Vincenza Gianfredi1, Annemarie Koster2, Simone J P M Eussen3, Anna Odone4, Andrea Amerio5, Carlo Signorelli6, Coen D A Stehouwer7, Hans H C M Savelberg8, Anke Wesselius9, Sebastian Köhler10, Miranda T Schram11, Nicolaas C Schaper12. 1. School of Public Health, University Vita-Salute San Raffaele, Milan, Italy; CARIM School for Cardiovascular Diseases, Maastricht University, Medical Center+, Maastricht, the Netherlands; CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy. Electronic address: v.gianfredi@maastrichtuniversity.nl. 2. CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Social Medicine, Maastricht University, Maastricht, the Netherlands; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy. Electronic address: a.koster@maastrichtuniversity.nl. 3. CARIM School for Cardiovascular Diseases, Maastricht University, Medical Center+, Maastricht, the Netherlands; Department of Epidemiology, Maastricht University, Maastricht, the Netherlands. Electronic address: simone.eussen@maastrichtuniversity.nl. 4. School of Public Health, University Vita-Salute San Raffaele, Milan, Italy. Electronic address: odone.anna@hsr.it. 5. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, United States. Electronic address: andrea.amerio@unige.it. 6. School of Public Health, University Vita-Salute San Raffaele, Milan, Italy. Electronic address: signorelli.carlo@hsr.it. 7. CARIM School for Cardiovascular Diseases, Maastricht University, Medical Center+, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands. Electronic address: cda.stehouwer@mumc.nl. 8. Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands; School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; NUTRIM, School for Nutrition and Translation Research Maastricht, Maastricht University, the Netherlands. Electronic address: hans.savelberg@maastrichtuniversity.nl. 9. NUTRIM, School for Nutrition and Translation Research Maastricht, Maastricht University, the Netherlands; Department of Complex Genetics, Maastricht University, Maastricht, the Netherlands. Electronic address: anke.wesselius@maastrichtuniversity.nl. 10. Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; MHeNS School for Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands. Electronic address: s.koehler@maastrichtuniversity.nl. 11. CARIM School for Cardiovascular Diseases, Maastricht University, Medical Center+, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; The Netherlands Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands. Electronic address: m.schram@maastrichtuniversity.nl. 12. CARIM School for Cardiovascular Diseases, Maastricht University, Medical Center+, Maastricht, the Netherlands; CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands. Electronic address: n.schaper@mumc.nl.
Abstract
BACKGROUND: Moderate to vigorous physical activity (MVPA) can help to prevent depression, but identification of the most important psycho-biological pathways involved is unclear. The improvement of cardio-respiratory fitness (CRF) in response to MVPA can vary markedly, we therefore examined the association between CRF and the incidence of depressive symptoms. METHODS: We used data from The Maastricht Study, a large population-based prospective-cohort study. CRF was estimated at baseline from a graded submaximal exercise protocol and MVPA was measured with accelerometry. Depressive symptoms were assessed using the validated Dutch version of the 9-item Patient Health Questionnaire, both at baseline and during annual follow-up over five years. Cox proportional hazards models were used. RESULTS: A total of 1,730 individuals without depressive symptoms at baseline were included in the analysis. During the 5-year follow-up, n = 166 (9.6%) of individuals developed depressive symptoms. Compared to individuals with a low CRF, those with a moderate-to-high CRF had a significantly lower risk of developing depressive symptoms, independent of MVPA (medium CRF: HR = 0.49 (95%CI = 0.33-0.72); high CRF: HR = 0.48 (95% CI = 0.30-0.75). These associations were adjusted for age, sex, level of education, diabetes status, smoking status, alcohol use, energy intake, waist circumferences and antidepressant medications. LIMITATIONS: PHQ-9 is a validated screening instrument, but it is not a diagnostic tool of depression. CONCLUSIONS: Higher CRF was strongly associated with a lower risk of incident depressive symptoms over 5-year follow-up, independent of the level of MVPA at baseline, suggesting that interventions aimed at improving CRF could reduce the risk of depression.
BACKGROUND: Moderate to vigorous physical activity (MVPA) can help to prevent depression, but identification of the most important psycho-biological pathways involved is unclear. The improvement of cardio-respiratory fitness (CRF) in response to MVPA can vary markedly, we therefore examined the association between CRF and the incidence of depressive symptoms. METHODS: We used data from The Maastricht Study, a large population-based prospective-cohort study. CRF was estimated at baseline from a graded submaximal exercise protocol and MVPA was measured with accelerometry. Depressive symptoms were assessed using the validated Dutch version of the 9-item Patient Health Questionnaire, both at baseline and during annual follow-up over five years. Cox proportional hazards models were used. RESULTS: A total of 1,730 individuals without depressive symptoms at baseline were included in the analysis. During the 5-year follow-up, n = 166 (9.6%) of individuals developed depressive symptoms. Compared to individuals with a low CRF, those with a moderate-to-high CRF had a significantly lower risk of developing depressive symptoms, independent of MVPA (medium CRF: HR = 0.49 (95%CI = 0.33-0.72); high CRF: HR = 0.48 (95% CI = 0.30-0.75). These associations were adjusted for age, sex, level of education, diabetes status, smoking status, alcohol use, energy intake, waist circumferences and antidepressant medications. LIMITATIONS: PHQ-9 is a validated screening instrument, but it is not a diagnostic tool of depression. CONCLUSIONS: Higher CRF was strongly associated with a lower risk of incident depressive symptoms over 5-year follow-up, independent of the level of MVPA at baseline, suggesting that interventions aimed at improving CRF could reduce the risk of depression.
Authors: Vincenza Gianfredi; Pietro Ferrara; Flavia Pennisi; Giulia Casu; Andrea Amerio; Anna Odone; Daniele Nucci; Monica Dinu Journal: Int J Environ Res Public Health Date: 2022-05-26 Impact factor: 4.614