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Original Research (Original Article) 


Abdul Rahman Ali Mohammed Shukr et al, 2020;4(2):378–382.

International Journal of Medicine in Developing Countries

The association between physical activity and symptoms of depression

Abdul Rahman Ali Mohammed Shukr1*, Amany Ali Alghamdi2, Shatha Gamal AbdulQader Alaghbari3, Ziad AbdulAziz Alzaid4, Meshal AbdulHameed Alolyan5, Ahmad Saleh Alshiha6, Abdulrahman Ali Abdullah Aloudah7

Correspondence to: Abdul Rahman Ali Mohammed Shukr

*General Practitioner, Bab Almajeedi Seasonal Health Center, Madinah, Saudi Arabia.

Email: dr-abdulrhman.shukr [at] hotmail.com

Full list of author information is available at the end of the article.

Received: 07 December 2019 | Accepted: 22 December 2019


ABSTRACT

Background:

Depression is one of the major health problems faced by the elderly today. The prevalence of this disorder has increased significantly and currently affects approximately 12%–25% of the elderly population. Depression is characterized by a core group of signs and symptoms, including despondent mood, social withdrawal, and loss of interest in usual activities, weight loss or gain, disturbance in sleeping pattern, low energy, and a state of hopelessness.


Methodology:

The current study addressed the relationship between self-reported physical activity and symptoms of depression in 500 men and women aged 35-year old, who met Diagnostic and Statistical Manual of Mental Disorders-IV criteria for a major depressive episode. The sample included individuals, either married, divorced, single, or widow.


Results:

Out of 500 participants, 60% were males and 40% were females. Regarding social status, the high percentage was divorced participants (n = 160, 32%), followed by married (n = 150, 30%). Among the participants, 26% were single, and a little number of participants were widows (n = 60, 12%). Analysis of the unadjusted regression showed a significant relationship between self-reported physical activity and depression (p = 0.04). Also, self-reported physical activity remained a statistically significant predictor of depression after age and gender adjustment.


Conclusion:

Our findings underlined the importance of increasing activity levels among the least active young people. Participation in sports provides an additional benefit over activity alone. Physical activity and sports participation in children, adolescents, and adults, based on mental as well as physical health, are recommended.


Keywords:

Association, physical activity, symptoms, depression.


Introduction

Mental health problems among youth, including depressive symptoms, have been identified as an important public health issue [1,2]. The symptoms of depression may include loss of interest in some enjoyed activities, loss of energy, more excessive anxiety, difficulty controlling worry, restlessness, and other symptoms, which may increase sedentary activity and decrease physical activity frequency [3]. Understanding the factors in adolescents that can reduce the risk of mental health problems is, therefore, important to prevent their incidence [4]. Research focusing on the role of physical activity and cardiovascular health is extensive, while the interest in the putative role of physical activity on mental health has more recently emerged.

Mental disorders, such as depression or anxiety, are a major public health problem. According to the World Health Organization, the number of individuals experiencing depression or anxiety increased by 50%, from 416 to 615 million, in the period between 1997 and 2013 [5]. It is estimated that mental disorders account for 30% of the global non-fatal disease burden [6]. The burden of mental disorders extends far beyond the condition itself, affecting the quality of life, cognitive function, psychosocial health, and all-cause and suicide mortality risk [7]. Many research studies have documented the correlation between physical behavior and mental health [8]. Being physically active is a major contributor to both physical and mental health. [9] A comprehensive body of high-quality evidence has found physical activity effective in reducing depression and anxiety in non-clinical populations [10].

There is decisive evidence that the physical health of adolescents is enhanced by frequent physical activity [11]. It was recommended that children and adolescents, aged 5–17 years, should be involved in moderate to vigorous activity for at least 60 minutes daily [11]. However, it has been reported that almost 80% of 13–15 year-olds children worldwide don’t accomplish this amount of activity per day [12]. Physical activity level has been found to diminish with age in adolescence, especially with girls who perform significantly less activity than boys in most countries and regions, worldwide [13]. Possible explanations for these sex variance is that boys are usually more appealed toward competitive activities, on the other hand, girls usually focus more on health and fitness [14].

Biddle and Asare [15] concluded that the physical activity has a potentially beneficial impact in reducing depression, but the evidence base is limited. A European cross-sectional study found no evidence of the benefit of daily physical activity for mental health in adolescents [16], and previous studies [17] showed a weak correlation between physical activity and mental health. However, recent longitudinal research found that US adolescents, who engaged in higher frequencies of physical activity, were more resilient in developing depressive symptoms [18].


Subjects and Methods

Persons were recruited for this study by referrals from physicians, psychologists, or other health care professionals in private office practices, psychiatric outpatient clinics, or self—referred in response to advertisement distributed throughout the community. Subjects, who met research criteria on an initial telephone screen, were interviewed by a clinical psychologist for the presence and severity of the major depressive disorder (MDD) using Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria [19]. MDD was determined by using parts of the Diagnostic Interview Schedule [20] and the 17-item Hamilton Rating Scale for Depression (HRSD) [21]. Subjects were considered eligible if they met DSM-IV criteria (i.e., depressed mood or loss of interest or pleasure in things, and at least four of the following symptoms: weight loss or gain; low energy or fatigue; feeling restless, fidgety, or slowed down; difficulty concentration or thinking; or suicidal ideation), and scored greater than 13 on the HRSD. Other inclusion criteria included: no medical contraindications to performing a treadmill test; no history of alcohol or drug abuse; no psychiatric disorder other than major depression; not currently on antidepressant medication; no psychotherapy in past years; and not actively suicidal.

In this manner, 500 adults aged 35 years and older, who met DSM-IV criteria for a major depressive episode, were studied. The sample primarily includes male and female, either married, divorced, single, or widow as shown in Table 1.

Self-reported depression scores were obtained using the Beck Depression Inventory (BDI) [22], a 21-item questionnaire that asks about various mood-related questions. Each response is scored on a scale from 0 to 3. The sum of all items indicated the degree of depression with a range between 0 and 63, with higher numbers indicating greater severity of depression. The BDI is a widely used self-evaluation measure of symptoms of depression and has been extensively validated against other clinical measures of depression [23].

Table 1. Demographic characteristics of the samples (n = 500).

Item N (%)
Age (SD) 35 (5.5)
Gender
Male 300 (60%)
Female 200 (40%)
Marital status
Married 150 (30%)
Divorced 160 (32%)
Single 130 (26%)
Widow 60 (12%)

Table 2. Multiple regression results.

Parameters estimate
Predictor variables Unstandardized regression coefficient Standardized regression coefficient 95% confidence limit P-value
Intercept 25.4 0.01 −0.11, 0.15
Age −0.9 −0.03 −1.01, 0.21 0.04
Gender 1.1 0.21 −0.29, 0.13 0.98
MQ −0.2 −0.19 −0.16, 0.04 0.05

To assess self-reported physical activity, subjects completed the Minnesota Leisure-Time Physical Activity Questionnaire (MQ) [24]; a self-report questionnaire, that lists 62 individual leisure time activities, is used to calculate the average energy expenditure during 1 year in kcal/day. Activities are classified as light, moderate, or heavy intensity. The number of minutes spent performing activities in each of these categories is also calculated separately to provide a measure of the average amount of energy (in kcal/day) used specifically to perform light, moderate, or heavy activity. The validity and reliability of the MQ have been established [25].


Results

Out of 500 participants, the majority was male (60%), while 40% were females. Regarding social status, the high percentage was divorced participants (n = 160, 32%), followed by married (n = 150, 30%). Among the participants, 26% were single, and a little number of participants were widows (n = 60, 12%), as shown in Table 1. To evaluate the relationship between MQ and BDI scores without adjusting any potential confounders, and after adjusting gender and age, multiple regression analysis was applied. Analysis of the unadjusted regression showed a significant relationship between self-reported physical activity and depression (p = 0.04). Also, self-reported physical activity remained a statistically significant predictor of depression after age and gender adjustment, as shown in Table 2. There were four participants with exceptionally high MQ scores (MQ > 300) compared to the rest of the sample. To ensure that the regression results were not unduly influenced by these scores, the analysis was repeated with those cases removed. The relationship between MQ and BDI remained statistically significant in both unadjusted (p = 0.03) and adjusted analyses (p = 0.04).


Discussion

In the sample of the current study of depressed men and women, it was shown that boys engaging in significantly high activity than girls. This result was in a similar trend with the result of another research [13]. Possible explanations for these sex disparities might be due to boys are more appealing to competitive activities than girls who might be more focused on health and fitness [14].

Also, in the present study, we reported an inverse relationship between self-reported physical activity and the symptoms of depression, which means that the participants who were engaged in higher frequencies of physical activity reported less depressive symptoms as compared to the participants who reported low levels of physical activity. This result was in harmony with the findings of Kleppang [17] and McMahon et al. [26]. The possible explanation of this result is that continuous engagement in a challenging/ physical activity may lead to an enhancement in the confidence of a person and subsequently to a decrease in the symptoms of depression [27], or the social relationships that developed from this regular participation in physical activity may have a positive impact upon mental health [28]. McMahon et al. [26] added that the sports participation provide some support through the social interaction in team sports in particular, and confirmed the importance of the psychological and social aspects of physical activity for the hypothesis that the mental health influenced by physical activity. Also, another author [29] mentioned that the participation in sports has also been found to be associated with reduced levels of suicidal ideation and adolescents who participate in team sports have been found to report higher levels of happiness than those who play individual sports [30].

We also noted that the level of physical activity reported by our participants was low compared to those of other populations. In addition, our clinically depressed sample had lower mean MQ scores compared to those of non-depressed populations. Taylor [24] reported a mean MQ of 240.4 in a sample of 175 healthy adults. These differences indicated that our participants showed greatly different patterns of physical activity practices from those of non-depressed patients, and who may be at high risk for mood disorders.

Taken together, these results indicated that regular physical activity is associated with fewer depressive symptoms. While this is a correlation study and does not establish a causal relationship between activity and depression, one implication of this study is, enhanced physical activity may be an effective method for maintaining functional ability and promoting an enhanced sense of well-being in participants. Using exercise as a treatment for depression has several potential advantages. An exercise program is relatively inexpensive, may be adopted by large segments of the general population, and may cause fewer side effects than antidepressant medications. Increased physical activity may also play an important preventive role. Public health efforts need to focus on increasing regular physical activity among populations at risk for depression. Programs and strategies are required to overcome the difficulties faced by the populations, which may include the promotion of social networks to provide support, improving patients’ confidence related to participation in physical activities, and improving the consultation in which physicians advise patients about the benefits of exercise. Physicians can aid in the physical and mental well-being of patients by increasing physical activity assessment, prescription, and long-term follow-up of regular physical activities among older adults.

General hypothesis for the benefit of the sports has been reported by different authors in a different age; Wiles et al. [31] suggested that physically active adolescents have lower odds of symptoms of depression. A meta-analysis conducted by Radovic [32] concluded that there is some evidence to suggest that physical activity can be used to reduce depressive symptoms in adolescents. A meta-analysis by Korczak [33] demonstrated that the physical activity in childhood or adolescence was associated with lower concurrent depressive symptoms. Inversely, our results disagreed with the finding of research done by Stavrakakis et al. [34], who showed that depression may negatively influence patterns of activity through symptoms, such as low energy levels, apathy, or social isolation or physical inactivity and depression and anxiety may also share other risk factors. In interpreting the present results, it is important to note some limitations; such as, our data were collected among participants who were 35 years of age. This may limit the applicability of the present findings to today’s society or other age groups, such as younger and older adults. Also, self-reported physical activity is problematic; a declaration bias, which cannot be ruled out. This implies that the relationship between physical activity and symptoms of anxiety and depression may have been underestimated. Objective measures of physical activity and an assessment of mental health based on the psychiatric interview are required for more accurate estimates.


Conclusion

Participation in a sports club is associated with significantly lower odds of depressive symptoms. Regular physical activity is associated with better mental health and well-being in participants, either men or women. Our findings underlined the importance of increasing activity levels among the least active young people. Participation in sport confers an additional benefit over the benefits provided by activity alone. It would be beneficial to recommend physical activity and sport participation to children, adolescents, and adults for better mental as well as physical health outcomes.


List of Abbreviations

BDI Beck Depression Inventory
HRSD Hamilton Rating Scale for Depression
MDD Major depressive disorder

Funding

None.


Declaration of conflicting interests

The authors declare that there is no conflict of interest regarding the publication of this article.


Ethical approval

The study was done after verbal approval of Bab Almajeedi Seasonal Health Center, data was collected through online survey.


Consent for publication

Informed consent was obtained from all the participants.


Author details

Abdul Rahman Ali Mohammed Shukr1, Amany Ali Alghamdi2, Shatha Gamal AbdulQader Alaghbari3, Ziad AbdulAziz Alzaid4, Meshal AbdulHameed Alolyan5, Ahmad Saleh Alshiha6, Abdulrahman Ali Abdullah Aloudah7

  1. General Practitioner, Bab Almajeedi Seasonal Health Center, Madinah, Saudi Arabia.
  2. Resident, Preventive Medicine, King Fahad Hospital, Jeddah, Saudi Arabia.
  3. General Practitioner Andalusia Hospital, Jeddah, Saudi Arabia.
  4. General Practitioner, Security Forces Hospital, Dammam, Saudi Arabia.
  5. General Practitioner, Shamyat Asfan Primary Health Care, Jeddah, Saudi Arabia.
  6. General Practitioner, Erwa Primary Health Care Center, Madinah, Saudi Arabia.
  7. General Practitioner, Buridah Central Hospital, Saudi Arabia.

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How to Cite this Article
Pubmed Style

Shukr ARAM, Alghamdi AA, Alaghbari SGA, Alzaid ZA, Alolyan MA, Alshiha AS, Aloudah AAA. The association between physical activity and symptoms of depression. IJMDC. 2020; 4(2): 378-382. doi:10.24911/IJMDC.51-1575757263


Web Style

Shukr ARAM, Alghamdi AA, Alaghbari SGA, Alzaid ZA, Alolyan MA, Alshiha AS, Aloudah AAA. The association between physical activity and symptoms of depression. https://www.ijmdc.com/?mno=77060 [Access: October 15, 2021]. doi:10.24911/IJMDC.51-1575757263


AMA (American Medical Association) Style

Shukr ARAM, Alghamdi AA, Alaghbari SGA, Alzaid ZA, Alolyan MA, Alshiha AS, Aloudah AAA. The association between physical activity and symptoms of depression. IJMDC. 2020; 4(2): 378-382. doi:10.24911/IJMDC.51-1575757263



Vancouver/ICMJE Style

Shukr ARAM, Alghamdi AA, Alaghbari SGA, Alzaid ZA, Alolyan MA, Alshiha AS, Aloudah AAA. The association between physical activity and symptoms of depression. IJMDC. (2020), [cited October 15, 2021]; 4(2): 378-382. doi:10.24911/IJMDC.51-1575757263



Harvard Style

Shukr, A. R. A. M., Alghamdi, . A. A., Alaghbari, . S. G. A., Alzaid, . Z. A., Alolyan, . M. A., Alshiha, . A. S. & Aloudah, . A. A. A. (2020) The association between physical activity and symptoms of depression. IJMDC, 4 (2), 378-382. doi:10.24911/IJMDC.51-1575757263



Turabian Style

Shukr, Abdul Rahman Ali Mohammed, Amany Ali Alghamdi, Shatha Gamal AbdulQader Alaghbari, Ziad AbdulAziz Alzaid, Meshal AbdulHameed Alolyan, Ahmad Saleh Alshiha, and Abdulrahman Ali Abdullah Aloudah. 2020. The association between physical activity and symptoms of depression. International Journal of Medicine in Developing Countries, 4 (2), 378-382. doi:10.24911/IJMDC.51-1575757263



Chicago Style

Shukr, Abdul Rahman Ali Mohammed, Amany Ali Alghamdi, Shatha Gamal AbdulQader Alaghbari, Ziad AbdulAziz Alzaid, Meshal AbdulHameed Alolyan, Ahmad Saleh Alshiha, and Abdulrahman Ali Abdullah Aloudah. "The association between physical activity and symptoms of depression." International Journal of Medicine in Developing Countries 4 (2020), 378-382. doi:10.24911/IJMDC.51-1575757263



MLA (The Modern Language Association) Style

Shukr, Abdul Rahman Ali Mohammed, Amany Ali Alghamdi, Shatha Gamal AbdulQader Alaghbari, Ziad AbdulAziz Alzaid, Meshal AbdulHameed Alolyan, Ahmad Saleh Alshiha, and Abdulrahman Ali Abdullah Aloudah. "The association between physical activity and symptoms of depression." International Journal of Medicine in Developing Countries 4.2 (2020), 378-382. Print. doi:10.24911/IJMDC.51-1575757263



APA (American Psychological Association) Style

Shukr, A. R. A. M., Alghamdi, . A. A., Alaghbari, . S. G. A., Alzaid, . Z. A., Alolyan, . M. A., Alshiha, . A. S. & Aloudah, . A. A. A. (2020) The association between physical activity and symptoms of depression. International Journal of Medicine in Developing Countries, 4 (2), 378-382. doi:10.24911/IJMDC.51-1575757263