risks (RRs) and 95% CIs through multivariate logistic regression.

RESULTS

During the followed-up, 100 (5.3%) participants developed depressive symptoms. Compared to the incidence of depressive symptoms in those who did not perform any LTPA (6.8%), it was significantly lower when the recommended physical activity criteria were met by combining moderate intensity (MET 3 to 6) and vigorous intensity (MET ≥ 6) exercise (3.3%). We observed a 43.7% lower risk of depressive symptoms among those performing more than the recommended minimum (RR, 0.563 [95% CI, 0.341-0.930]) than those who had no LTPA.

LIMITATIONS

This study did not address psychosocial factors, and physical activities in daily life and the occupational environment were not considered.

CONCLUSIONS

Performing adequate LTPA might be advisable to alleviate depressive symptoms.

A longitudinal study on depressive symptoms and physical activity during the Spanish lockdown

Background/Objective: The aim was to evaluate the evolution of depressive symptoms and to explore the influence of physical activity (PA) practice during the home confinement due to the COVID-19 outbreak in Spain. Method: Information was collected from 595 confined participants who reported personal and contextual information, depressive symptoms and PA levels at four time points. Results: The changes in depressive symptoms were analyzed using a linear mixed model with cubic splines. Results showed a significant increase, with a significant rise between T1 and T2 (OR = 2.38, 95% CI = 1.83-3.10). It continued growing until T4 (OR = 2.93, 95% CI = 1.97-4.38). A negative relationship was observed between the increase in depressive symptoms and moderate-to-vigorous physical activity (MVPA) levels, with a significant slope up to 4 hours of MVPA per week (OR = 0.51, 95% CI = 0.29-0.90) that tended to increase until 16 hours per week of MVPA (OR = 0.41, 95% CI = 0.20-0.87). Conclusions: Results from a partition model showed that moderate intensity of PA could be enough to prevent an increase of depressive symptoms during home isolation.

Accelerometer-derived sedentary time and physical activity and the incidence of depressive symptoms - The Maastricht Study

BACKGROUND

This study examined the associations between accelerometer-derived sedentary time (ST), lower intensity physical activity (LPA), higher intensity physical activity (HPA) and the incidence of depressive symptoms over 4 years of follow-up.

METHODS

We included 2082 participants from The Maastricht Study (mean ± s.d. age 60.1 ± 8.0 years; 51.2% men) without depressive symptoms at baseline. ST, LPA and HPA were measured with the ActivPAL3 activity monitor. Depressive symptoms were measured annually over 4 years of follow-up with the 9-item Patient Health Questionnaire (PHQ-9). Cox regression analysis was performed to examine the associations between ST, LPA, HPA and incident depressive symptoms (PHQ-9 ⩾ 10). Analyses were adjusted for total waking time per day, age, sex, education level, type 2 diabetes mellitus, body mass index, total energy intake, smoking status and alcohol use.

RESULTS

During 7812.81 person-years of follow-up, 203 (9.8%) participants developed incident depressive symptoms. No significant associations [Hazard Ratio (95% confidence interval)] were found between sex-specific tertiles of ST (lowest v. highest tertile) [1.13 (0.76-1.66], or HPA (highest v. lowest tertile) [1.14 (0.78-1.69)] and incident depressive symptoms. LPA (highest v. lowest tertile) was statistically significantly associated with incident depressive symptoms in women [1.98 (1.19-3.29)], but not in men (p-interaction <0.01).

CONCLUSIONS

We did not observe an association between ST or HPA and incident depressive symptoms. Lower levels of daily LPA were associated with an increased risk of incident depressive symptoms in women. Future research is needed to investigate accelerometer-derived measured physical activity and ST with incident depressive symptoms, preferably stratified by sex.

Cross-sectional and prospective relationship between physical activity and depression symptoms

This study aimed to analyse the cross-sectional and prospective relationship between moderate and vigorous physical activity (PA) and depression symptoms. This study analysed 32,392 European late middle-aged to older adults, from 14 European countries across a 4-year follow-up. Data was collected in the fourth (in 2011) and sixth (in 2015) wave, from the Survey of Health, Ageing and Retirement in Europe (SHARE). For the present analysis, participants were considered who responded to the EURO-D 12-item scale of depression symptoms and reported the intensity and frequency of PA. ANCOVAs were conducted to assess the cross-sectional and prospective associations. For both men and women, engaging in moderate or vigorous PA in 2011 was associated with a lower score of depression in 2011 and 2015. From the prospective analysis, moderate and vigorous PA in 2011 was inversely associated with the score of depression. This association remains significant in the fully adjusted for self-rated health, sociodemographic characteristics, and the presence of chronic diseases. Moderate and vigorous PA at least once a week is negatively related to the score of depression, both in men and women. PA is negatively associated with depression symptoms, and from prospective analysis PA predicts lower depression scores 4 years later.

Different levels of physical activity and depression symptoms among older adults from 18 countries: A population-based study from the Survey of Health, Ageing and Retirement in Europe (SHARE)

Objective: Analyse the relationship between different levels of physical activity (PA) and depression symptoms in a representative sample of European older adults. Methods: Data on PA, depression symptoms and sociodemographic variables from 64688 (28015 men) older adults participating in SHARE wave 6 was collected through a face-to-face interview. The EURO-D 12-item scale was administered for depression symptoms. Participants reported the frequency they engaged in moderate-intensity PA (MPA) and vigorous-intensity PA (VPA). Results: Men and women engaging in MPA and VPA once or more than once a week had less depression symptoms than those who engage less than once a week. MPA and VPA once or more than once a week were inversely associated with the depression symptoms score. Furthermore, engaging in MPA and VPA decreased the odds of depression (cut-off point of ≥4 depression symptoms) compared to engaging in PA less than once a week. Conclusions: Policies for promoting mental health should include PA for the prevention or treatment of depression symptoms. PA presents physical and psychological benefits and can be used as an overall health-promoting strategy, facing numerous problems at a time.

A citizen science approach to determine perceived barriers and promoters of physical activity in a low-income South African community

The study's objective was to assess the feasibility of using citizen science to identify and address physical activity (PA) barriers in a low-income South African community. We purposively selected as citizen scientists, eleven participants (21-45 years) from a cohort study who expressed interest in becoming physically active or were already active. They used the Stanford Neighborhood Discovery Tool mobile application to take photos and provide audio narratives of factors in their community that were barriers to or facilitated PA. Thereafter, in a facilitated workshop, citizen scientists thematically reviewed their findings, prioritised issues and proffered potential solutions. Researchers also thematically coded these data. PA levels were measured using standard questionnaires. None of the citizen scientists owned a car, and their PA was either work- or transport-related. Themes identified as priorities that hindered citizen scientists' PA were dirt, sidewalks appropriated by vendors or homeowners, parks and gym vandalisation, and personal safety fears. Access to stadiums and parks enabled PA. Citizen scientists identified their local councillors and street committee chairpersons as fundamental for advocacy for a PA-friendly environment. Low-income community members can be empowered to gather meaningful data using mobile technology and work together to identify potential solutions for promoting PA-friendly environments.

A tangled web: The reciprocal relationship between depression and educational outcomes in China

Research on depression and education usually focuses on a unidirectional relationship. This paper proposes a reciprocal relationship, simultaneously estimating the effects of depression on education and of education on depression. China, which has the world's largest education system, is used as a case study. This paper applies structural equation modeling to three datasets: the China Family Panel Studies, the China Education Panel Survey, and the Gansu Survey of Children and Families. Analyses reveal a reciprocal and negative relationship between depression and educational outcomes. Specifically, early depression reduces later educational achievement, and higher educational achievement also lowers the level of subsequent depression by resulting in less peers' unfriendliness, less pressure from parents' expectations, and less teachers' criticism. More time spent on studies is not associated with higher educational achievement but significantly increases the level of depression. Children from lower SES families bear more pressure and spend more time on studies, which does not correspond to higher educational achievement but rather to higher levels of depression. In the long term, prior depression lowers educational attainment and, after controlling for prior depression, lower educational attainment is also associated with higher levels of subsequent depression. This paper shows that the lower achievers, not the high achievers, bear the major psychological burden of the education system's quest to produce high achievement. This situation reinforces these students' educational disadvantage.

Physical activity and depression in men: Increased activity duration and intensity associated with lower likelihood of current depression

OBJECTIVES

Depression is a significant public health issue for men, however men are less likely to use mental health services. Alternative interventions, such as physical activity, may be of value for this population. This study sought to determine what levels and intensity of physical activity are associated with lower depression prevalence in Australian men.

METHODS

Using baseline data from 13,884 participants in the Australian Longitudinal Study on Male Health we compared current depression in men who completed the recommended 150 min of physical activity in the past week with men who did not. Duration of activity was examined using logistic regression with restricted cubic splines. Intensity of physical activity was examined by isotemporal substitution of hours of moderate activity with hours of vigorous activity.

RESULTS

Men who completed at least 150 min/week of activity had lower odds of moderate/severe depression symptoms. Duration of activity was inversely associated with moderate/severe depression symptoms. Among physically active men, each additional hour of moderate activity replaced with vigorous activity was associated with lower odds of depression.

LIMITATIONS

This is a cross-sectional study and so cannot determine causal direction in the relationship between physical activity and depression symptoms observed. Self-report measures of physical activity are widely used but are not as accurate as biometric measurement.

CONCLUSIONS

In adult men, meeting minimum recommendations is associated with lower current depression. Increased duration and greater intensity of activity were both associated with further reduction in prevalence. Promoting higher levels of physical activity is potentially an intervention for improving men's mental wellbeing.

Physical activity of people with mental disorders compared to the general population: a systematic review of longitudinal cohort studies

PURPOSE

We investigated if (a) people with lower physical activity have an increased risk of subsequent mental disorders (compared to those with higher physical activity); and (b) people with mental disorders have reduced subsequent physical activity (compared to those without mental disorders).

METHODS

A systematic review of population-based longitudinal studies examining physical activity and mental disorders was conducted. Mental disorders were defined by International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders. The results were described in a narrative summary.

RESULTS

Twenty-two studies were included. The majority (19) examined mood disorders and physical activity. Only two studies found consistent association between lower physical activity and a reduced risk of subsequent mental disorders. One study found the bidirectional association between physical activity and major depression. Twelve studies found mixed results (i.e., no consistency in direction and significance of the findings), and seven studies found no association between the variables of interest.

CONCLUSIONS

There is a lack of consistent evidence linking physical activity to be either a risk factor or consequence of mental disorders.

PROSPERO REGISTRATION ID

CRD42017071737.

Mediating effects of depression on anxiety and leisure constraints in patients with breast cancer

Background

Patients with breast cancer often exhibit high levels of anxiety and depression and a considerable decrease in their ability to participate in leisure activities, which result in the long-term disruption of their daily lives. This study intended to explore the relationships among anxiety, leisure constraints, and depression and evaluate whether depression mediates the effects of anxiety on leisure constraints in patients with breast cancer.

Method

This prospective study included 106 patients with breast cancer. All the patients completed the Taiwanese version of the Hospital Anxiety and Depression Scale and Leisure constraints questionnaire. Path analysis was used to test the mediating role of depression.

Results

Leisure constraints, anxiety, and depression were positively interrelated and co-occurred in the patients. The accelerated bootstrapping confidence intervals of the indirect effect did not include zero (0.276–1.663). Moreover, depression completely mediated the effects of anxiety on leisure constraints in patients with earlier cancer stages but not in patients with advanced cancer stages.

Conclusions

Depression is a crucial mechanism underlying the relationship between anxiety and leisure constraints in patients with breast cancer. Although many patients experience minimal disruption of activities and roles during survivorship, they are unable to perform functional activities and satisfactorily play their roles. This is the first study to explore leisure constraints in patients with breast cancer and investigate the mediating role of depression that underlies the relationship between anxiety and leisure constraints. The current findings are clinically crucial because they suggest the need to consider the simultaneous management of anxiety and depression for alleviating leisure constraints.

Long distance ski racing is associated with lower long-term incidence of depression in a population based, large-scale study

Physical activity has been proposed to be beneficial for prevention of depression, although the importance of exercise intensity, sex-specific mechanisms, and duration of the effects need to be clarified. Using an observational study design, following 395,369 individuals up to 21 years we studied whether participation in an ultralong-distance cross-country ski race was associated with lower risk of developing depression. Skiers (participants in the race) and matched non-skiers from the general population (non-participants in the race) were studied after participation (same year for non-participation) in the race using the Swedish population and patient registries. The risk of depression in skiers (n = 197,685, median age 36 years, 38% women) was significantly lower, to nearly half of that in non-skiers (adjusted hazard ratio, HR 0.53) over the follow-up period. Further, a higher fitness level (measured as the finishing time to complete the race, a proxy for higher exercise dose) was associated with lower incidence of depression in men (adjusted HR 0.65), but not in women. Our results support the recommendations of engaging in physical activity as a preventive strategy decreasing the risk for depression in both men and women. Furthermore, the exercise could reduce risk for depression in a dose-dependent matter, in particular in males.

Personal, behavioral, and perceived environmental factors associated with late-life depression in older men and women

INTRODUCTION

Previous investigations on factors associated with depression were highly focused on personal characteristics and health behaviors; however, few studies used an ecological perspective on the issue, much less on sex differences. This study examined the factors associated with depression, including any sex differences.

METHODS

A total of 1025 Taiwanese adults older than 65 years were recruited. Their personal demographics, lifestyle behaviors, and perceived environmental factors were obtained through a telephone-based survey. The multiple factors associated with depression in older adults were examined using logistic regression analyses.

RESULTS

Fully logistic regression analyses revealed that poor self-rated health (odds ratio =2.54) was correlated with a greater likelihood of depression. Aside from poor self-rated health, being older, sufficient leisure time spent in walking, and perceptions of a safe environment were associated with lower risks of depression in older men, whereas having hypertension and excessive TV viewing were associated with higher risks of depression in older women.

CONCLUSION

Apart from self-rated health, sex differences in the associations of factors such as leisure-time walking, TV watching, and safe traffic environment with depression were observed among older adults. Strategies applied for geriatric depression prevention should take into consideration different sex group.

Social stress, obesity, and depression among women: clarifying the role of physical activity

Objective: This study examined the role of stress in the association among physical activity, obesity, and depression among women. The extent to which physical activity moderated these relationships was also examined. Design: Data from the National Survey of American Life (N = 3235) and multivariable regression analyses were used to examine the effects of chronic stress, material hardship, racial discrimination, and physical activity on obesity and depression among African American, Caribbean Black and White women. Results: Stress was not related to body mass index (BMI) for African American or White women, but chronic stress was associated with higher BMI for Caribbean Black women. Stress was associated with depressive symptoms, but there was variation by the type of stressor under consideration. Physical activity was associated with fewer depressive symptoms and lower BMI, but the relationships varied by type of stressor and race/ethnicity. Physical activity moderated the effect of chronic stress on depressive symptoms and BMI, but only for African American women who reported high levels of chronic stress. Among White women, physical activity moderated the effect of racial discrimination on BMI for those who reported experiencing both high and low levels of discrimination. Conclusion: This study was the first to document physical activity as a moderator in the relationship among stress, depression, and obesity using a nationally representative sample of racially/ethnically diverse women. Findings provide insight into the role of stress in relation to depression and obesity while highlighting heterogeneity among Black Americans.

Prospective associations between physical activity and clinician diagnosed major depressive disorder in adults: A 13-year cohort study

Regular physical activity (PA) appears to protect against the emergence of depression, but prospective studies linked to clinician diagnoses of major depressive disorder (MDD) remain scarce. It is also unclear whether PA levels recommended for general health are prospectively related to depression onset. We explored these relationships in a cohort of adults followed over 13 years. In total, 43,863 Swedish adults were surveyed in 1997 and responses linked to clinician-diagnosed MDD obtained from specialist medical registers until 2010. Weekly durations of habitual moderate (including walking) and vigorous PA were self-reported. Relationships between total durations of PA, 0-149 ('below'), 150-299 ('achieve'), and ≥300 min ('exceed') with incident MDD were explored using survival analysis with Cox proportional hazards regression. Models were adjusted for relevant covariates. Those with indications of depression at baseline were removed from the primary analyses. Of 25,520 participants with complete data (mean age = 49 years, SD = 16, 65% female), 76% met the recommended weekly duration of PA (≥150 min), and 38% exceeded this duration (≥300 min). During 13-years follow-up 549 MDD cases (1.5%) were identified (incidence rate = 111 cases per 100,000 person-years). Compared to participants who were below, those who exceeded the recommended weekly duration (≥300 min/week) had 29% reduced risk of depression onset (HR 0.71, 95% CI = 0.53-0.96). A non-significant inverse association was observed among those who achieved the minimum duration of 150-min/week (HR 0.86, 95% CI = 0.64-1.14). Habitual PA levels that exceed the duration recommended for general health may reduce the risk of clinician-diagnosed major depression in adults.

Association between Physical Activity and Depressive Mood among Korean Adults with Chronic Diseases

Background

This study aimed to investigate the association between physical activity and depressive mood among Korean adults with chronic diseases.

Methods

This study analyzed the 2014 Korean National Health and Nutrition Examination Survey data. The study was restricted to participants aged ≥20 years who had completed the survey and were not diagnosed as having depression. After exclusion, 4,676 participants were included in the final analysis. Subjects were categorized according to their level of physical activity. Physical activity was assessed using the International Physical Activity Questionnaire. Patients were categorized into two groups according to depressive traits (normal and depressed) based on the 9-item Patient Health Questionnaire scores.

Results

In univariate analysis, significant associations were observed between the level of physical activity and depressive mood in both chronic and healthy groups. Participants with higher levels of physical activity had lower risks of depressive mood than those with lower levels of physical activity, especially patients with chronic diseases (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.31–0.73). Similar trends were observed in multivariate logistic regression analysis (OR, 0.54; 95% CI, 0.34–0.88).

Conclusion

Physical activity significantly decreased the development of depressive mood among Korean adults with chronic diseases compared with their healthy counterparts. Physical activity must be emphasized in patients with chronic diseases.

The Effect of Leisure Activity Diversity and Exercise Time on the Prevention of Depression in the Middle-Aged and Elderly Residents of Taiwan

Previous studies have confirmed that activity participation is beneficial to mental health, but few studies focus on older adults' depression. Based on the theory of social integration, this study examined the effects of leisure activity diversity and exercise time on depression in late adulthood. Subjects in the 2011 Survey of Health and Living Status of the Middle-Aged and Elderly in Taiwan were extracted. A series of logistic regressions were conducted to discern factors related to the odds of having depression. Among study subjects (N = 3727; age ≥ 58), 20.9% indicated an inclination of having depression (CESD-10 score ≥ 8). This study found that participating in diverse leisure activities and longer exercise time decreases older adults' risk of having depression. Additionally, the results confirmed that depression is positively correlated with chronic diseases. Consequently, efforts should be continually spent on encouraging older adults' participation in activities to reduce the prevalence of depression.

Do health-related factors predict major depression? A longitudinal epidemiologic study

Major depressive disorder (MDD) is a leading cause of global disease burden. Hence, examining the role of risk and protective factors for MDD is an important target in psychological research. Various studies showed that obesity, smoking, and alcohol consumption are related to depressive symptoms. In contrast, physical activity has been found to be a protective factor. The present population-based study tested whether these health-related factors are prospectively associated with incidence of MDD. Data were taken from the Dresden Predictor Study, which was designed to investigate risk and protective factors of mental health in young women. It included two assessments approximately 17 months apart. Results of single logistic regression analyses showed that being overweight, being a smoker, and being in a high-risk drinking group at baseline were predictive of developing MDD at follow-up. Engaging in regular physical activity and having good physical health were found to be protective factors of MDD. However, being in a medium-risk drinking group was not predictive of incidence of MDD, and irregular physical activity was not a protective factor. This is the first prospective, longitudinal study to show that obesity, smoking, and high-risk drinking are predictive of new onsets of MDD and that physical health is a protective factor. These data provide promising avenues for future research.

Psychiatric In-Patients Are More Likely to Meet Recommended Levels of Health-Enhancing Physical Activity If They Engage in Exercise and Sport Therapy Programs

Background: People with mental disorders engage in sedentary behaviors more often than their healthy counterparts. In Switzerland, nearly all psychiatric hospitals offer structured exercise and sport therapy as part of their standard therapeutic treatment. However, little is known about the degree to which psychiatric patients make use of these treatment offers. The aim of this study is to examine, in a sample of psychiatric in-patients (a) how many participate in the structured exercise and sport therapy programs offered by the clinic, (b) how many engage in exercise and sport activities on an individual basis, and (c) how many meet recommended levels of health-enhancing physical activity during their stay at the clinic. Furthermore, we examine whether those who engage in exercise and sport activities are more likely to meet internationally accepted physical activity recommendations. Methods: 107 psychiatric in-patients (49% women, M_age = 39.9 years) were recruited at three psychiatric clinics in the German-speaking part of Switzerland. All participants were engaged in treatment and received usual care. Based on accelerometer data, participants were classified as either meeting or not meeting physical activity recommendations (≥150 min of moderate-to-vigorous physical activity per week). Participation in structured and individually performed exercise and sport activities was assessed with the Simple Physical Activity Questionnaire. Results: In total, 57% of all patients met physical activity recommendations. 55% participated in structured exercise and sport therapy activities, whereas only 22% of all patients engaged in exercise and sport activities independently. Psychiatric patients were significantly more likely to meet recommended levels of health-enhancing physical activity if they engaged in at least 60 min per week of structured exercise and sport therapy or in at least 30 min of individually performed exercise and sport activity. Conclusions: Given that prolonged immobilization and sedentary behavior have harmful effects on patients' physical and mental well-being, promoting exercise and sport activities is an important endeavor in psychiatric care. Clinics currently succeed in involving between 50 and 60% of all patients in sufficient physical activity. While this is encouraging, more systematic efforts are needed to ensure that all patients get enough physical activity.

Relationships Between Youth Sports Participation and Mental Health in Young Adulthood Among Finnish Males

Purpose:

To examine whether retrospectively assessed sports participation (SP) and competitive sports (CS) at the age of 12 years is associated with mental health and health behavior in young adulthood among males.

Design:

A cross-sectional study using self-administered questionnaires.

Setting:

Conducted prior to compulsory military refresher training course in Finland allowing geographically representative sample of Finnish young men.

Participants:

Six hundred eighty males aged between 20 and 35 years.

Measures:

Mental well-being was measured with the short version of Warwick-Edinburgh Mental Well-Being Scale and mental distress with 5 items of The Short Form Helalth Survey (SF-36) scale.

Analysis:

Binary logistic regression models.

Results:

Sports participation at the age of 12 was associated with better mental health in young adulthood, with both mental well-being (odds ratio [OR] = 1.86, 95% confidence interval 1.11-3.11) and mental distress (OR = 0.61, 0.41-0.90). Age, years of education, and current physical activity were controlled. Higher level of intensity of SP and the level of CS in childhood were associated with lower level of mental distress in adulthood. No association was found between the level of CS in childhood and mental well-being in adulthood. Further, youth SP seemed to be a risk factor for increased alcohol consumption and use of snuff in adulthood.

Conclusions:

Despite negative outcomes related to health behavior, the findings provide support for the association between youth SP and positive mental health outcomes in adulthood among males.

An examination of objectively-measured sedentary behavior and mental well-being in adults across week days and weekends

BACKGROUND

Limited research has explored the links between sedentary behaviour, mental health and quality of life. This study examines objectively measured sedentary behaviour and perceived mental health and quality of life across week days and weekends.

METHODS

42 adults (19M, 23F; mean age 38yrs (range 18-67) & BMI 24.8kg/m2 (range 18.7-33.8) wore an activPAL monitor 24h/day for one week and completed the Hospital Anxiety and Depression Scale (HADS) and SF12 Health Survey. Average weekday and weekend day sitting time was computed. Differences between sitting (Group 1 = <8hrs/day, Group 2 = 8-10 hrs/day, Group 3 = >10hrs/day) and components of the HADS and SF12 health survey were examined using an ANCOVA with a measure of physical activity (step count) included as a covariate.

RESULTS

Average sitting time on a weekday was 9hrs 29mins (range 5hrs 52mins to 12hrs 55mins) and 8hrs 59mins (range 4hrs, 07mins to 14hrs, 40mins) on a weekend day. There was a main effect (p<0.05) for weekday sitting time on total anxiety and depression (HADS) and mental health and vitality (SF12). Planned contrasts identified individuals in group 1 had lower anxiety and depression and higher mental health and vitality scores than individuals in groups 2 or 3 (p<0.05). No difference was found between individuals in group 2 and group 3 (p>0.05). No main effects were found for weekend sitting (p>0.05).

CONCLUSIONS

Weekday sitting time below 8 hours/day is associated with better perceived mental health and quality of life.

Leisure Activity and Caregiver Involvement in Middle-Aged and Older Adults With Down Syndrome

The present study examined leisure activity and its association with caregiver involvement (i.e., residence and time spent with primary caregiver) in 62 middle-aged and older adults with Down syndrome (aged 30-53 years). Findings indicated that middle-aged and older adults with Down syndrome frequently participated in social and passive leisure activities, with low participation in physical and mentally stimulating leisure activities. Residence and time spent with primary caregiver were associated with participation in physical leisure activity. The findings suggest a need for support services aimed at increasing opportunities for participating in physical and mentally stimulating leisure activity by middle-aged and older adults with Down syndrome. These support services should partner with primary caregivers in order to best foster participation in physical leisure activity.

Children's Physical Activity and Depression: A Meta-analysis

CONTEXT

Research regarding the protective effects of early physical activity on depression has yielded conflicting results.

OBJECTIVE

Our objective was to synthesize observational studies examining the association of physical activity in childhood and adolescence with depression.

DATA SOURCES

Studies (from 2005 to 2015) were identified by using a comprehensive search strategy.

STUDY SELECTION

The included studies measured physical activity in childhood or adolescence and examined its association with depression.

DATA EXTRACTION

Data were extracted by 2 independent coders. Estimates were examined by using random-effects meta-analysis.

RESULTS

Fifty independent samples (89 894 participants) were included, and the mean effect size was significant (r = -0.14; 95% confidence interval [CI] = -0.19 to -0.10). Moderator analyses revealed stronger effect sizes in studies with cross-sectional versus longitudinal designs (k = 36, r = -0.17; 95% CI = -0.23 to -0.10 vs k = 14, r = -0.07; 95% CI = -0.10 to -0.04); using depression self-report versus interview (k = 46, r = -0.15; 95% CI = -0.20 to -0.10 vs k = 4, r = -0.05; 95% CI = -0.09 to -0.01); using validated versus nonvalidated physical activity measures (k = 29, r = -0.18; 95% CI = -0.26 to -0.09 vs k = 21, r = -0.08; 95% CI = -0.11 to -0.05); and using measures of frequency and intensity of physical activity versus intensity alone (k = 27, r = -0.17; 95% CI = -0.25 to -0.09 vs k = 7, r = -0.05; 95% CI = -0.09 to -0.01).

LIMITATIONS

Limitations included a lack of standardized measures of physical activity; use of self-report of depression in majority of studies; and a small number of longitudinal studies.

CONCLUSIONS

Physical activity is associated with decreased concurrent depressive symptoms; the association with future depressive symptoms is weak.

The association between leisure time physical activity in adolescence and poor mental health in early adulthood: a prospective cohort study

BACKGROUND

The incidence of poor mental health (MH) is increasing in Denmark and worldwide, especially among 16-24 year olds. Low physical activity (PA) during adolescence seems to be a risk factor for poor MH in early adulthood. Among adults, it appears that a high level of PA may be protective against poor MH. We aimed to examine whether high levels of leisure time physical activity (LTPA) during adolescence reduced the risk of poor MH at age 20/21.

METHODS

Prospective cohort study with data collected during 2004-2010 in the western part of Denmark. The study population was 3031 young people (age 14/15 in 2004). LTPA was the exposure variable and originates from questionnaires in 2004/2007. MH was the outcome variable and was measured at age 20/21 in 2010. MH was evaluated using a short version of the CES-DC. Logistic regression was used to analyse the associations between levels of LTPA and MH. All analyses were stratified by gender.

RESULTS

1,589 adolescents were included in the final analyses. Girls at 14/15 years of age with a low level of LTPA had an Adjusted Odds Ratio(AOR) of 1.63 (95% CI = 1.23-2.17) for poor MH as 20/21 year olds, compared to girls with a high level of LTPA. Among boys, the corresponding AOR = 1.19 (95% CI = 0.85-1.66). We found an exposure-response relationship between levels of LTPA and MH among girls, but not among boys. Girls with a reduction/persistent low level of LTPA between the ages of 15-18 had an increased risk for poor MH at age 20/21 compared to the reference group.

CONCLUSIONS

Among girls, we found an association between a low level of LTPA among 14/15 year olds as well as a reduction/persistent low level of LTPA over time with poor MH at 20/21 years. We found no association between low levels of LTPA and poor MH among 14/15 year olds boys however it appears that a reduction/persistent low level of LTPA over time may have some influence on the risk of poor MH at 20/21 years. It is important to address the change in habits of LTPA during adolescence to prevent poor MH.

Participation in a 9-month selected physical exercise programme enhances psychological well-being in a prison population

BACKGROUND

There is general population evidence that physical exercise is effective in reducing the risk of depression and has positive effects on mood. Some prisons encourage exercise, but there is no evidence specific to this group on its benefits or the relative merits of different programmes.

AIMS

To test the effect of physical exercise on the psychological well-being of prisoners and to determine which mental disorders are most affected by physical activity.

METHODS

Sixty-four participants were randomly assigned across three groups: cardiovascular plus resistance training (CRT), high-intensity strength training (HIST) and no exercise. Before and after the 9-month experimental period, all participants completed the Symptom Checklist-90-Revised.

RESULTS

Each form of exercise significantly reduced depression scale scores compared with those in the control group, in which average depression scale scores actually increased. The CRT group also showed a significant decrease in GSI scores on the Symptom Checklist-90 and on its interpersonal sensitivity scale, whereas the HIST group also significantly improved on the anxiety, phobic anxiety and hostility scale scores.

CONCLUSIONS

Our evidence, taken together with general population studies, supports introduction of supervised, moderately intense exercise for at least 1 h per week for men in prison. They form a high risk group for mental disorders, and such exercise reduces depression and anxiety. Minimal special equipment is needed for CRT. Further research should replicate the study in a larger, multi-centre trial, and examine impact on shorter-term and longer-term prisoners, female prisoners and effects on recidivism.

Associations between fruit and vegetable consumption and depressive symptoms: evidence from a national Canadian longitudinal survey

BACKGROUND

Several cross-sectional studies have demonstrated associations between diet quality, including fruit and vegetable consumption, and mental health. However, research examining these associations longitudinally, while accounting for related lifestyle factors (eg, smoking, physical activity) is scarce.

METHODS

This study used data from the National Population Health Survey (NPHS), a large, national longitudinal survey of Canadians. The sample included 8353 participants aged 18 and older. Every 2 years from 2002/2003 to 2010/2011, participants completed self-reports of daily fruit and vegetable consumption, physical activity, smoking and symptoms of depression and psychological distress. Using generalised estimating equations, we modelled the associations between fruit and vegetable consumption at each timepoint and depression at the next timepoint, adjusting for relevant covariates.

RESULTS

Fruit and vegetable consumption at each cycle was inversely associated with next-cycle depression (β=-0.03, 95% CI -0.05 to -0.01, p<0.01) and psychological distress (β=-0.03, 95% CI -0.05 to -0.02, p<0.0001). However, once models were adjusted for other health-related factors, these associations were attenuated (β=-0.01, 95% CI -0.04 to 0.02, p=0.55; β=-0.00, 95% CI -0.03 to 0.02, p=0.78 for models predicting depression and distress, respectively).

CONCLUSIONS

These findings suggest that relations between fruit and vegetable intake, other health-related behaviours and depression are complex. Behaviours such as smoking and physical activity may have a more important impact on depression than fruit and vegetable intake. Randomised control trials of diet are necessary to disentangle the effects of multiple health behaviours on mental health.

Trajectories of physical activity and risk factors among Taiwanese older adults

BACKGROUND

The significance of physical activity has been noticed. However, the dynamic change and the heterogeneity of physical activity patterns among older people are little explored.

PURPOSE

This study aimed to identify the trajectory patterns of engaging in physical activity over time and its related factors.

METHOD

Nationally representative four-wave panel data from Taiwanese older adults, gathered between 1996 and 2007, were used (n = 4,018). The participants ranged in age from 50 to 96 years old. "Being physically active" was defined as performing physical activity in sports or exercises at least three times per week and lasting for at least 30 min each time. Group-based trajectory analysis was performed for analyzing the data.

RESULTS

Four trajectory patterns were identified: inactive (47.83%), decreasing (12.21%), increasing (23.36%), and active (16.60%). Older respondents and those with more education were more likely to be active. Those respondents having more depressive symptoms, having more physical functional limitations, and having jobs were less likely to be physically active in the decreasing, increasing, and active patterns.

CONCLUSION

There is heterogeneity among the trajectory patterns of physical activity across time in the older adults. Different strategies of physical activity promotion for the older people should be developed by the group characteristics.

Effects of adjunctive exercise on physiological and psychological parameters in depression: a randomized pilot trial

OBJECTIVE

Major depressive disorder (MDD) is associated with decreased physical activity and increased rates of the metabolic syndrome (MetS), a risk factor for the development of type 2 diabetes and cardiovascular disorders. Exercise training has been shown to improve cardiorespiratory fitness and metabolic syndrome factors. Therefore, our study aimed at examining whether patients receiving an exercise program as an adjunct to inpatient treatment will benefit in terms of physiological and psychological factors.

METHOD

Fourty-two inpatients with moderate to severe depression were included. Twenty-two patients were randomized to additional 3x weekly exercise training (EXERCISE) and compared to treatment as usual (TAU). Exercise capacity was assessed as peak oxygen uptake (VO2peak), ventilatory anaerobic threshold (VAT) and workload expressed as Watts (W). Metabolic syndrome was defined according to NCEP ATPIII panel criteria.

RESULTS

After 6 weeks of treatment, cardiorespiratory fitness (VO2peak, VAT, Watt), waist circumference and HDL cholesterol were significantly improved in EXERCISE participants. Treatment response expressed as ≥50% MADRS reduction was more frequent in the EXERCISE group.

CONCLUSIONS

Adjunctive exercise training in depressed inpatients improves physical fitness, MetS factors, and psychological outcome. Given the association of depression with cardiometablic disorders, exercise training is recommended as an adjunct to standard antidepressant treatment.

Physical activity and energy expenditure during depressive episodes of major depression

BACKGROUND

Recent data suggest a substantial association between physical activity and depressive symptoms, but there is a lack of research evaluating the physical activity levels in patients suffering from unipolar depression across different stages of disease in an objective way. The aim of the present pilot study was to objectively examine physical activity levels of this patient group compared to healthy controls.

METHODS

Physical activity performance of 19 patients with major depressive episode and 19 healthy controls was assessed at three different time points using a multisensory armband device (SenseWear® Pro3 Armband) and was reported as total energy expenditure (TEE), active energy expenditure (EE), metabolic equivalents (METs), physical activity (PA) and time of lying down (LD), in each case over 24h.

RESULTS

Over all measurements, depressive patients presented a significantly lower mean TEE and EE over 24h. Moreover, the patient group showed significantly shorter duration of PA and lower average MET over 24h. When depressive symptoms abated, physical activity parameters significantly increased in the patient group. Correlation analyses demonstrated a significant relation between depressive status/anhedonia and parameters of physical activity, especially in healthy subjects.

LIMITATIONS

Results represented valid data for inpatients only.

CONCLUSION

Acute unipolar depression was associated with a significantly lower level of physical activity and showed a significant increase in parallel to clinical improvement. Electronic monitoring of physical activity may be an additional tool for evaluating and controlling therapeutic effects.

Association between internalizing disorders and day-to-day activities of low energetic expenditure

The objective of this study is to compare energetic expenditure in day-to-day activities among subjects with internalizing disorders (depression and anxiety), externalizing disorders (attention deficit/hyperactivity disorder and oppositional defiant disorder) and healthy children and adolescents without any psychiatric diagnosis. One hundred and five (n = 105) students from a community sample were evaluated throughout a structured psychiatric interview and categorized into three groups: internalizing (n = 54), externalizing (n = 12) and typically developing controls (TDC, n = 39). Energetic expenditure was evaluated using 3-day physical activity record. Subjects with internalizing disorders performed activities with lower energetic expenditure as compared to those with externalizing disorders and TDC. Participants with externalizing disorders had more energetic expenditure variability. Our study suggests that internalizing disorders are associated with activities of low energetic expenditure in day-to-day activities, extending previous findings with physical exercise. These findings may further contribute to the understanding of the associated morbidity previously described in patients with internalizing disorders.

Physical activity and risk of alcohol use disorders: results from a prospective cohort study

AIMS

To examine the effect of physical activity on risk of developing alcohol use disorders in a large prospective cohort study with focus on leisure-time physical activity.

METHODS

Data came from the four examinations of the Copenhagen City Heart Study (CCHS), performed in 1976-1978, 1981-1983, 1991-1994 and 2001-2003. Information on physical activity (classified as Moderate/high, low or sedentary) and covariates was obtained through self-administered questionnaires, and information on alcohol use disorders was obtained from the Danish Hospital Discharge Register, the Danish Psychiatric Central Research Register and the Winalco database. In total, 18,359 people participated in the study, a mean follow-up time of 20.9 years. Cox proportional hazards model with delayed entry was used. Models were adjusted for available covariates (age, smoking habits, alcohol intake, education, income and cohabitation status) including updated time-dependent variables whenever possible.

RESULTS

A low or moderate/high leisure-time physical activity was associated with almost half the risk of developing alcohol use disorder compared with a sedentary leisure-time physical activity. This translates into a 1.5- to 2-fold increased risk of developing alcohol use disorder (Hazard ratios for men 1.64; 95% CI 1.29-2.10 and women 1.45; 1.01-2.09) in individuals with a sedentary leisure-time physical activity, compared with a moderate to high level. However, when stratifying by presence of other psychiatric disorders, no association was observed in women with psychiatric comorbidity. Residual confounding may have been present in this study, especially according to rough measures of income and education.

CONCLUSIONS

In both men and women, being sedentary in leisure time was a risk factor for developing an alcohol use disorder.

The effect of a community-based self-help multimodal behavioral intervention in Korean American seniors with high blood pressure

BACKGROUND

Great strides have been made in improving heart health in the United States during the last 2 decades, yet these strides have not encompassed many ethnic minority populations. There are significant health disparity gaps stemming from both a paucity of valid research and a lack of culturally sensitive interventions. In particular, many Korean Americans with chronic illnesses encounter difficulty navigating the healthcare system because of limited health literacy.

METHODS

The effect of a multimodal Self-Help Intervention Program on the Control of High Blood Pressure (HBP) was tested in a community-based clinical trial for Korean American seniors. Of 440 seniors enrolled, 369 completed the study (184 in the intervention group and 185 in the control group; mean age = 70.9±5.3 years). The intervention group received 6 weekly educational sessions on HBP management skill building, including health literacy training, followed by telephone counseling and home blood pressure (BP) monitoring for 12 months.

RESULTS

Findings support that the Self-Help Intervention Program on the Control of HBP was effective in controlling BP in this ethnic/linguistic minority population. The BP control rates for the intervention and control groups were 49.5% vs. 43.2% at baseline, 58.5% vs. 42.4% at 6 months, 67.9% vs. 52.5% at 12 months, and 54.3% vs. 53.0% at 18 months. Significant changes were observed over time in some psychobehavioral outcomes, including self-efficacy for BP control, medication adherence behavior, HBP knowledge, and depression.

CONCLUSIONS

The study findings suggest that the multimodal Self-Help Intervention Program on the Control of HBP is effective at promoting optimal HBP control for this ethnic/linguistic minority population.

CLINICAL TRIALS REGISTRY

NCT00406614.

A longitudinal cohort study of intelligence and later hospitalisation with mental disorder

OBJECTIVE

Few studies on the associations between pre-morbid IQ and mental disorders are based on comprehensive assessment of intelligence in both women and men and include a wide range of confounding variables. Thus, the objective of the present study was to examine the association between pre-morbid IQ and hospitalisation with any mental disorder, including possible gender differences in the association.

METHODS

The study population was born in 1959-61 and premorbid IQ was assessed with the WAIS between 1982 and 1994. Information on mental disorders was obtained from Danish hospital registers with a mean follow-up interval of 21.1years. A total of 1106 participants were analysed.

RESULTS

Those with a mental disorder had a significantly lower mean pre-morbid IQ score than those without. For women, the adjusted IQ difference was 8.5 points, and for men it was 5.1 points. A decrease of one standard deviation in pre-morbid IQ was associated with 83% greater risk of developing a mental disorder among women (HR=1.83, 95% CI: 1.41-2.36), and 36% among men (HR=1.36, 95% CI: 1.07-1.73). The interaction between gender and IQ was not statistically significant. Associations did not differ noteworthy between verbal and non-verbal IQ.

CONCLUSIONS

Pre-morbid IQ was found to be significantly associated with the development of mental disorder.

Muscle strength and physical activity are associated with self-rated health in an adult Danish population

OBJECTIVE

To describe associations of muscle strength, physical activity and self-rated health.

METHOD

Isometric muscle strength by maximal handgrip strength (HGS) or muscle strength by 30s repeated chair stand test (30s-CS) was combined with leisure time physical activity. Using logistic regression odds ratio was calculated for good self-rated health according to the combined associations among 16,539 participants (59.7% women), mean age 51.9 (SD: 13.8) years, from a cross-sectional study in Denmark 2007-2008.

RESULTS

Good self-rated health was positively associated with higher levels of physical activity and greater muscle strength. Regarding HGS the highest OR for good self-rated health was in the moderate/vigorous physically active participants with high HGS (OR=6.84, 95% CI: 4.85-9.65 and OR=7.34, 95% CI: 5.42-9.96 for men and women, respectively). Similarly the highest OR for good self-rated health was in the moderate/vigorous physically active participants with high scores in the 30s-CS test (6.06, 95% CI: 4.32-8.50 and 13.38, 95% CI: 9.59-18.67 for men and women, respectively). The reference groups were sedentary participants with low strength (HGS or 30s-CS).

CONCLUSION

The combined score for physical activity level with either HGS or 30s-CS was strongly positively associated with self-related health.

The association between dietary intake of folate and physical activity with psychological dimensions of depressive symptoms among students from Iran

Depression in students is a major public health problem. Although several risk factors associated with depression have been identified, the cause of depression is still not clear. Several studies have demonstrated that physical activity and nutrient intake, such as increased levels of B vitamins in serum, decrease symptoms of depression. The aim of this study was to investigate the association between physical activity and dietary intake of vitamins B₆, B₉, and B₁₂ and symptoms of depression among postgraduate students. The results of this study suggest that intake of vitamin B9 may modulate the total score of Center for Epidemiological Studies Depression Scale (CES-D) and two subscales of the CES-D including depressive affect and interpersonal difficulties. This study also showed that moderate/high levels of physical activity were inversely and significantly associated with symptoms of depression (total scores) and three subscales of the CES-D including depressive affect, positive affect, and somatic complaints.

Mental health and social participation skills of wheelchair basketball players: a controlled study

The aim of this study was to assess differences in psychological well-being, symptomatic psychological disorders and social participation, between competitive wheelchair basketball participants and those non-participants. Forty-six wheelchair participants, 24 Basketball players (aged 35.60 ± 7.56) and 22 non-players (aged 36.20 ± 6.23), completed three validated self-report questionnaires: Participation Scale (PS), Psychological Well-Being Scale [PWBS] and Symptom Checklist 90 R [SCL-90-R]. ANOVA showed significant overall differences between the two groups. The social restriction score, evaluated by PS, was significantly higher in the non-basketball participants (p=0.00001) than the basketball participants. The PWB Scale showed significant differences in all 6 dimensions: positive relations with others, environmental mastery, personal growth, purpose in life and self-acceptance (p<0.01), and autonomy (p<0.05), with better scores in the basketball participants. The SCL-90-R scores were significantly lower for the basketball group in the following 6 symptomatic dimensions: depression, phobic anxiety, and sleep disorder (p<0.01), somatization, interpersonal sensitivity and psychoticism (with p<0.05). It was concluded that competitive wheelchair basketball participants showed better psychological well-being and social skills than those non-participants.

Physical activity and the prevention of depression: a systematic review of prospective studies

CONTEXT

Given its high prevalence and impact on quality of life, more research is needed in identifying factors that may prevent depression. This review examined whether physical activity (PA) is protective against the onset of depression.

EVIDENCE ACQUISITION

A comprehensive search was conducted up until December 2012 in the following databases: MEDLINE, Embase, PubMed, PsycINFO, SPORTDiscus, and Cochrane Database of Systematic Reviews. Data were analyzed between July 2012 and February 2013. Articles were chosen for the review if the study used a prospective-based, longitudinal design and examined relationships between PA and depression over at least two time intervals. A formal quality assessment for each study also was conducted independently by the two reviewers.

EVIDENCE SYNTHESIS

The initial search yielded a total of 6363 citations. After a thorough selection process, 30 studies were included for analyses. Among these, 25 studies demonstrated that baseline PA was negatively associated with a risk of subsequent depression. The majority of these studies were of high methodologic quality, providing consistent evidence that PA may prevent future depression. There is promising evidence that any level of PA, including low levels (e.g., walking <150 minutes/weeks), can prevent future depression.

CONCLUSIONS

From a population health perspective, promoting PA may serve as a valuable mental health promotion strategy in reducing the risk of developing depression.

Psychiatric disease incidence among Danish Seventh-day Adventists and Baptists

PURPOSE

Previous studies suggest that religious practice can have a positive effect on mental health, but may also have potential for harm. In Denmark, unique possibilities are available for studying the influence of religious practice on mental health: Denmark is characterized as a secular society and it is possible to follow members of religious societies in nationwide registers. In this study, we follow a cohort of Danish Seventh-day Adventists (SDA) and Baptists in a nationwide psychiatry register and compare the incidence in this cohort with the general population.

METHODS

We followed a cohort of 5,614 SDA and 3,663 Baptists in the Danish Psychiatric Central Register, which contained information on psychiatric hospitalizations from 1970 to 2009. Psychiatric disease incidence in the cohort was compared with that in the general Danish population as standardized incidence ratios and within-cohort comparisons were made with a Cox model.

RESULTS

The cohort had decreased incidence of abuse disorders compared to the general population. Furthermore, among Baptists, decreased incidence of unipolar disorders among men and decreased incidence of schizophrenia among women were observed. Surprisingly, we observed an increased incidence rate of unipolar disorder among women.

CONCLUSIONS

In this nationwide cohort study with 40 years of follow-up, we observed increased incidence rates of unipolar disorders among women and decreased rates of alcohol- and drug-related psychiatric disorders compared to the general Danish population. We have no mechanistic explanation for the increased incidence of unipolar disorders among women, but discuss several hypotheses that could explain this observation.

Physical activity and onset of depression in adolescents: a prospective study in the general population cohort TRAILS

Although it has often been suggested that physical activity and depression are intertwined, only few studies have investigated whether specific aspects of physical activity predict the incidence of major depression in adolescents from the general population. Therefore the aim of this study was to investigate the effects of nature, frequency, duration and intensity of physical activity during early adolescence on the onset of a major depressive episode in early adulthood. In a population sample of adolescents (N = 1396), various aspects of physical activity were assessed at early adolescence (mean age 13.02, SD = 0.61). Major depressive episode onset was assessed using the Composite International Diagnostic Interview. A Cox regression model was performed to investigate whether physical activity characteristics and their interactions with gender predicted a major depressive episode onset up until mean age 18.5 (SD = 0.61). The individual characteristics of physical activity (nature, frequency, duration and intensity) or their interactions with gender did not predict a major depressive episode onset (p values >0.05). So far, there is no prospective evidence that physical activity protects against the development of adolescent depressive episodes in either boys or girls.