University of Groningen
Physical Activity and Functional Recovery in Late-life Depression
Wassink-Vossen, Sanne
DOI:
10.33612/diss.147538340
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Publication date:
2020
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Wassink-Vossen, S. (2020). Physical Activity and Functional Recovery in Late-life Depression. University of
Groningen. https://doi.org/10.33612/diss.147538340
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CHAPTER 3
T
HE
PREDICTIVE
VALUE
OF
PHYSICAL
ACTIVITY
AND
SEDENTARY
BEHAVIOR
ON
DEPRESSION
IN
OLDER
ADULTS
Shorter version (letter to the editor) published
Sanne Wassink - Vossen, Eric O. Noorthoorn, Rose M. Collard,
40
Abstract
Objectives: To investigate the predictive value of physical activity and sedentary behavior on depression outcomes after 2 years of follow-up in depressed older adults.
Methods: Participants of the Netherlands Study of Depression in Older Persons (NESDO) with available longitudinal data were included (N=231). Multiple linear and logistic regression analysis models were built to predict depression after two years follow-up with physical activity and sedentary behavior - assessed with the International Physical Activity Questionnaire (IPAQ) - as predictors.
Results: There was no significant association found between physical activity or sedentary behavior at baseline and depression outcome after 2 years.
Conclusion: this study revealed that physical activity and/or sedentary behavior at baseline has no predictive contribution to various depression outcomes after 2 years follow-up. These results stress the need for long-term intervention studies on the impact of physical activity on late-life depression.
Chapter 3
Introduction
Numerous studies have shown that depression is associated with decreased levels of physical activity and passive sedentary behavior which may partly mediate the negative
health outcomes in depressed older adults.64,106 Prospective studies confined to physical
activity and sedentary behavior in late-life depression, however, are scarce. Also, most previous studies primarily focus on depressive symptoms instead of on depressive
disorder.42 Due to the lack of data, little is known about the predictive value of physical
activity and sedentary behavior for the course of depressive disorders in older adults. We tested the hypothesis that the level of physical activity and sedentary behavior influences the outcomes of depressive disorder in older adults after two years follow up.
Methods
Data were obtained from the baseline and 2 years follow up assessment of the Netherlands Study of Depression in Older Persons (NESDO). NESDO is a longitudinal multi-site naturalistic cohort study aimed at examining the course and consequences of depressive disorders in older adults. The NESDO study design and measure are described in detail
elsewhere.57 At baseline, 378 subjects with a diagnoses of depression within the last
6 months and 132 non-depressed subjects were included. Subjects had no primary diagnosis of dementia or other serious psychiatric disease as set by a clinician, had mini mental state examination (MMSE) scores of 18 or higher and had sufficient command of the Dutch language. For the present study, only subjects with depression diagnosis at time of the assessment of the measurement on physical activity (the last month prior to baseline measure) and with complete follow-up were included. Therefore, the current study sample consisted of 231 depressed older adults.
Measurements
Three depression measures at two years follow up were obtained: Depression diagnosis, chronicity of depression and the residual gain score on severity in depression symptoms. Depression diagnosis (major/minor depression and dysthymia) as measured by the Composite Interview Diagnostic Instrument version 2.1 (CIDI). Chronicity of depression was defined as a diagnosis of depression combined with severity of symptoms assessed with the 30-item self-rating Inventory of Depressive Symptomatology (IDS). Included were scores > 14 on five measurement points in two years. Residual gain scores were used to indicate the individual change in the severity of depressive symptoms after two years.
42
Z-score from the Time 2 Z-score corrected for a higher or lower score at baseline as
expressed in: (RG = Z2 - Z1 * r1,2).107 Residual gain scores near zero indicate an average
gain on the symptoms. Positive scores indicate less than average gain, or an increase of symptoms. Negative scores indicate greater than average gain, or improvement on symptoms. Residual gain scores were calculated for total depression severity score, measured with the IDS, and for three symptom subscales; the motivation, mood and
somatic subscales.82
Predictive factors: For total amount of Physical Activity in the past week, the Dutch short version of the International Physical Activity Questionnaire (IPAQ) was used. Data are summed into multiples of the basal resting energy expenditure (Metabolic Equivalent of Task= MET). Total METminutes / per week at baseline is used for analyses where higher scores mean more physical activity. The IPAQ questions on sitting are used as an indicator of time (minutes) spent in sedentary behavior on an average day.
Potential confounders from the baseline assessment were divided in the following subgroups: socio demographics (age, gender, education), global cognitive function (MMSE), somatic condition (Functional limitations (WHO-Das), medication use (total number of different medications), Body Mass Index (BMI), chronic diseases (total number of different diseases), other lifestyle factors (smoking (yes/no), hazardous and harmful alcohol use (yes/no)) and psycho-social and environmental factors (partner status, network size (small/middle/large) sense of mastery, inpatient setting (yes/no)).
Missing data of outcomes, predictive factors and confounders was handled by multiple imputation using the fully conditional specification method with IBM SPSS statistics. For the exploration of the predictive contribution of physical activity and sedentary behavior on the depression outcomes at follow-up, multiple regression analyses were performed. Physical activity (total MET/min per week Z-score) or sedentary behavior (total sitting min/day) were the primary independent predictors. First, the analyses were performed unadjusted. Next, gender, education, and age were added to the model (adjusted model). Subsequently, multiple regression models were built; each with a different set of potential confounders - clustered into cognitive function, somatic condition, lifestyle factors and psychosocial determinants. The potential significant variables (p= <.20) of the different models were then combined in a final model. For this final model we used the backward stepwise de-selection procedure. Multi-collinearity was tested by the variance-inflating factor (VIF). Statistical Package of the Social Sciences (SPSS) 22.0 software for Windows was used to perform all the statistical analyses.
Chapter 3
Results
Compared with the 72 subjects who dropped out of the study, subjects that were included in the present study were more physical active at baseline (mean [standard deviation (SD)] METmin/week: 2651 [1628]; unequal variance t: 2.08, df: 110.45, p: .004), showed less sedentary behavior (mean [SD] sitting min/day: 429.3 [487.9], unequal variance t: 2.9, df: 91.85, p: .04) and had better cognitive function (mean [SD] MMSE score: 27.8 [26.9], unequal variance t: -2.5, df: 92.45, p: .014). They did not differ in other determinants. Logistic and linear regression analyses showed that physical activity had no predictive value for any of our depression outcomes at 2-year follow-up (table 1). Post hoc analyses with a categorical division of data in low, moderate and high levels of physical activity at baseline showed similar result. Also for sedentary behavior we did not find a significant predictive value (data not shown).
44
Table 1: Independent contribution of physical activity (METmin/week) on depr ession outcomes at 2 years (diagnosis, chr onicity and residual gain on depr essive symptoms) Depr ession (no/yes) a Chr onicity (no/yes) aResidual gain on depr
ession symptoms Total seve -rity b Subscales N=231 Mood b Motivation b Somatic b METmin/week B S.E OR 95% CI p B S.E. OR 95% CI p B p B p B p B p unadjusted -.231 .145 794 .597 - 1.054 .111 -.256 .155 .774 .572 - 1.049 .098 .041 .486 -.014 .824 -.012 .844 .026 .661 Adjusted c -.212 .148 .809 .605 - 1.081 .151 -.235 .157 .791 .581 - 1.075 .135 .060 .310 003 .961 .005 .939 .049 .374 Final model d -.189 .160 .827 .605 - 1.131 .235 -.251 .166 .860 .622 - 1.190 .362 .098 .082 .019 .735 .031 .611 .097 .089 Mc fadden r2 .085 .102 R Squar e .139 .117 .104 .161 aLogistic r egr
ession models with physical activity (total METmin-week) as pr
edictor
.
b Linear r
egr
ession models with Inventory of Depr
essive Symptomatology (IDS) r
esidual gain scor1es as dependent variable and physical activity (total MET min) as pr
edictor:
c Adjusted for age, sexe and education. d Adjusted for final significant covariates fr
om additionally adjusted analysis cluster
ed in cognition (memory) , somatic condition (functional limit
ations, chr onic diseases, medication use, BMI), other lifestyle (harmful alcohol use, curr ent smoker) and psycho-social factors (partner status, sense of mastery , network, inpatient setting) with ‘best fit
model’ principle: When variable p <.200= added to next step with backwar
Chapter 3
Discussion
In this longitudinal follow-up study of depressed older adults, we found that physical activity and sedentary behavior had no predictive value with respect to depression diagnosis, chronicity of depression or residual gain in depressive symptoms after 2 years. Prior to the study, we expected to find that more physical activity and/or less sedentary behavior was associated with a better outcome of depression at follow-up.
Evidence for the protective effect of physical activity on the course of depression has been contradictory. While some researchers found evidence that higher levels of physical
activity were related to lower depressive symptoms in older adults at 5 yrs follow-up,108 or
to a reduced risk on persistence of the depressive disorder in younger adults,109 another
cohort study found that baseline physical activity did not predict change in depression
outcome over 10 years in initially depressed adults aged>18 (mean 39.9).110 Although
research on this subject in a clinical depressed older population is scarce, and the existing studies have methodological differences, these contradictory findings give rise to the assumption that the role of physical activity on risk on depression (symptoms) in the population differs from that of physical activity in older adults who already are depressed. In addition, a growing number of well-designed studies showed that physical activity as a therapeutic intervention could reduce depressive symptoms in older people. Nonetheless, these studies stress the need for a long-term follow-up as the effect diminish over time
with only no or small effects at one-year follow-up.42,91
One of the major strengths of this study is that results are based on a large sample of clinically depressed older adults that also had a thorough follow up. Furthermore, many known potential confounders in the relationship between physical activity and depression in older adults were included. However, two limitations should be acknowledged. First, depressed subjects tend to have a negatively biased cognition and therefore subjects could have underscored their physical activity and sedentary behavior on the IPAQ. Verification of the validity of this self-report on physical activity with accelerometers is needed. Secondly, subjects who dropped out of the study were at baseline the least physical active, had more sedentary behavior and worse cognitive function. This suggests that the most frail subjects with probably the worst outcomes were not included in our analysis.
