Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies

Objective:

The authors examined the prospective relationship between physical activity and incident depression and explored potential moderators.

Method:

Prospective cohort studies evaluating incident depression were searched from database inception through Oct. 18, 2017, on PubMed, PsycINFO, Embase, and SPORTDiscus. Demographic and clinical data, data on physical activity and depression assessments, and odds ratios, relative risks, and hazard ratios with 95% confidence intervals were extracted. Random-effects meta-analyses were conducted, and the potential sources of heterogeneity were explored. Methodological quality was assessed using the Newcastle-Ottawa Scale.

Results:

A total of 49 unique prospective studies (N=266,939; median proportion of males across studies, 47%) were followed up for 1,837,794 person-years. Compared with people with low levels of physical activity, those with high levels had lower odds of developing depression (adjusted odds ratio=0.83, 95% CI=0.79, 0.88; I2=0.00). Furthermore, physical activity had a protective effect against the emergence of depression in youths (adjusted odds ratio=0.90, 95% CI=0.83, 0.98), in adults (adjusted odds ratio=0.78, 95% CI=0.70, 0.87), and in elderly persons (adjusted odds ratio=0.79, 95% CI=0.72, 0.86). Protective effects against depression were found across geographical regions, with adjusted odds ratios ranging from 0.65 to 0.84 in Asia, Europe, North America, and Oceania, and against increased incidence of positive screen for depressive symptoms (adjusted odds ratio=0.84, 95% CI=0.79, 0.89) or major depression diagnosis (adjusted odds ratio=0.86, 95% CI=0.75, 0.98). No moderators were identified. Results were consistent for unadjusted odds ratios and for adjusted and unadjusted relative risks/hazard ratios. Overall study quality was moderate to high (Newcastle-Ottawa Scale score, 6.3). Although significant publication bias was found, adjusting for this did not change the magnitude of the associations.

Conclusions:

Available evidence supports the notion that physical activity can confer protection against the emergence of depression regardless of age and geographical region.

Read the Research

 

References:

  • 1GBD 2015 Disease and Injury Incidence and Prevalence Collaborators: Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1545–1602 Crossref, Medline, Google Scholar
  • 2Vancampfort D, Correll CU, Galling B, et al.: Diabetes mellitus in people with schizophrenia, bipolar disorder, and major depressive disorder: a systematic review and large scale meta-analysis. World Psychiatry 2016; 15:166–174 Crossref, Medline, Google Scholar
  • 3Chisholm D, Sweeny K, Sheehan P, et al.: Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry 2016; 3:415–424 Crossref, Medline, Google Scholar
  • 4Walker ER, McGee RE, Druss BG: Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry 2015; 72:334–341 Crossref, Medline, Google Scholar
  • 5Cuijpers P, Beekman AT, Reynolds CF 3rd: Preventing depression: a global priority. JAMA 2012; 307:1033–1034 Crossref, Medline, Google Scholar
  • 6Hallgren M, Stubbs B, Vancampfort D, et al.: Treatment guidelines for depression: Greater emphasis on physical activity is needed. Eur Psychiatry 2017; 40:1–3 Crossref, Medline, Google Scholar
  • 7Schuch F, Vancampfort D, Firth J, et al.: Physical activity and sedentary behavior in people with major depressive disorder: a systematic review and meta-analysis. J Affect Disord 2017; 210:139–150 Crossref, Medline, Google Scholar
  • 8Schuch FB, Vancampfort D, Richards J, et al.: Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J Psychiatr Res 2016; 77:42–51 Crossref, Medline, Google Scholar
  • 9Mammen G, Faulkner G: Physical activity and the prevention of depression: a systematic review of prospective studies. Am J Prev Med 2013; 45:649–657 Crossref, Medline, Google Scholar
  • 10Teychenne M, Ball K, Salmon J: Physical activity and likelihood of depression in adults: a review. Prev Med 2008; 46:397–411 Crossref, Medline, Google Scholar
  • 11Stroup DF, Berlin JA, Morton SC, et al.: Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 2000; 283:2008–2012 Crossref, Medline, Google Scholar
  • 12Moher D, Liberati A, Tetzlaff J, et al.: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6:e1000097 Crossref, Medline, Google Scholar
  • 13Schuch FB, Vancampfort D, Sui X, et al.: Are lower levels of cardiorespiratory fitness associated with incident depression? A systematic review of prospective cohort studies. Prev Med 2016; 93:159–165 Crossref, Medline, Google Scholar
  • 14Zhai L, Zhang Y, Zhang D: Sedentary behaviour and the risk of depression: a meta-analysis. Br J Sports Med 2015; 49:705–709 Crossref, Medline, Google Scholar
  • 15Craig CL, Marshall AL, Sjöström M, et al.: International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003; 35:1381–1395 Crossref, Medline, Google Scholar
  • 16Caspersen CJ, Powell KE, Christenson GM: Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 1985; 100:126–131 Medline, Google Scholar
  • 17Cairns KE, Yap MBH, Pilkington PD, et al.: Risk and protective factors for depression that adolescents can modify: a systematic review and meta-analysis of longitudinal studies. J Affect Disord 2014; 169:61–75 Crossref, Medline, Google Scholar
  • 18Beck AT, Ward CH, Mendelson M, et al.: An inventory for measuring depression. Arch Gen Psychiatry 1961; 4:561–571 Crossref, Medline, Google Scholar
  • 19American Psychiatry Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed (DSM-5). Washington, DC, American Psychiatric Association, 2013 Crossref, Google Scholar
  • 20World Health Organization: The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva, World Health Organization, 1993 Google Scholar
  • 21Bland JM, Altman DG: The odds ratio. BMJ 2000; 320:1468 Crossref, Medline, Google Scholar
  • 22Wu W, Tong Y, Zhao Q, et al.: Coffee consumption and bladder cancer: a meta-analysis of observational studies. Sci Rep 2015; 5:9051 Crossref, Medline, Google Scholar
  • 23Thompson SG, Higgins JP: How should meta-regression analyses be undertaken and interpreted? Stat Med 2002; 21:1559–1573 Crossref, Medline, Google Scholar
  • 24Begg CB, Mazumdar M: Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50:1088–1101 Crossref, Medline, Google Scholar
  • 25Egger M, Davey Smith G, Schneider M, et al.: Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315:629–634 Crossref, Medline, Google Scholar
  • 26Duval S, Tweedie R: Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56:455–463 Crossref, Medline, Google Scholar
  • 27Higgins JPT, Thompson SG, Deeks JJ, et al.: Measuring inconsistency in meta-analyses. BMJ 2003; 327:557–560 Crossref, Medline, Google Scholar
  • 28Rosenthal R: The file drawer problem and tolerance for null results. Psychol Bull 1979; 86:638 Crossref, Google Scholar
  • 29Almeida OP, Norman P, Hankey G, et al.: Successful mental health aging: results from a longitudinal study of older Australian men. Am J Geriatr Psychiatry 2006; 14:27–35 Crossref, Medline, Google Scholar
  • 30Augestad LB, Slettemoen RP, Flanders WD: Physical activity and depressive symptoms among Norwegian adults aged 20–50. Public Health Nurs 2008; 25:536–545 Crossref, Medline, Google Scholar
  • 31Baumeister SE, Leitzmann MF, Bahls M, et al.: Associations of leisure-time and occupational physical activity and cardiorespiratory fitness with incident and recurrent major depressive disorder, depressive symptoms, and incident anxiety in a general population. J Clin Psychiatry 2017; 78:e41–e47 Crossref, Medline, Google Scholar
  • 32Beard JR, Heathcote K, Brooks R, et al.: Predictors of mental disorders and their outcome in a community based cohort. Soc Psychiatry Psychiatr Epidemiol 2007; 42:623–630 Crossref, Medline, Google Scholar
  • 33Brown DR, Croft JB, Anda RF, et al.: Evaluation of smoking on the physical activity and depressive symptoms relationship. Med Sci Sports Exerc 1996; 28:233–240 Crossref, Medline, Google Scholar
  • 34Cabello M, Miret M, Caballero FF, et al.: The role of unhealthy lifestyles in the incidence and persistence of depression: a longitudinal general population study in four emerging countries. Global Health 2017; 13:18 Crossref, Medline, Google Scholar
  • 35Chang M, Snaedal J, Einarsson B, et al.: The association between midlife physical activity and depressive symptoms in late life: Age Gene/Environment Susceptibility–Reykjavik Study. J Gerontol A Biol Sci Med Sci 2016; 71:502–507 Crossref, Medline, Google Scholar
  • 36Chang SC, Pan A, Kawachi I, et al.: Risk factors for late-life depression: a prospective cohort study among older women. Prev Med 2016; 91:144–151 Crossref, Medline, Google Scholar
  • 37Chen J, Millar WJ: Health effects of physical activity. Health Rep 1999; 11:21–30 Medline, Google Scholar
  • 38Choi Y, Park EC, Kim JH, et al.: A change in social activity and depression among Koreans aged 45 years and more: analysis of the Korean Longitudinal Study of Aging (2006–2010). Int Psychogeriatr 2015; 27:629–637 Crossref, Medline, Google Scholar
  • 39Clark C, Haines MM, Head J, et al.: Psychological symptoms and physical health and health behaviours in adolescents: a prospective 2-year study in East London. Addiction 2007; 102:126–135 Crossref, Medline, Google Scholar
  • 40Collard RM, Comijs HC, Naarding P, et al.: Frailty as a predictor of the incidence and course of depressed mood. J Am Med Dir Assoc, 2015; 16:509–514 Crossref, Medline, Google Scholar
  • 41Cooper-Patrick L, Ford DE, Mead LA, et al.: Exercise and depression in midlife: a prospective study. Am J Public Health 1997; 87:670–673 Crossref, Medline, Google Scholar
  • 42Da Silva MA, Singh-Manoux A, Brunner EJ, et al.: Bidirectional association between physical activity and symptoms of anxiety and depression: the Whitehall II Study. Eur J Epidemiol 2012; 27:537–546 Crossref, Medline, Google Scholar
  • 43Espana-Romero V, Artero EG, Lee DC, et al.: A prospective study of ideal cardiovascular health and depressive symptoms. Psychosomatics 2013; 54:525–535 Crossref, Medline, Google Scholar
  • 44Farmer ME, Locke BZ, Moscicki EK, et al.: Physical activity and depressive symptoms: the NHANES I Epidemiologic Follow-Up Study. Am J Epidemiol 1988; 128:1340–1351 Crossref, Medline, Google Scholar
  • 45Gallegos-Carrillo K, Denova-Gutierrez E, Dosamantes-Carrasco LD, et al.: Physical activity and reduced risk of depression: results of a longitudinal study of Mexican adults. Health Psychol 2013; 32:609–615 Crossref, Medline, Google Scholar
  • 46Garcia-Pena C, Wagner FA, Sanchez-Garci S, et al.: Late-life depressive symptoms: prediction models of change. J Affect Disord 2013; 150:886–894 Crossref, Medline, Google Scholar
  • 47Giltay EJ, Zitman FG, Kromhout D: Dispositional optimism and the risk of depressive symptoms during 15 years of follow-up: the Zutphen Elderly Study. J Affect Disord 2006; 91:45–52 Crossref, Medline, Google Scholar
  • 48Groffen DA, Koster A, Bosma H, et al.: Unhealthy lifestyles do not mediate the relationship between socioeconomic status and incident depressive symptoms: the Health ABC Study. Am J Geriatr Psychiatry 2013; 21:664–674 Crossref, Medline, Google Scholar
  • 49Hiles SA, Baker AL, de Malmanche T, et al.: Unhealthy lifestyle may increase later depression via inflammation in older women but not men. J Psychiatr Res 2015; 63:65–74 Crossref, Medline, Google Scholar
  • 50Jerstad SJ, Boutelle KN, Ness KK, et al.: Prospective reciprocal relations between physical activity and depression in female adolescents. J Consult Clin Psychol 2010; 78:268–272 Crossref, Medline, Google Scholar
  • 51Jonsdottir IH, Rodjer L, Hadzibajramovic E, et al.: A prospective study of leisure-time physical activity and mental health in Swedish health care workers and social insurance officers. Prev Med 2010; 51:373–377 Crossref, Medline, Google Scholar
  • 52Joshi S, Mooney SJ, Kennedy GJ, et al.: Beyond METs: types of physical activity and depression among older adults. Age Ageing 2016; 45:103–109 Crossref, Medline, Google Scholar
  • 53Koster A, Bosma H, Kempen GI, et al.: Socioeconomic differences in incident depression in older adults: the role of psychosocial factors, physical health status, and behavioral factors. J Psychosom Res 2006; 61:619–627 Crossref, Medline, Google Scholar
  • 54Ku PW, Fox KR, Chen LJ: Physical activity and depressive symptoms in Taiwanese older adults: a seven-year follow-up study. Prev Med 2009; 48:250–255 Crossref, Medline, Google Scholar
  • 55Kuwahara K, Honda T, Nakagawa T, et al.: Associations of leisure-time, occupational, and commuting physical activity with risk of depressive symptoms among Japanese workers: a cohort study. Int J Behav Nutr Phys Act 2015; 12:119 Crossref, Medline, Google Scholar
  • 56McKercher C, Sanderson K, Schmidt MD, et al.: Physical activity patterns and risk of depression in young adulthood: a 20-year cohort study since childhood. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1823–1834 Crossref, Medline, Google Scholar
  • 57Messier L, Elisha B, Schmitz N, et al.: Changes in depressive symptoms and changes in lifestyle-related indicators: a 1-year follow-up study among adults with type 2 diabetes in Quebec. Can J Diabetes 2013; 37:243–248 Crossref, Medline, Google Scholar
  • 58Mihrshahi S, Dobson AJ, Mishra GD: Fruit and vegetable consumption and prevalence and incidence of depressive symptoms in mid-age women: results from the Australian longitudinal study on women’s health. Eur J Clin Nutr 2015; 69:585–591 Crossref, Medline, Google Scholar
  • 59Mikkelsen SS, Tolstrup JS, Flachs EM, et al.: A cohort study of leisure time physical activity and depression. Prev Med 2010; 51:471–475 Crossref, Medline, Google Scholar
  • 60Mobily KE, Rubenstein LM, Lemke JH, et al.: Walking and depression in a cohort of older adults: the Iowa 65 plus rural health study. J Aging Phys Act 1996; 4:119–135 Crossref, Google Scholar
  • 61Park JE, Lee JY, Kim BS, et al.: Above-moderate physical activity reduces both incident and persistent late-life depression in rural Koreans. Int J Geriatr Psychiatry 2015; 30:766–775 Crossref, Medline, Google Scholar
  • 62Pasco JA, Williams LJ, Jacka FN, et al.: Habitual physical activity and the risk for depressive and anxiety disorders among older men and women. Int Psychogeriatr 2011; 23:292–298 Crossref, Medline, Google Scholar
  • 63Rius-Ottenheim N, Geleijnse JM, Kromhout D, et al.: Physical activity after myocardial infarction: is it related to mental health? Eur J Prev Cardiol 2013; 20:399–408 Crossref, Medline, Google Scholar
  • 64Roh HW, Hong CH, Lee Y, et al.: Participation in physical, social, and religious activity and risk of depression in the elderly: a community-based three-year longitudinal study in Korea. PLoS One 2015; 10:e0132838 Crossref, Medline, Google Scholar
  • 65Sanchez-Villegas A, Ara I, Guillen-Grima F, et al.: Physical activity, sedentary index, and mental disorders in the sun cohort study. Med Sci Sports Exerc 2008; 40:827–834 Crossref, Medline, Google Scholar
  • 66Sanchez-Villegas A, Ruiz-Canela M, Gea A, et al.: The association between the Mediterranean lifestyle and depression. Clin Psychol Sci 2016; 4:1085–1093 Crossref, Google Scholar
  • 67Smith TL, Masaki KH, Fong K, et al.: Effect of walking distance on 8-year incident depressive symptoms in elderly men with and without chronic disease: the Honolulu-Asia Aging Study. J Am Geriatr Soc 2010; 58:1447–1452 Crossref, Medline, Google Scholar
  • 68Strawbridge WJ, Deleger S, Roberts RE, et al.: Physical activity reduces the risk of subsequent depression for older adults. Am J Epidemiol 2002; 156:328–334 Crossref, Medline, Google Scholar
  • 69Ströhle A, Höfler M, Pfister H, et al.: Physical activity and prevalence and incidence of mental disorders in adolescents and young adults. Psychol Med 2007; 37:1657–1666 Crossref, Medline, Google Scholar
  • 70ten Have M, de Graaf R, Monshouwer K: Physical exercise in adults and mental health status: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). J Psychosom Res 2011; 71:342–348 Crossref, Medline, Google Scholar
  • 71Tsai AC, Chi SH, Wang JY: Cross-sectional and longitudinal associations of lifestyle factors with depressive symptoms in ≥ 53-year old Taiwanese: results of an 8-year cohort study. Prev Med 2013; 57:92–97 Crossref, Medline, Google Scholar
  • 72Tsutsumimoto K, Makizako H, Hotta R, et al.: Prospective associations between sedentary behaviour and incident depressive symptoms in older people: a 15‐month longitudinal cohort study. Int J Geriatr Psychiatry 2017; 32:193–200 Crossref, Medline, Google Scholar
  • 73Veronese N, Solmi M, Maggi S, et al.: Frailty and incident depression in community-dwelling older people: results from the elsa study. Int J Geriatr Psychiatry 2017; 32:e141–e149 Crossref, Medline, Google Scholar
  • 74Wang F, DesMeules M, Luo W, et al.: Leisure-time physical activity and marital status in relation to depression between men and women: a prospective study. Health Psychol 2011; 30:204–211 Crossref, Medline, Google Scholar
  • 75Weyerer S: Physical inactivity and depression in the community: evidence from the Upper Bavarian Field Study. Int J Sports Med 1992; 13:492–496 Crossref, Medline, Google Scholar
  • 76Wise LA, Adams-Campbell LL, Palmer JR, et al.: Leisure time physical activity in relation to depressive symptoms in the Black Women’s Health Study. Ann Behav Med 2006; 32:68–76 Crossref, Medline, Google Scholar
  • 77Yoshida Y, Iwasa H, Kumagai S, et al.: Longitudinal association between habitual physical activity and depressive symptoms in older people. Psychiatry Clin Neurosci 2015; 69:686–692 Crossref, Medline, Google Scholar
  • 78Pasco JA, Williams LJ, Jacka FN, et al.: Habitual physical activity and the risk for depressive and anxiety disorders among older men and women. Int Psychogeriatr 2011; 23:292–298 Crossref, Medline, Google Scholar
  • 79Ioannidis JP: Integration of evidence from multiple meta-analyses: a primer on umbrella reviews, treatment networks, and multiple treatments meta-analyses. CMAJ 2009; 181:488–493 Crossref, Medline, Google Scholar
  • 80Schuch FB, Deslandes AC, Stubbs B, et al.: Neurobiological effects of exercise on major depressive disorder: a systematic review. Neurosci Biobehav Rev 2016; 61:1–11 Crossref, Medline, Google Scholar
  • 81Brellenthin AG, Crombie KM, Hillard CJ, et al.: Endocannabinoid and mood responses to exercise in adults with varying activity levels. Med Sci Sports Exerc 2017; 49:1688–1696 Crossref, Medline, Google Scholar
  • 82Lindqvist D, Dhabhar FS, James SJ, et al.: Oxidative stress, inflammation, and treatment response in major depression. Psychoneuroendocrinology 2017; 76:197–205 Crossref, Medline, Google Scholar
  • 83Erickson KI, Leckie RL, Weinstein AM: Physical activity, fitness, and gray matter volume. Neurobiol Aging 2014; 35(suppl 2):S20–S28 Crossref, Medline, Google Scholar
  • 84Szuhany KL, Bugatti M, Otto MW: A meta-analytic review of the effects of exercise on brain-derived neurotrophic factor. J Psychiatr Res 2015; 60:56–64 Crossref, Medline, Google Scholar
  • 85Toups MSP, Rethorst C, Carmody T, et al.: Cytokines in the relationship between exercise treatment and anhedonia and changes in arousal in depressed subjects. Biol Psychiatry 2014; 75:48S Google Scholar
  • 86Schuch FB, Vasconcelos-Moreno MP, Borowsky C, et al.: The effects of exercise on oxidative stress (TBARS) and BDNF in severely depressed inpatients. Eur Arch Psychiatry Clin Neurosci 2014; 264:605–613 Crossref, Medline, Google Scholar
  • 87Lavebratt C, Herring MP, Liu JJ, et al.: Interleukin-6 and depressive symptom severity in response to physical exercise. Psychiatry Res 2017; 252:270–276 Crossref, Medline, Google Scholar
  • 88Cairney J, Faulkner G, Veldhuizen S, et al.: Changes over time in physical activity and psychological distress among older adults. Can J Psychiatry 2009; 54:160–169 Crossref, Medline, Google Scholar
  • 89Ku PW, Steptoe A, Chen LJ: Prospective associations of exercise and depressive symptoms in older adults: the role of apolipoprotein E4. Qual Life Res 2017; 26:1799–1808 Crossref, Medline, Google Scholar
  • 90Dotson VM, Hsu FC, Langaee TY, et al.: Genetic moderators of the impact of physical activity on depressive symptoms. J Frailty Aging 2016; 5:6–14 Medline, Google Scholar