Summary: Researchers say exercise is crucial to the overall health of those with depression. The study reveals people with higher levels of fitness during middle age were significantly less likely to die from cardiovascular disease, even if they were diagnosed with depression.
Source: UT Southwestern.
Exercise may be just as crucial to a depression patient’s good health as finding an effective antidepressant.
A new study of nearly 18,000 participants found that those with high fitness at middle age were significantly less likely to die from heart disease in later life, even if they were diagnosed with depression.
The research – a collaboration between UT Southwestern and The Cooper Institute – underscores the multiple ways in which depression may ultimately impact health and mortality. It also highlights the importance of overcoming a common dilemma among patients: How does one cope with hopelessness and still find motivation to exercise?
“Maintaining a healthy dose of exercise is difficult, but it can be done. It just requires more effort and addressing unique barriers to regular exercise,” says Dr. Madhukar Trivedi, co-author of the study and Director of the Center for Depression Research and Clinical Care, part of the Peter O’Donnell Jr. Brain Institute at UT Southwestern.
The study published in the Journal of the American Medical Association Psychiatry utilized a Cooper Institute database of participants who had their cardiorespiratory fitness measured at an average age of 50 years. Researchers used Medicare administrative data to establish correlations between the participants’ fitness at midlife to rates of depression and heart disease in older age. Among the findings, participants with high fitness were 55 percent less likely to eventually die from heart disease following a depression diagnosis.
Dr. Trivedi says the findings are just as relevant to younger age groups, in particular college-age adults who are just entering the workforce.
“This is the age where we typically see physical activity drop off because they’re not involved in school activities and sports,” Dr. Trivedi says. “The earlier you maintain fitness, the better chance of preventing depression, which in the long run will help lower the risk of heart disease.”
Depression has been linked to several other chronic medical conditions such as diabetes, obesity, and chronic kidney disease, which studies show can affect whether antidepressants are likely to help. For patients with these conditions, the more appropriate treatment may be exercise.
Dr. Trivedi says the reasons behind this may partly be connected to the general health effects of physical activity, including the fact that exercise decreases inflammation that may cause depression. By reducing inflammation, the risk for depression and heart disease are lowered.
“There is value to not starting a medication if it’s not needed,” says Dr. Trivedi, who’s leading a national effort to establish biological tests for choosing antidepressants. “Being active and getting psychotherapy are sometimes the best prescription, especially in younger patients who don’t have severe depression.”
Dr. Trivedi cites previous research showing that depressed patients can often perform about three-fourths of the exercise they’re asked to do. He recommends patients take several steps to boost their chances of success:
Set aside a consistent time to exercise every day, but do not get discouraged by stretches of inactivity. Resume activities as soon as possible.
Keep a log to track progress.
Vary the exercises to avoid monotony. Keep the workout interesting and fun.
Exercise with a friend.
Task someone with holding you accountable for maintaining the exercise regimen.
Dr. Trivedi has organized large studies to further solidify the cause and effect among fitness, depression, and heart disease. One example is RAD, Resilience in Adolescent Development, a 10-year study that will enroll 1,500 participants who are at risk to develop depression but have not done so. The study’s primary aim is to examine whether personal factors such as lifestyle and biology influence a teenager’s ability to resist mood disorders. But researchers will also document fitness levels and track whether depression and heart issues arise in later years.
“There is enough evidence to show that the effect of low fitness on depression and heart disease is real,” Dr. Trivedi says. “But further study is needed to establish the mechanism by which this effect happens.”
Dr. Trivedi is a Professor of Psychiatry who holds the Betty Jo Hay Distinguished Chair in Mental Health and the Julie K. Hersh Chair for Depression Research and Clinical Care. He collaborated with Dr. Benjamin Willis of The Cooper Institute for the JAMA Psychiatry study.
“These new insights demonstrate the ongoing importance of fitness throughout the lifespan,” says Dr. Willis, Director of Epidemiology at The Cooper Institute and lead author of the study. “Now we know that the long-term benefits, and the connection between mind-body wellness, are more significant than we thought. We hope our study will highlight the role of fitness and physical activity in early prevention efforts by physicians in promoting healthy aging.”
About this neuroscience research article
Source: James Beltran – UT Southwestern Publisher: Organized by NeuroscienceNews.com. Image Source: NeuroscienceNews.com image is in the public domain. Original Research: Open access research “Association of Midlife Cardiorespiratory Fitness With Incident Depression and Cardiovascular Death After Depression in Later Life” by Benjamin L. Willis, MD, MPH; David Leonard, PhD; Carolyn E. Barlow, PhD; Scott B. Martin, PhD; Laura F. DeFina, MD; and Madhukar H. Trivedi, MD in JAMA Psychiatry. Published June 27 2018. doi:10.1001/jamapsychiatry.2018.1467
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[cbtabs][cbtab title=”MLA”]UT Southwestern”Don’t Let Depression Keep You From Exercising.” NeuroscienceNews. NeuroscienceNews, 27 June 2018. <https://neurosciencenews.com/exercise-depression-9455/>.[/cbtab][cbtab title=”APA”]UT Southwestern(2018, June 27). Don’t Let Depression Keep You From Exercising. NeuroscienceNews. Retrieved June 27, 2018 from https://neurosciencenews.com/exercise-depression-9455/[/cbtab][cbtab title=”Chicago”]UT Southwestern”Don’t Let Depression Keep You From Exercising.” https://neurosciencenews.com/exercise-depression-9455/ (accessed June 27, 2018).[/cbtab][/cbtabs]
Association of Midlife Cardiorespiratory Fitness With Incident Depression and Cardiovascular Death After Depression in Later Life
Importance Cardiorespiratory fitness (hereinafter referred to as fitness) as estimated by exercise testing is a modifiable risk factor independently associated with chronic diseases, cardiovascular disease (CVD) events, and mortality, but the association of fitness at midlife with incidence of later-life depression and the risk of CVD mortality after a depression diagnosis is unknown.
Objective To determine whether fitness measured in midlife would be inversely associated with later-life CVD mortality with antecedent depression.
Design, Setting, and Participants This retrospective cohort study at a single-center, community-based preventive medicine clinic was performed as part of the Cooper Center Longitudinal Study. Data were collected from January 13, 1971, through December 31, 2009, and analyzed from October 6, 2015, through August 14, 2017. Participants included generally healthy men and women who presented for preventive medicine examinations at midlife and who were eligible for Medicare from 1999 to 2010. Those with a self-reported history of depression, myocardial infarction, or stroke at examination were excluded.
Exposures Objective midlife fitness estimated from results of treadmill exercise testing.
Main Outcomes and Measures Depression diagnosis from Medicare claims files using established algorithms and CVD mortality from National Death Index records.
Results A total of 17 989 participants (80.2% men) with a mean (SD) age of 50.0 (8.7) years were included. After 117 218 person-years of Medicare follow-up, 2701 depression diagnoses, 610 deaths due to CVD without prior depression, and 231 deaths due to CVD after depression were observed. A high level of fitness in midlife was associated with a 16% lower risk of depression (hazard ratio [HR], 0.84; 95% CI, 0.74-0.95) compared with a low level of fitness. A high fitness level was also associated with a 61% lower risk of death due to CVD without depression (HR, 0.39; 95% CI, 0.31-0.48) compared with a low level of fitness. After a diagnosis of depression, a high fitness level was associated with a 56% lower risk of death due to CVD (HR, 0.44; 95% CI, 0.31-0.64) compared with a low fitness level.
Conclusions and Relevance Midlife fitness is associated with a lower risk of later-life depression, CVD mortality, and CVD mortality after incident later-life depression. These findings suggest the importance of midlife fitness in primary prevention of depression and subsequent CVD mortality in older age and should encourage physicians to consider fitness and physical activity in promoting healthy aging.