mmc1

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 Baseline age (years), gender

Follow-up period (years)

N included in prospective analysis

Measures of physical activity

Measures of depression (cut-off scores to define depression) Methods of analysis

Aberg (2012)16 Sweden

18 M only

340 1,117,294 Cardiovascular fitness via cycle ergometer test

Swedish National Hospital Discharge Register

Cox regression

Augestad (2008)17 Norway

2140 M and F

10 6,661 Self-reported Hospital Anxiety and Depression Scale, depression subscale (HADS-D: 8)

Logistic regression

Backmand (2003)18 Finland

Mean=65 M only

10 1,164 Self-reported Brief Symptom Inventory (BSI-53: 8) Logistic regression

Ball,19 2008,Australia

2227 F only

3 6,677 Self-reported CESD-10: 10 Logistic regression

Bernaards (2006)20 Netherlands

Unreported 3 1,747 Self-reported

CESD-11: 6 Generalized estimating equation modeling

Brown (2005)21 Australia

4550 F only

5 9,207 Self-reported

CESD-10: 10 and mental health subscale 52 of Short Form (SF-36) functioning and well-being scale

Logistic regression

Camacho (1991)22 USA

20 M and F


40-item measure constructed independently by researchers: 5

Logistic regression

Carroll (2010)23 USA

5161 M and F

6 5,389 Self-reported CESD-8: women/girls 4; men/boys 3 Logistic regression

Cooper-Patrick (1997)24 USA

Unreported (during medical school and midlife) M and F

15 752 Self-reported General Health Questionnaire: 4 Cox regression

Am J Prev Med 2013;45(5) A-1






Farmer (1988)25 USA

2577 M and F

8 1,497

Self-reported CESD-20: 16 Logistic regression

Gallegos-Carillo (2012)26 Mexico

18 M and F


Hamer (2009)27 England

Mean=63 M and F


Jerstad (2010)28 USA

1115 F only

6 496 Self-reported The Schedule for Affective Disorders and Schizophrenia for School-Age Children: 5

Generalized Linear Model regression

Jonsdottir (2010)29 Sweden

Mean=47 M andF

2 3,114 Self-reported Hospital Anxiety and Depression Scale (HAD: 10)

Cox regression

Kritz-Silverstein (2001)30 USA

5089 M and F

8 944 Self-reported Beck Depression Inventory (BDI: 13)

ANCOVA

Ku (2009)31 Taiwan

50 M and F


Lampinen (2000)32 Finland

6584 M and F

8

663 Self-reported Beck Depression Inventory (BDI: 5) Logistic regression

Lucas (2011)33 USA

3055 F only

10 49,821 Self-reported Defined as reporting a physicians diagnosis of depression or the use of antidepressants Also used CESD-10: 10

Cox regression

Mikkelsen (2010)34 Denmark

20 M and F


Danish Hospital Discharge Register Cox regression

Mobily (1996)35 USA

65 M and F

3 2,084 Self-reported via interview

CESD-11:>15 Logistic regression

Morgan (1998)36 UK

65 M and F

4 497 Self-reported via interview

Symptoms of Anxiety and Depression (SAD: 6)

Logistic regression

Paffenbarger (1994)37 USA

3574 M only


Questionnaire developed by researchers Cox regression

Rothon (2010)38 England

1114 M and F


Short Moods 7 Feelings Questionnaire (SMFQ: 8)

Logistic regression

Smith (2010)39 USA

7193 M only


CESD-11: 9 or taking antidepressants Logistic regression

Strawbridge (2002)40 USA

5094 M and F


DSM-12D: 5 Logistic regression

Am J Prev Med 2013;45(5) A-2






Sund (2011)41 Norway

1215 M and F

12

2,360 Self-reported Mood and Feelings Questionnaire (MFQ: 25)

Logistic regression

van Gool (2006)42 Netherlands

2481 M and F


Wang (2011)43 Canada

12+ M and F

2, 4, and 6 17,276 Self-reported

Composite International Diagnostic Interview Short Form for Depression (CIDI-SF: 90%)

Cox regression

Weyerer (1992)44 Germany

15 M and F

5 1,341 Self-reported via interview

Interviewed by trained psychiatrist using the ICD

Logistic regression

Wise, 200645, USA 2169 F only


CESD-10: 16 Logistic regression

CESD, Center for Epidemiologic Studies Depression Scale; F, female; M, male

Am J Prev Med 2013;45(5) A-3

Appendix B

Findings of Prospective Studies Examining Physical Activity and Depression

Study Odds of developing depression Changes in PA levels and relationship to depression

Did PA prevent depression? Covariates accounted for in prospective analysis

Aberg (2012)16 Subjects with low levels of cardiovascular fitness at T1 were at an increased risk for developing depression (HR=1.96) at T2

Unreported Yes Calendar year/BMI/region/health tests/parent education level

Augestad (2008)17 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

Unreported Yes Age/BMI/education/alcohol/smoking/living arrangements

Backmand (2003)18

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

Unreported Yes Age/health/SES/ alcohol/smoking/marital status/personality characteristics/life events

Ball (2009)19 Subjects reporting low PA levels (OR= 0.77; 150 min/week) at T1 were at a decreased risk of developing depression at T2 relative to sedentary women.

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

Yes Health disabilities/BMI/education/smoking status/marital status/occupation/parity status

Bernaards (2006)20

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

Unreported Yes Gender/time of measurement/outcome of measurement

Brown (2005)21 Subjects reporting low PA (OR=0.92; 60150 min moderate PA/week); moderate PA (OR=0.81; 150300 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

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

Am J Prev Med 2013;45(5) A-4

Camacho (1991)22 Subjects reporting low PA levels (OR=1.75;04 points on activity index) at T1 were at an increased risk of developing depression at T2 relative to those with high PA levels

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

Carroll (2010)23 Women/girls who decreased their vigorous PA levels from high (>3 times/week) to low (13 times/month) were at a higher risk (OR=1.66) of developing depression at T2 in relation to those who maintained their PA levels

Women/girls who decreased their vigorous PA levels from high (>3 times/week) to low (13 times/month) were more likely (OR=1.66) to develop depression at follow-up in relation to those who maintained their PA levels

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

Cooper-Patrick (1997)24

No significant longitudinal associations Unreported No Gender/age/smoking/substance abuse

Farmer (1988)25 Women/girls reporting little/no PA (OR= 1.9) at T1 were at an increased risk of developing depression at T2

Unreported Yes in women, no in men

Age/chronic conditions/education/employment status/income/length of follow-up

Gallegos-Carrillo (2012)26

Subjects reporting moderately active PA patterns (OR=0.62; >11.01 to 27.18 METs) at T1 were at a decreased risk of developing depression at T2 relative to those who were inactive

Unreported Yes

Gender/chronic conditions/mobility problems/BMI/education/tobacco/marital status/tobacco/mobility problems

Hamer (2009)27 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 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

Yes Age/gender/long-standing illnesses/SES/smoking/alcohol

Jerstad (2010)28 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

Unreported Yes Body satisfaction/bulimic symptoms/social support/BMI

Am J Prev Med 2013;45(5) A-5

Jonsdottir (2010)29 Subjects reporting light PA (RR=0.37; gardening for 2 hr/week) or moderate-vigorous PA (RR=0.29; dancing/swimming for 25 hr/week) at T1 were at a decreased risk of developing depression at T2 relative to sedentary participants

Unreported Yes Age/gender/BMI/education/anxiety

Kritz-Silverstein (2001)30

No significant longitudinal associations Unreported No Age/BMI/smoking/alcohol/social support/estrogen use

Ku (2009)31 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

No significant findings

Yes Age/gender/chronic diseases/health status/SES/income satisfaction/education/alcohol/smoking/marital status/ living status/social support

Lampinen (2000)32

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 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

Yes Age/gender/health status/SES/physical functioning/changes in PA/stability of PA

Lucas (2011)33 Subjects reporting 1029 min of PA/day (RR=0.90); 3059 min of PA/day (RR=0.91); 6089 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

Mobily (1996)35 No significant longitudinal associations Unreported No Age/gender/physical illness/marital status/smoking/ Morgan (1998)36 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

Unreported Yes Age/health Index score/social engagement/social class

Paffenbarger (1994)37

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

Unreported Yes Age/smoking/alcohol

Rothon (2010)38 No significant longitudinal associations No significant findings No General health/long-standing behaviors/health behaviors

Smith (2010)39 Subjects reporting intermediate (0.251.5 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

Unreported Yes Age/education/marital status/BMI/cardiovascular risk factors/hypertension/alcohol/smoking/diabetes/preva-lent diseases/functional impairment

Strawbridge (2002)40

Subjects with greater PA levels at T1 were at a decreased risk of developing depression (OR=0.83) at T2

Unreported Yes Age/gender/ethnicity/financial strain/chronic conditions/disability/BMI/alcohol/smoking/social relations

Sund (2011)41 Subjects reporting low-vigorous PA (OR= 1.23; 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

Subjects who maintained PA throughout (RR=0.56) decreased their risk of future depression relative to those who were inactive throughout

Yes Age/gender/marital status/education level/ instrumental activities of daily living/chronic diseases

Wang (2011)43 Women/girls who were inactive at T1 (HR=1.27;

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 never-active 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

References for Appendixes A and B (from the main text)

1. WHO. Depression. www.who.int/mental_health/management/depression/definition/en/, 2010. 2. Lopez AD, Mathers CD, Ezzati M, Jamison D, Maurray CJL. Measuring the global burden of disease and risk factors, 19902001. In Global

burden of diseases and risk factors. New York: Oxford University Press, 2006. 3. Blazer DG. Depression in late life: review and commentary. Series A: J Gerontol Ser A-Biol Sci Med Sci 2003;58A:24965. 4. Cassano P, Fava M. Depression and public health: an overview. J Psychosam Res 2002;53:84957. 5. Chapman DP, Perry GS. Depression as a major component of public health for older adults. Prev Chron Dis 2008;5:A22. 6. Kessler RC. The cost of depression. Psychiatr Clin North Am 2012;35:114. 7. Krogh J, Nordentoft M, Sterne J, Lawlor D. The effect of exercise in clinically depressed adults: Systematic review and meta-analysis of

randomized controlled trials. J Clin Psychol 2011;72:52938. 8. Robertson R, Robertson A, Jepson R, Maxwell M. Walking for depression or depressive symptoms: a systematic review and meta-analysis.

MENPA 2012;5:6675. 9. Rimmer J, Dwan K, Lawlor DA, Greig CA, McMurdo M, Morley W, Mead GE. Exercise for depression. Cochrane Database Syst Rev 2012;

11:CD004366. 10. Teychenne M, Ball K, Salmon J. Physical activity and likelihood of depression in adults: a review. Prev Med 2008;46:397411. 11. Hill AB.The environment and disease: association or causation? Proc R Soc Med 1965;58:295300.

Am J Prev Med 2013;45(5) A-8

12. Mutrie N. The relationship between physical activity and clinically defined depression. In physical activity and psychological well-being. London: Routledge, 2000.

13. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097.

14. Critical Appraisal Skills Program (CASP). Making sense of evidence. www.casp-uk.net. 15. Barnett I, van Sluijs, E, Ogilvie D. Physical activity and transitioning to retirement. A systematic review. Am J Prev Med 2012;43:32936. 16. Aberg M, Waern M, Nyberg J, et al. Cardiovascular fitness in males at age 18 and risk of serious depression in adulthood: Swedish

prospective population-based study. BJ Psych 2012;10:18. 17. Augestad LB, Slettemoen RP, Flanders WD. Physical activity and depressive symptoms among Norwegian adults aged 2050. Public Health

Nurs 2008;25:53645. 18. Backmand H, Kaprio J, Kujala U, Sarna S. Influence of physical activity on depression and anxiety of former elite athletes. Int J Sports Med

2003;24:60919. 19. Ball K, Burton N, Brown W. A prospective study of overweight, physical activity, and depressive symptoms in young women. Obesity 2009;

17:6671. 20. Bernaards CM, Jans MP, van den Heuvel SG, Hendriksen IJ, Houtman IL, Bongers, PM. Can strenuous leisure time physical activity prevent

psychological complaints in a working population? Occup Environ Med 2006;63:106. 21. Brown WJ, Ford JH, Burton NW, Marshall AL, Dobson AJ. Prospective study of physical activity and depressive symptoms in middle-aged

women. Am J Prev Med 2005;29:26572. 22. Camacho TC, Roberts RE, Lazarus NB, Kaplan GA, Cohen RD. Physical activity and depression: evidence from the Alamada County study.

Am J Epidiomiol 1991;134:22031. 23. Carroll DD, Blanck HM, Serdula MK, Brown DR. Obesity, physical activity, and depressive symptoms in a cohort of adults aged 51 to 61. J

Aging Health 2010; 22:38498. 24. Cooper-Patrick L, Ford DE, Mead LA, Chang PP, Klag MJ. Exercise and depression in midlife: a prospective study. Am J Public Health

1997;87:6703. 25. Farmer ME, Locke BZ, Mosciki EK, Dannenberg AL, Larson DB, Radloff LS. Physical activity and depressive symptoms: the NHANES I

epidemiologic follow-up study. Am J Epidemiol 1988;128:134051. 26. Gallegos-Carrillo K, Flores YN, Denova-Gutirrez E, et al. Physical activity and reduced risk of depression: results of a longitudinal study of

mexican adults. Health Psychol 2012. In press 27. Hamer M, Molloy G, Oliveria C, Demakakos P. Leisure time physical activity, risk of depressive symptoms, and inflammatory mediators: the

English longitudinal study of ageing. Psychoneuroendocrino 2009;34:10505. 28. Jerstad SJ, Boutelle KN, Ness KK, Stice E. Prospective reciprocal relations between physical activity and depression in female adolescents. J

Consult Clin Psychol 2010;78:26872. 29. Jonsdottir IH, Rdjerc L, Hadzibajramovica E, Brjessonc M, Ahlborga E. A prospective study of leisure-time physical activity and mental

health in Swedish health care workers and social insurance officers. Prev Med 2010;51:3737.

Am J Prev Med 2013;45(5) A-9

30. Kritz-Silverstein D, Barrett-Connor E, Corbeau C. Cross-sectional and prospective study of exercise and depressed mood in the elderly: the Rancho Bernardo study. Am J Epidemiol 2001;153:596603.

31. Ku PW, Fox KR, Chen LJ. Physical activity and depressive symptoms in Taiwanese older adults: a seven-year follow-up study. Prev Med 2009;48:2505.

32. Lampinen P, Heikkinen RL, Ruoppila I. Changes in intensity of physical exercise as predictors of depressive symptoms among older adults: an eight year follow-up study. Prev Med 2000;12:11380.

33. Lucas M, Mekary R, Pan A, et al. Relation between clinical depression risk and physical activity and time spent watching television among older women: a 10-year prospective follow-up study. Am J Epidemiol 2011;174:101727.

34. Mikkelsen S, Tolstrup J, Flachs E, Mortensen E, Schnohr P, Flensborg-Madsen T. A cohort study of leisure time physical activity and depression. Prev Med 2010;51:4715.

35. Mobily KE, Rubinstein LM, Lemke JH, OHara MW, Wallace RB. Walking and depression in a cohort of older adults: The Iowa 65+ Rural Health Study. JAPA 1996;4:11935.

36. Morgan K, Bath PA. Customary physical activity and psychological wellbeing: a longitudinal study. Age Ageing 1998;27:3540. 37. Paffenbarger RS, Lee I-M, Leung R. Physical activity and personal characteristics associated with depression and suicide in American college

men. Acta Psychiatr Scan Suppl 1994;377:1622. 38. Rothon C, Edwards P, Bhui K, Viner RM, Taylor S, Stansfeld SA. Physical activity and depressive symptoms in adolescents: a prospective

study. BMC Med 2010;8:32. 39. Smith T, Masaki K, 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;58:144752. 40. Strawbridge WJ, Deleger S, Roberts RE, et al. Physical activity reduces the risk of subsequent depression for older adults. Am J Epidemiol

2002;156:32834. 41. Sund AM, Larsson B, Wichstrom L. Role of physical and sedentary activities in the development of depressive symptoms in early

adolescence. Soc Psychiatry Psychiatr Epidemiol 2011;46:43141. 42. van Gool CH, Kempen GI, Bosma H, van Boxtel MP, Jolles J, van Eijk JT. Associations between lifestyle and depressed mood: longitudinal

results from the Maastricht Aging Study. Am J Public Health 2006;97:88794. 43. Wang F, DesMeules M, Luo W, Dai S, Lagace C, Morrison H. Leisure time physical activity and marital status in relation to depression

between men and women: a prospective study. Health Psychol 2011;30:20411. 44. Weyerer S. Physical inactivity and depression in the community: evidence from the Upper Bavarian field study. Int J Sports Med 1992;13:

4926. 45. Wise LA, Adams-Campbell LL, Palmer JR, Rosenberg L. Leisure time physical activity in relation to depressive symptoms in the Black

Women's Health Study. Ann Behav Med 2006;32:6876. 46. Chipperfield JG, Newall NE, Chuchmach LP, Swift AU, Haynes TL. Differential determinants of men's and women's everyday physical

activity in later life. J Gerontol B Psychol Sc Soc Sci 2008;63:S211S218.

Am J Prev Med 2013;45(5) A-10

47. Teychenne M, Ball K, Salmon J. Associations between physical activity and depressive symptoms in women. Int J Behav Nutr Phys Act 2008a;5:27.

48. Murrell SA, Himmelfarb S, Wright K. Prevalence of depression and its correlates in older adults. Am J Epidemiol 1983;117:17385. 49. Pahkala K, Kesti E, Kongas-Saviaro P, et al. Prevalence of depression in an aged population in Finland. Soc Psychiatry Psychiatr Epidemiol

1995;30:99106. 50. Everson SA, Maty SC, Lynch JW, Kaplan GA. Epidemiologic evidence for the relation between socioeconomic status and depression, obesity,

and diabetes. J Psychosom Res 2002;53:8915. 51. Luppino FS, de Wit LM, Bouvy PF. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch

Gen Psychiatry 2010;67:2209. 52. Faulkner G, Carless D. Physical activity and the process of psychiatric rehabilitation: theoretical and methodological issues. Psych Rehab J

2006;29:25866. 53. Cairney J, Faulkner G, Veldhuizen S, Wade TJ. Physical activity and psychological distress in older adults: a longitudinal analysis. Can J

Psychiatry 2009;54:1609. 54. De Moor, Marleen HM. Testing causality in the association between regular exercise and symptoms of anxiety and depression. Arch Gen

Psych 2008;65:897. 55. Eaton WW, Muntaner C, Smith C, Tien A, Ybarra M. Center for Epidemiologic Studies Depression Scale: review and revision (CESD and

CESD-R). In: Maruish ME, ed. The use of psychological testing for treatment planning and outcomes assessment. 3rd ed. Mahwah NJ: Lawrence Erlbaum, 2004:36377.

Am J Prev Med 2013;45(5) A-11

Physical Activity and the Prevention of DepressionA Systematic Review of Prospective Studies

Appendix AMethodologic characteristics of prospective studies examining physical activity and depression

Appendix BFindings of Prospective Studies Examining Physical Activity and DepressionReferences for Appendixes A and B (from the main text)

Documents

mmc1