Elsevier

Preventive Medicine

Volume 121, April 2019, Pages 121-127
Preventive Medicine

Associations between aerobic and muscle-strengthening exercise with depressive symptom severity among 17,839 U.S. adults

https://doi.org/10.1016/j.ypmed.2019.02.022Get rights and content

Highlights

  • 17.8% meet both aerobic exercise and strength training guidelines.

  • Aerobic and strength exercise each associated with a low prevalence of depression

  • Combined aerobic-strength exercise associated with lowest prevalence of depression

  • Strategies to prevent depression should promote combined aerobic-strength exercise.

Abstract

For the prevention and management of chronic diseases, global physical activity guidelines state that an adult should engage in regular moderate-to-vigorous aerobic physical activity (MVPA; e.g. walking, cycling, running) and muscle-strengthening exercise (MSE; e.g. strength/resistance training). However, the associations between combined MVPA-MSE with chronic health conditions are rarely examined in large population studies. In particular, little is known associations between combined MVPA-MSE with depressive disorders, one of the leading causes of disability worldwide. The aim of this study is to describe the associations between MVPA and MSE with depressive symptom severity among a large sample of U.S. adults. Data were drawn from the U.S. 2015 Behavioral Risk Factor Surveillance System. During phone interviews, MVPA, MSE and depressive symptom severity were assessed by validated questionnaires. Poisson regression with a robust error or variance were used to assess prevalence ratios (PR) of depressive symptom severity (mild, moderate, moderately severe/severe) across categories of physical activity guideline adherence (met neither [reference]; MSE only; MVPA only; met both), adjusting for a set of potential cofounders. Data were available on 17,839 adults (18–85 years). When compared with those meeting neither guideline, for mild, moderate and moderately severe/severe depressive symptoms, the PRs were lowest among meeting both guidelines (range: 0.26–0.54), followed by MVPA only (range: 0.36–0.62) and MSE only (range: 0.49–0.84). Among a large sample of U.S. adults, compared to other guideline adherence categories, meeting both MVPA-MSE guidelines was associated with a lowest likelihood of reporting depressive symptoms.

Introduction

Globally, one in five adults experience a common mental disorder (e.g. depression, anxiety or substance abuse disorders) each year (Steel et al., 2014), with depressive disorders one of the leading causes of disability world-wide (Greenberg et al., 2015). In 2010, the economic burden attributed to individuals with depressive disorders was estimated to be $210 billion (USD) in the U.S. alone (Greenberg et al., 2015). Given that the incidence of people living with depressive disorders has increased considerably (~18%) over the last decade (Vos et al., 2016), from a public health perspective, identifying modifiable factors that may prevent the development of depressive symptoms is imperative.

For the prevention and treatment of chronic diseases (including both physical and mental illness), the World Health Organisation (WHO) recommends adults engage in a minimum of 150 min/week of moderate-intensity aerobic physical activity (or 75 min of vigorous-intensity aerobic physical activity, or an equivalent combination) (MVPA); and at least 2 days/week of muscle-strengthening exercise (World Health Organization, 2010). Given the distinction made in the guidelines between the two types of activity (i.e. aerobic MVPA versus muscle strengthening exercise), it is important to examine the link between both aerobic and muscle strengthening exercise and depressive symptoms.

Convincing epidemiological evidence shows that physical activity can be used to prevent (Mammen and Faulkner, 2013; Schuch et al., 2018; McDowell et al., 2018a) and treat depression and/or depressive symptoms in clinical and non-clinical populations (Rebar et al., 2015; Schuch et al., 2016). However, most of this evidence comes from either observational studies that have assessed physical activity in general (i.e. a lack of distinction between activity type/modality such as aerobic physical activity versus strength training) (Mammen and Faulkner, 2013; McDowell et al., 2018a); or from interventions that have utilised only aerobic (e.g. walking, running, cycling) exercise to treat depressive symptoms (Nystrom et al., 2015).

Research investigating the association between muscle strengthening exercise and/or combined aerobic-muscle strengthening exercise and depressive symptoms is limited (Nystrom et al., 2015). Although evidence from clinical trials has demonstrated that resistance training alone (i.e. muscle strengthening exercise) may result in a moderate reduction in symptoms of depression (Gordon et al., 2018a) and anxiety (Gordon et al., 2017). Moreover, a recent meta-analysis of clinical exercise studies showed that when comparing aerobic exercise only and muscle strengthening exercise only, there was no significant difference between exercise modalities in reducing depressive symptoms (Gordon et al., 2018a). However, the current data remain limited, including rather few studies and small sample sizes likely lacking statistical power (Brenes et al., 2007). Moreover, importantly, no studies have investigated the independent associations between adhering to different combinations of the WHO's 2010 physical activity guidelines (World Health Organization, 2010) (which include both aerobic and muscle-strengthening exercise) and depressive symptoms among a large population sample of adults.

The aim of this study is to describe the associations between different combinations of physical activity guideline adherence and depressive symptom severity in a nationally representative sample of U.S. adults.

Section snippets

Behavioral Risk Factor Surveillance System

Data were drawn from the U.S. 2015 ‘Behavioral Risk Factor Surveillance System’ (henceforth - BRFSS 2015). Initiated in 1984, the BRFSS is a public health surveillance system conducted with the purpose of collecting state-specific data on public health pertinent risk behaviours among U.S. adults (Centers for Disease Control and Prevention, n.d.-a). Comprehensive information on the procedures and methodology used in the BRFSS 2015 can be obtained elsewhere (Centers for Disease Control and

Sample description

The final sample in the analysis was 17,839 (18–80 years) (Table 1). Over half of the sample were female, employed, within the two highest income categories, either attended college or graduated from college and had never smoked. Most were White, non-Hispanic and had ‘good’ to ‘excellent’ self-rated health. Under a quarter had a previous diagnosis of depression and <5% were classified as a heavy drinker.

Across physical activity classification categories, 45.2% met neither guideline, 9.6% met

Discussion

We are the first to describe the associations between combined aerobic MVPA-MSE with depressive symptom severity among a large population-based sample of adults. The key finding was that compared to other physical activity guideline adherence categories (i.e. MSE only; aerobic MVPA only), meeting both guidelines was associated with the lowest prevalence ratios for depressive symptom severity across levels of depressive symptom severity (e.g. mild, moderate, moderately severe/severe). A further

Conclusion

The prevention and management of depression is a key 21st century public health challenge. This study showed that, among a large population sample of U.S. adults, when compared to meeting one physical activity guideline alone, meeting both the aerobic MVPA and MSE guidelines was associated with a lower likelihood of depressive symptom severity. Future public health strategies to prevent/manage depression should promote both aerobic MVPA and MSE.

The following are the supplementary data related

Conflict of interest statement

All authors declare that there is no current conflict of interest to disclose with any organizations that might have an interest in the submitted work.

Financial disclosure

All authors declare that there is no financial relationships with any organizations that might have an interest in the submitted work.

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