Elsevier

General Hospital Psychiatry

Volume 31, Issue 4, July–August 2009, Pages 306-315
General Hospital Psychiatry

Authored by Trainees
The longitudinal effects of depression on physical activity

https://doi.org/10.1016/j.genhosppsych.2009.04.002Get rights and content

Abstract

Objectives

It has been posited that depression and sedentary lifestyle have bidirectional relationships. Although the role of baseline physical activity as a risk factor for emerging depression has been recently reviewed, there has been no systematic review of the literature to assess the reverse relationship. We reviewed the results of longitudinal studies in the world's literature that have studied the effect of baseline depression on ensuing levels of physical activity.

Measures

MEDLINE, PsycINFO, CINHAL Plus, Health Source: Nursing Academic Edition and Cochrane databases were searched from 1959 to 2008 with a focus on depression, sedentary lifestyle and exercise. Published longitudinal studies in English and more than 100 patients were included.

Results

Eleven studies met our inclusion criteria, eight of which reported that baseline depression was significantly associated with subsequent sedentary lifestyle or poor adherence to the physical exercise regimens recommended by physicians after a coronary event. However, the studies used different depression scales and physical activity outcome measures, and varied a great deal in the range of potential confounders they controlled for. In addition, there were only three studies that were specifically designed to assess the role of baseline depression on the subsequent level of physical activity.

Conclusions

Baseline depression may be a significant risk factor for development of sedentary lifestyle or decreased level of physical exercise. Future studies should examine mechanisms by which depression may lead to decline in activity.

Introduction

Exercise has been shown in aging populations to be a protective factor in decreasing risk of cognitive impairment [1], [2], [3] and decline in physical functioning [4], [5]. Aerobic physical activity and improved fitness can enhance cognitive function in the elderly population with [6] and without cognitive impairment [7], [8]. Regular exercise can also help decrease risk of coronary artery disease [9], diabetes [10], [11] and stroke [12] and improve outcomes of patients with these medical illnesses[13], [14]. Regular exercise has shown to reduce blood pressure in both hypertensive and normotensive individuals [15], and recreational physical activity may also reduce the risk of developing colon [16], pancreatic [17] and breast [18], [19] cancer. Moderate exercise is also helpful for the pain and decline in physical function seen in osteoarthritis [20], [21]. Given the many benefits of exercise, it is important to understand factors that decrease motivation and ability to participate in regular physical activity.

Depression is a common illness in aging populations and the prevalence of this affective illness is two- to threefold higher in patients with chronic medical illnesses such as diabetes [22], coronary artery disease [23] and osteoarthritis [24], [25]. Many cross-sectional studies have reported that depressed patients are more sedentary [26]. However, this association may be bidirectional: depression may lead to decreased levels of exercise due to low motivation and energy and decreased exercise may be a risk factor for depression. A recent review of literature showed that regular physical exercise significantly decreased the risk for developing depression in adult populations [27]. Regular aerobic exercise has also been found to improve depressive symptoms in most, but not all, treatment studies [27], [28], [29].

Despite the well studied effects of physical activity on subsequent development of depression, there have been no systematic reviews that examined the association of depression with decrements in physical activity or exercise over time. Given this lack of evidence, the purpose of this study was to fill this gap in the literature by completing a systematic review of prospective studies that measured the association of baseline depression on subsequent levels of physical activity.

Section snippets

Method

MEDLINE, PsycINFO, CINHAL Plus, Health Source: Nursing Academic Edition and Cochrane databases were searched using “depress*” or “mood disorder” or “affective disorder” with “longitudinal” or “prospective” or “follow-up” and with “sedentary” or “exercise” or “physical inactivity” or “physical activity” or “modifiable risk factors” or “cardiac risk factors.” The following inclusion criteria: (1) the publications were dated from date 1959–September 2008; (2) the study assessed, or provided enough

Description

Table 1 provides an overview and critique of the eleven studies identified by the authors. Van Gool et al. [30] reported results from the Longitudinal Aging Study Amsterdam describing the relationship between changes in depressive symptoms and unhealthy lifestyles in 1280 Dutch middle-aged and elderly community dwellers over a 6-year period. After controlling for potential confounders, logistic regression analyses did not show a significant relationship between baseline depression and changes

Discussion

This literature review investigated evidence of the longitudinal relationship between baseline depression and subsequent development of changes in physical activity. Although numerous studies and a recent review article [27] have investigated the relationship between the baseline level of physical activity and the subsequent risk of depression, to our best knowledge, this study is the first published review of the literature that assessed the reverse relationship. Most of the reviewed studies

Conclusion

Eight of eleven studies reviewed found that depression was a significant risk factor for development of sedentary lifestyle or a decreased level of physical exercise. Given the importance of physical activity in maintaining health, it is important that future studies examine mechanisms by which depression may lead to decline in activity.

Acknowledgment

This study was supported by a K-24 grant from the National Institute of Mental Health to Dr. Katon (MH069741).

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