Physical Activity and the Prevention of Depression

Physical Activity and the Prevention of Depression
A Systematic Review of Prospective Studies
George Mammen, MSc, Guy Faulkner, PhD
Appendix A
Methodologic characteristics of prospective studies examining physical activity and depression
Study, location
Aberg (2012)16
Sweden
Augestad (2008)17
Norway
Backmand (2003)18
Finland
Ball,19
2008,Australia
Bernaards (2006)20
Netherlands
Baseline age
(years), gender
18
M only
21–40
M and F
Mean=65
M only
22–27
F only
Unreported
Follow-up
period
(years)
3–40
N included in
prospective
analysis
1,117,294
10
6,661
Measures of physical
activity
Cardiovascular fitness
via cycle ergometer test
Self-reported
10
1,164
Self-reported
Measures of depression (cut-off scores to
define depression)
Swedish National Hospital Discharge
Register
Hospital Anxiety and Depression Scale,
depression subscale (HADS-D: ≥8)
Brief Symptom Inventory (BSI-53: ≥8)
3
6,677
Self-reported
CESD-10: ≥10
Logistic regression
3
1,747
Self-reported
CESD-11: ≥6
Generalized
estimating equation
modeling
Logistic regression
Brown (2005)21
Australia
45–50
F only
5
9,207
Self-reported
Camacho (1991)22
USA
Carroll (2010)23
USA
Cooper-Patrick
(1997)24
USA
≥20
M and F
51–61
M and F
Unreported
(during
medical
school and
midlife)
M and F
9
6,928
Self-reported
6
5,389
Self-reported
CESD-10: ≥10 and mental health
subscale ≤52 of Short Form (SF-36)
functioning and well-being scale
40-item measure constructed
independently by researchers: ≥5
CESD-8: women/girls ≥4; men/boys ≥3
752
Self-reported
General Health Questionnaire: ≥4
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15
Methods of analysis
Cox regression
Logistic regression
Logistic regression
Logistic regression
Logistic regression
Cox regression
A-1
Study, location
Farmer (1988)25
USA
Gallegos-Carillo
(2012)26
Mexico
Hamer (2009)27
England
Jerstad (2010)28
USA
Baseline age
(years), gender
25–77
M and F
≥18
M and F
Follow-up
period
(years)
8
N included in
prospective
analysis
1,497
Measures of physical
activity
Self-reported
Measures of depression (cut-off scores to
define depression)
CESD-20: ≥16
Methods of analysis
Logistic regression
6
1,047
Self-reported
CESD-20: ≥16
Logistic regression
Mean=63
M and F
11–15
F only
4
4,323
Self-reported
CESD-8: ≥4
Logistic regression
6
496
Self-reported
Generalized Linear
Model regression
Jonsdottir (2010)29
Sweden
Kritz-Silverstein
(2001)30
USA
Ku (2009)31
Taiwan
Lampinen (2000)32
Finland
Lucas (2011)33
USA
Mean=47
M andF
50–89
M and F
2
3,114
Self-reported
8
944
Self-reported
The Schedule for Affective Disorders and
Schizophrenia for School-Age Children:
≥5
Hospital Anxiety and Depression Scale
(HAD: ≥10)
Beck Depression Inventory (BDI: ≥13)
≥50
M and F
65–84
M and F
30–55
F only
7
2,831
Self-reported
CESD-10: ≥10
Logistic regression
8
663
Self-reported
Beck Depression Inventory (BDI: ≥5)
Logistic regression
10
49,821
Self-reported
Cox regression
Mikkelsen (2010)34
Denmark
Mobily (1996)35
USA
Morgan (1998)36
UK
Paffenbarger
(1994)37
USA
Rothon (2010)38
England
Smith (2010)39
USA
Strawbridge
(2002)40
USA
≥20
M and F
≥65
M and F
≥65
M and F
35–74
M only
26
14,223
Self-reported
Defined as reporting a physician’s
diagnosis of depression or the use of
antidepressants
Also used CESD-10: ≥10
Danish Hospital Discharge Register
3
2,084
CESD-11:>15
Logistic regression
4
497
Self-reported via
interview
Self-reported via
interview
Self-reported
Symptoms of Anxiety and Depression
(SAD: ≥6)
Questionnaire developed by researchers
Logistic regression
11–14
M and F
71–93
M only
50–94
M and F
2
2,093
Self-reported
Logistic regression
8
1,417
Self-reported
Short Moods 7 Feelings Questionnaire
(SMFQ: ≥8)
CESD-11: ≥9 or taking antidepressants
5
1,947
Self-reported
DSM-12D: ≥5
Logistic regression
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23–27
10,201
Cox regression
ANCOVA
Cox regression
Cox regression
Logistic regression
A-2
Study, location
Sund (2011)41
Norway
van Gool (2006)42
Netherlands
Wang (2011)43
Canada
Baseline age
(years), gender
12–15
M and F
24–81
M and F
≥12+
M and F
Weyerer (1992)44
Germany
≥15
M and F
Wise, 200645, USA
Follow-up
period
(years)
1–2
6
2, 4, and 6
5
N included in
prospective
analysis
2,360
Measures of physical
activity
Self-reported
1,169
Self-reported
17,276
Self-reported
1,341
Self-reported via
interview
21–69
4
35,224
Self-reported
F only
CESD, Center for Epidemiologic Studies Depression Scale; F, female; M, male
Am J Prev Med 2013;45(5)
Measures of depression (cut-off scores to
define depression)
Mood and Feelings Questionnaire (MFQ:
≥25)
CESD-20: ≥16
Methods of analysis
Logistic regression
Logistic regression
Composite International Diagnostic
Interview Short Form for Depression
(CIDI-SF: ≥90%)
Interviewed by trained psychiatrist using
the ICD
Cox regression
CESD-10: ≥16
Logistic regression
Logistic regression
A-3
Appendix B
Findings of Prospective Studies Examining Physical Activity and Depression
Study
Aberg (2012)16
Augestad (2008)17
Backmand
(2003)18
Ball (2009)19
Bernaards
(2006)20
Brown (2005)21
Odds of developing depression
Subjects with low levels of cardiovascular
fitness at T1 were at an increased risk for
developing depression (HR=1.96) at T2
Men/boys (OR=0.63) and women/girls
(OR=0.69) reporting low and medium
levels of PA, respectively, at T1 were at a
decreased risk of developing depression
at T2 relative to inactive subjects
Subjects reporting low (OR=3.77) PA
(0.39 MET/day) at T1 were at an
increased risk of developing depression
at T2 relative to those with extremely high
PA
Subjects reporting low PA levels (OR=
0.77; <150 min/week) and high PA
(OR=0.79; >150 min/week) at T1 were at
a decreased risk of developing depression
at T2 relative to sedentary women.
Subjects reporting strenuous PA one or
two times per week (OR=0.62) at T1 were
at a decreased risk of developing
depression at T2 relative to those who
reported strenuous PA less than once per
month
Subjects reporting low PA (OR=0.92; 60–
150 min moderate PA/week); moderate
PA (OR=0.81; 150–300 min moderate
PA/week); and high PA levels (OR=0.73;
>300 min of moderate PA/week) at T1
were at a decreased risk of developing
future depression at T2 relative to those
reporting very low levels of PA
Am J Prev Med 2013;45(5)
Changes in PA levels and
relationship to depression
Unreported
Did PA prevent
depression?
Yes
Unreported
Yes
Age/BMI/education/alcohol/smoking/living
arrangements
Unreported
Yes
Age/health/SES/ alcohol/smoking/marital
status/personality characteristics/life events
Subjects who increased their
PA level from none/very low to
either moderate (OR=0.65) or
high level (OR=0.50) were at
a decreased risk of future
depressive symptoms
Unreported
Yes
Health disabilities/BMI/education/smoking
status/marital status/occupation/parity status
Yes
Gender/time of measurement/outcome of
measurement
Subjects who increased their
PA were at a decreased risk
(OR=0.83) of developing
future depression compared
to those who remained
inactive
Yes
Chronic conditions/menopause status/
BMI/education/smoking/marital
status/occupation/area of residence/country of birth
Covariates accounted for in prospective analysis
Calendar year/BMI/region/health tests/parent
education level
A-4
Camacho (1991)22
Carroll (2010)23
Cooper-Patrick
(1997)24
Farmer (1988)25
Gallegos-Carrillo
(2012)26
Hamer (2009)27
Jerstad (2010)28
Subjects reporting low PA levels
(OR=1.75;0–4 points on activity index) at
T1 were at an increased risk of developing
depression at T2 relative to those with
high PA levels
Women/girls who decreased their
vigorous PA levels from high (>3
times/week) to low (1–3 times/month)
were at a higher risk (OR=1.66) of
developing depression at T2 in relation to
those who maintained their PA levels
No significant longitudinal associations
Women/girls reporting little/no PA (OR=
1.9) at T1 were at an increased risk of
developing depression at T2
Subjects reporting moderately active PA
patterns (OR=0.62; >11.01 to <27.18
MET hr/week) and highly active PA
patterns (OR=0.47; >27.18 METs) at T1
were at a decreased risk of developing
depression at T2 relative to those who
were inactive
Subjects reporting moderate (OR=0.73;
1/week) and vigorous (OR=0.60;
>1/week) PA levels at T1 were at a
decreased risk of developing depression
at T2 relative to those with none/mild PA
levels
Subjects reporting PA at T1 were at a
decreased risk of developing depressive
symptoms (RR=0.99); minor depression
(RR=0.90); and major depression
(RR=0.86) at T2
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Subjects who decreased their
activity (OR=1.61) were at an
increased risk of developing
depression
Yes
Age/gender/physical health/SES/
alcohol/smoking/social supports/life events/anomy/
status/weight
Women/girls who decreased
their vigorous PA levels from
high (>3 times/week) to low
(1–3 times/month) were
more likely (OR=1.66) to
develop depression at followup in relation to those who
maintained their PA levels
Unreported
Yes in
women/girls/
No for
men/boys
Number of chronic diseases/SES/education
level/smoking/alcohol/psychopharmacologic
treatment/marital status/ number of activities of daily
living difficulties
No
Gender/age/smoking/substance abuse
Unreported
Yes in women,
no in men
Age/chronic conditions/education/employment
status/income/length of follow-up
Yes
Gender/chronic conditions/mobility
problems/BMI/education/tobacco/marital
status/tobacco/mobility problems
Unreported
Subjects who decreased their
PA levels were at an
increased risk of developing
future depression (OR=1.56)
relative to those who
maintained stable levels of PA
Unreported
Yes
Age/gender/long-standing
illnesses/SES/smoking/alcohol
Yes
Body satisfaction/bulimic symptoms/social support/BMI
A-5
Jonsdottir (2010)29
Kritz-Silverstein
(2001)30
Ku (2009)31
Lampinen (2000)32
Lucas (2011)33
Mikkelsen (2010)34
Subjects reporting light PA (RR=0.37;
gardening for 2 hr/week) or moderatevigorous PA (RR=0.29; dancing/swimming
for 2–5 hr/week) at T1 were at a
decreased risk of developing depression
at T2 relative to sedentary participants
No significant longitudinal associations
Subjects reporting PA less than 2
times/week (OR=1.34) at T1 were at an
increased risk of developing depression
at T2 relative to subjects engaging in PA
≥3 times/week
Subjects reporting low PA levels
(OR=10.56; regular walking) at T1 were at
an increased risk of developing
depression at T2 relative to those with
high levels of regular walking PA
Subjects reporting 10–29 min of PA/day
(RR=0.90); 30–59 min of PA/day
(RR=0.91); 60–89 min of PA/day
(RR=0.84); and ≥90 min/day (RR=0.80)
at T1 were at a decreased risk of
developing depression at T2 relative to
those engaging in <10 min of PA/day
Depression risk decreased with
increasing time spent walking at an
‘average pace’ (<20 min/day, RR=0.94;
20–40 min/day, RR=0.94; ≥40 min/day,
RR=0.80) or brisk/very brisk pace (<20
min/day, RR=0.95; 20–40 min/day,
RR=0.88; ≥40 min/day, RR=0.83) but not
related to time spent walking at an easy
pace
Women/girls reporting low LTPA
(HR=1.80; <2 hr/week) at T1 were at an
increased risk of developing depression
at T2 relative to women/girls reporting
moderate levels of LTPA (HR=1.07;>2
hr/week)
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Unreported
Yes
Age/gender/BMI/education/anxiety
Unreported
No
Age/BMI/smoking/alcohol/social support/estrogen use
Yes
Age/gender/chronic diseases/health
status/SES/income
satisfaction/education/alcohol/smoking/marital status/
living status/social support
Subjects who decreased PA
(OR=10.56) in the “regular
walking group” were at an
increased risk of developing
future depression relative to
those who remained active or
increased their PA levels
Unreported
Yes
Age/gender/health status/SES/physical
functioning/changes in PA/stability of PA
Yes
Age/BMI/postmenopausal hormone/marital
status/community involvement/smoking/total energy
intake/coffee intake/diabetes/cancer/high blood
pressure/arthritis/osteoarthritis/asthmas/emphysema/
TV watching/physical limitations
Unreported
Yes for women/
no for men
Age/chronic disease/BMI/education/income/
smoking/alcohol/occupational PA
No significant findings
A-6
Mobily (1996)35
Morgan (1998)36
Paffenbarger
(1994)37
Rothon (2010)38
Smith (2010)39
Strawbridge
(2002)40
Sund (2011)41
van Gool (2006)42
No significant longitudinal associations
Subjects reporting lower levels of PA
(outdoor/leisure activities) at T1 were at
an increased risk (OR=0.92/hr of activity)
of developing depression at T2
Subjects who expended between 1000
and 2499 kcal/week (RR=0.83) and
>2500 kcal/week (RR=0.72) at T1 were at
a decreased risk of developing depression
at T2
No significant longitudinal associations
Unreported
Unreported
No
Yes
Age/gender/physical illness/marital status/smoking/
Age/health Index score/social engagement/social class
Unreported
Yes
Age/smoking/alcohol
No significant findings
No
General health/long-standing behaviors/health
behaviors
Subjects reporting intermediate (0.25–
1.5 miles/day, OR= 0.52) and high (>1.5
miles/day, OR= 0.61) levels of walking at
T1 were at a decreased risk of developing
depression at T2 relative to those with low
levels of walking
Subjects with greater PA levels at T1 were
at a decreased risk of developing
depression (OR=0.83) at T2
Subjects reporting low-vigorous PA (OR=
1.23; <3 hr/week) and sedentary
behavior (OR=1.22) at T1 were at an
increased risk of developing depression
at T2
Subjects reporting >30 min of PA/day
(RR=0.52) at T1 were at a decreased risk
of developing depression at T2 relative to
those reporting no PA
Unreported
Yes
Age/education/marital status/BMI/cardiovascular risk
factors/hypertension/alcohol/smoking/diabetes/prevalent diseases/functional impairment
Unreported
Yes
Unreported
Yes
Age/gender/ethnicity/financial strain/chronic
conditions/disability/BMI/alcohol/smoking/social
relations
Age/gender/parental SES/ethnicity/somatic disease/
pubertal development/BMI/obesity/physical
impairment
Subjects who maintained PA
throughout (RR=0.56)
decreased their risk of future
depression relative to those
who were inactive throughout
Women/girls who decreased
their PA overtime (HR=1.49)
were more likely to develop
depression relative to those
who remained active
Yes
Age/gender/marital status/education level/
instrumental activities of daily living/chronic diseases
Yes in women
No in men
Age/gender/chronic disease/activity prevented due to
pain/BMI/smoking/alcohol/marital status/working
status/income/education/restriction of
activity/perceived social support/self-rated health
Unreported
No
Age/gender/physical health/somatic disorders/social
class
Wang (2011)43
Women/girls who were inactive at T1
(HR=1.27; <1.5 kcal/kg) and T2
(HR=1.22; <1.5 kcal/kg) were at an
increased risk of developing future
depression at T3, relative to those who
were active
Weyerer (1992)44
No significant longitudinal associations
Am J Prev Med 2013;45(5)
A-7
Wise (2006)45
Women reporting 7+ hours/week of PA
(OR=0.75) at T1 were at a decreased risk
of developing depression at T2 relative to
those who reported no vigorous PA
Women who maintained their
activity levels in both high
school (≥5 hr/week) and
adulthood (≥ 2hr/week) were
at a decreased risk of
developing future depression
(OR=0.76) relative to neveractive women
(OR=0.90) or women who
were active in high school but
inactive in adulthood
(OR=0.83) or women who
were inactive in high school
but active in adulthood
Yes
Age/education/occupation/marital status/geographic
region/BMI/health conditions/energy
intake/smoking/alcohol/child care responsibilities
F, female; HR, hazard ratios; hr, hour(s); Kcal, kilocalories; LTPA, leisure-time physical activity; M, male; min, minutes; T1, Time 1; T2, Time 2; PA, physical activity; RR,
relative risk
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