Relationship between physical activity and depressive symptoms in stroke survivors: a cross-sectional study of 1,140 individuals
DOI:
https://doi.org/10.2340/jrm.v57.41272Keywords:
stroke, depression, physical activity, NHANES data, propensity score matchingAbstract
Objectives: To investigate the relationship between physical activity and depressive symptoms in stroke survivors.
Design: A cross-sectional study utilizing National Health and Nutrition Examination Survey (NHANES) 2007–2018 data, employing propensity score matching to control for confounders.
Patients: 1,140 stroke survivors from NHANES, assessing depressive symptoms through the Patient Health Questionnaire-9 (PHQ-9) conducted via family interview or a mobile examination centre examination.
Methods: PA was surveyed concurrently with the PHQ-9, categorized into vigorous, moderate, and moderate-to-vigorous intensities. Propensity score matching was used to match participants based on their activity levels, and the relationship between physical activity and depressive symptoms was analysed by logistic regression.
Results: Among all the subjects, 225 individuals had significant depressive symptoms. If vigorous-intensity PA duration is longer than 75 min (odds ratio [OR] = 0.41, 95% CI 0.21–0.75) or longer than 150 min (OR = 0.42, 95% CI 0.19–0.85), and moderate-intensity physical activity duration is longer than 150 min (OR = 0.59, 95% CI 0.38–0.90) or between 150 and 300 min (OR = 0.36, 95% CI 0.15–0.77), and moderate-to-vigorous PA duration is greater than 150 min (OR = 0.61, 95% CI 0.40–0.91) or exceeding 300 min (OR = 0.50, 95% CI 0.31–0.78), this might be associated with lower depressive symptoms.
Conclusion: Regular physical activity, particularly of moderate or higher intensity, is associated with milder depressive symptoms in stroke survivors, suggesting the potential for non-pharmacological intervention.
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References
GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20: 795-820.
https://doi.org/10.1016/S1474-4422(21)00252-0 DOI: https://doi.org/10.1016/S1474-4422(21)00252-0
Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W, et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022. Int J Stroke 2022; 17: 18-29.
https://doi.org/10.1177/17474930211065917 DOI: https://doi.org/10.1177/17474930211065917
Chun HY, Ford A, Kutlubaev MA, Almeida OP, Mead GE. Depression, anxiety, and suicide after stroke: a narrative review of the best available evidence. stroke 2022; 53: 1402-1410.
https://doi.org/10.1161/STROKEAHA.121.035499 DOI: https://doi.org/10.1161/STROKEAHA.121.035499
hordacre b, austin d, brown ke, graetz l, pareés i, de trane s, et al. evidence for a window of enhanced plasticity in the human motor cortex following ischemic stroke. Neurorehabil Neural Repair 2021; 35: 307-320.
https://doi.org/10.1177/1545968321992330 DOI: https://doi.org/10.1177/1545968321992330
Hamre C, Fure B, Helbostad JL, Wyller TB, Ihle-Hansen H, Vlachos G, et al. Factors associated with level of physical activity after minor stroke. J Stroke Cerebrovasc Dis 2021; 30: 105628.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105628 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105628
Cross JG, May BR, Mai PQM, Anderson E, Welsh C, Chandran S, et al. A systematic review and evaluation of post-stroke depression clinical practice guidelines. J Stroke Cerebrovasc Dis 2023; 32: 107292.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107292 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107292
Feigin VL, Owolabi MO. Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization-Lancet Neurology Commission. Lancet Neurol 2023; 22: 1160-1206.
https://doi.org/10.1016/S1474-4422(23)00277-6 DOI: https://doi.org/10.1016/S1474-4422(23)00277-6
Pearce M, Garcia L, Abbas A, Strain T, Schuch FB, Golubic R, et al. Association between physical activity and risk of depression: a systematic review and meta-analysis. JAMA Psychiatry 2022; 79: 550-559.
https://doi.org/10.1001/jamapsychiatry.2022.0609 DOI: https://doi.org/10.1001/jamapsychiatry.2022.0609
Piwoński J, Piwońska A, Zdrojewski T, Cicha-Mikołajczyk A, Rutkowski M, Bandosz P, et al. Association between cardiovascular diseases and depressive symptoms in adults. A pooled analysis of population-based surveys: WOBASZ, NATPOL 2011, and WOBASZ II. Pol Arch Intern Med 2021; 131: 503-511.
https://doi.org/10.20452/pamw.15945 DOI: https://doi.org/10.20452/pamw.15945
Sibbritt PD, Peng DW, Hosseini DM, Maguire PJ, Bayes J, Adams PJ. An examination of modifiable risk factors in stroke survivors, with a view to recurrent stroke prevention. J Stroke Cerebrovasc Dis 2022; 31: 106547.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106547 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106547
Staff TE, O'Leary M, Fretts AM. Depression, physical activity, and incident cardiovascular disease among American Indians: The strong heart family study. Psychiatry Res Commun 2023; 3:
https://doi.org/10.1016/j.psycom.2023.100125 DOI: https://doi.org/10.1016/j.psycom.2023.100125
Ghozy S, Zayan AH, El-Qushayri AE, Parker KE, Varney J, Kallmes KM, et al. Physical activity level and stroke risk in US population: A matched case-control study of 102,578 individuals. Ann Clin Transl Neurol 2022; 9: 264-275.
https://doi.org/10.1002/acn3.51511 DOI: https://doi.org/10.1002/acn3.51511
Singh B, Olds T, Curtis R, Dumuid D, Virgara R, Watson A, et al. Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. Br J Sports Med 2023; 57: 1203-1209.
https://doi.org/10.1136/bjsports-2022-106195 DOI: https://doi.org/10.1136/bjsports-2022-106195
Physical activity. DOI: https://www.who.int/zh/news-room/fact-sheets/detail/physical-activity.:
Bovim MR, Indredavik B, Hokstad A, Cumming T, Bernhardt J, Askim T. Relationship between pre-stroke physical activity and symptoms of post-stroke anxiety and depression: An observational study. J Rehabil Med 2019; 51: 755-760.
https://doi.org/10.2340/16501977-2610 DOI: https://doi.org/10.2340/16501977-2610
Paprocka-Borowicz M, Wiatr M, Ciałowicz M, Borowicz W, Kaczmarek A, Marques A, et al. Influence of physical activity and socio-economic status on depression and anxiety symptoms in patients after stroke. Int J Environ Res Public Health 2021; 18:
https://doi.org/10.3390/ijerph18158058 DOI: https://doi.org/10.3390/ijerph18158058
Ashizawa R, Honda H, Yoshizawa K, Kameyama Y, Yoshimoto Y. Association between physical activity levels and depressive symptoms in patients with minor ischemic stroke. J Stroke Cerebrovasc Dis 2022; 31: 106641.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106641 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106641
Phan A, Askim T, Lydersen S, Indredavik B, Wethal T. Accelerometer-measured physical activity at 3 months as a predictor of symptoms of depression and anxiety 1 year after stroke: a multicentre prospective cohort study in central Norway. J Rehabil Med 2023; 55: jrm12309.
https://doi.org/10.2340/jrm.v55.12309 DOI: https://doi.org/10.2340/jrm.v55.12309
Liang JH, Huang S, Pu YQ, Zhao Y, Chen YC, Jiang N, et al. Whether weekend warrior activity and other leisure-time physical activity pattern reduce the risk of depression symptom in the representative adults? A population-based analysis of NHANES 2007-2020. J Affect Disord 2023; 340: 329-339.
https://doi.org/10.1016/j.jad.2023.07.113 DOI: https://doi.org/10.1016/j.jad.2023.07.113
Xing Y, Yang SD, Dong F, Wang MM, Feng YS, Zhang F. The beneficial role of early exercise training following stroke and possible mechanisms. Life Sci 2018; 198: 32-37.
https://doi.org/10.1016/j.lfs.2018.02.018 DOI: https://doi.org/10.1016/j.lfs.2018.02.018
Buvarp D, Viktorisson A, Axelsson F, Lehto E, Lindgren L, Lundström E, et al. Physical activity trajectories and functional recovery after acute stroke among adults in Sweden. JAMA Netw Open 2023; 6: e2310919.
https://doi.org/10.1001/jamanetworkopen.2023.10919 DOI: https://doi.org/10.1001/jamanetworkopen.2023.10919
Towfighi A, Ovbiagele B, El Husseini N, Hackett ML, Jorge RE, Kissela BM, et al. Poststroke depression: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2017; 48: e30-e43.
https://doi.org/10.1161/STR.0000000000000113 DOI: https://doi.org/10.1161/STR.0000000000000113
Johnson C. National Health and Nutrition Examination Survey. 137st APHA Annual Meeting and Exposition 2009; 2009; 2009.
NCHS Ethics Review Board (ERB) Approval. Available from https://www.cdc.gov/nchs/nhanes/irba98.htm.
Kroenke K, Spitzer RL, Williams JB, Löwe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry 2010; 32: 345-359.
https://doi.org/10.1016/j.genhosppsych.2010.03.006 DOI: https://doi.org/10.1016/j.genhosppsych.2010.03.006
Weng SF, Hsu HR, Weng YL, Tien KJ, Kao HY. Health-related quality of life and medical resource use in patients with osteoporosis and depression: a cross-sectional analysis from the National Health and Nutrition Examination Survey. Int J Environ Res Public Health 2020; 17: 1124.
https://doi.org/10.3390/ijerph17031124 DOI: https://doi.org/10.3390/ijerph17031124
Farag YMK, Blasco-Colmenares E, Zhao D, Sanon M, Guallar E, Finkelstein FO. Effect of Anemia on Physical Function and Physical Activity in CKD: The National Health and Nutrition Examination Survey, 1999-2016. Kidney360 2023; 4: e1212-e1222.
https://doi.org/10.34067/KID.0000000000000218 DOI: https://doi.org/10.34067/KID.0000000000000218
About the National Health and Nutrition Examination Survey. Available from: https://www.cdc.gov/nchs/nhanes/about_nhanes.htm.
Weight. Avialable from: https://wwwn.cdc.gov/nchs/nhanes/tutorials/Weighting.aspx.
Yao XI, Wang X, Speicher PJ, Hwang ES, Cheng P, Harpole DH, et al. Reporting and guidelines in propensity score analysis: a systematic review of cancer and cancer surgical studies. J Natl Cancer Inst 2017; 109: djw323.
https://doi.org/10.1093/jnci/djw323 DOI: https://doi.org/10.1093/jnci/djw323
Mayman NA, Tuhrim S, Jette N, Dhamoon MS, Stein LK. Sex differences in post-stroke depression in the elderly. J Stroke Cerebrovasc Dis 2021; 30: 105948.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105948 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105948
Deng X, Liu D, Li M, He J, Fu Y. Association between depression and stroke and the role of sociodemographic factors: A study among hypertensive populations. J Stroke Cerebrovasc Dis 2023; 32: 107457.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107457 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107457
Saunders DH, Greig CA, Mead GE. Physical activity and exercise after stroke: review of multiple meaningful benefits. Stroke 2014; 45: 3742-3747.
https://doi.org/10.1161/STROKEAHA.114.004311 DOI: https://doi.org/10.1161/STROKEAHA.114.004311
Krawcyk RS, Vinther A, Petersen NC, Faber J, Iversen HK, Christensen T, et al. High-intensity training in patients with lacunar stroke: A one-year follow-up. J Stroke Cerebrovasc Dis 2023; 32: 106973.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106973 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106973
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