Association between depressive symptoms and objectively measured daily step count in individuals at high risk of cardiovascular disease in South London, UK: a cross-sectional study

Vera M Ludwig; Adam Bayley; Derek G Cook; Daniel Stahl; Janet L Treasure; Mark Asthworth; Anne Greenough; Kirsty Winkley; Stefan R Bornstein; Khalida Ismail

doi:10.1136/bmjopen-2017-020942

Association between depressive symptoms and objectively measured daily step count in individuals at high risk of cardiovascular disease in South London, UK: a cross-sectional study

BMJ Open. 2018 Apr 12;8(4):e020942. doi: 10.1136/bmjopen-2017-020942.

Authors

Affiliations

¹ Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
² Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
³ Population Health Research Institute, St George's, University of London, London, UK.
⁴ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁵ Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁶ Department of Primary Care and Public Health Sciences, King's College London, London, UK.
⁷ MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.
⁸ Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
⁹ NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.

Abstract

Objectives: Depressive symptoms are common but rarely considered a risk factor for unhealthy lifestyles associated with cardiovascular disease (CVD). This study investigates whether depressive symptoms are associated with reduced physical activity (PA) in individuals at high risk of developing CVD.

Design: Secondary analysis of the cross-sectional baseline data from a randomised controlled trial of an intensive lifestyle intervention.

Setting: 135 primary care practices in South London, UK.

Participants: 1742 adults, 49-74 years, 86% male at high (≥20%) risk of developing CVD in the next 10 years as defined via QRISK2 score.

Outcome measures: The main explanatory variable was depressive symptoms measured via the Patient Health Questionnaire-9 (PHQ-9). The main outcome was daily step count measured with an accelerometer (ActiGraph GT3X) stratified by weekdays and weekend days.

Results: The median daily step count of the total sample was 6151 (IQR 3510) with significant differences (P<0.001) in mean daily step count between participants with low (PHQ-9 score: 0-4), mild (PHQ-9 score: 5-9) and moderate to severe depressive symptoms (PHQ-9 score: ≥10). Controlling for age, gender, ethnicity, education level, body mass index (BMI), smoking, consumption of alcohol, day of the week and season, individuals with mild depressive symptoms and those with moderate to severe depressive symptoms walked 13.3% (95% CI 18.8% to 7.9%) and 15.6% (95% CI 23.7% to 6.5%) less than non-depressed individuals, respectively. Furthermore, male gender, white ethnicity, higher education level, lower BMI, non-smoking, moderate alcohol intake, weekdays and summer season were independently associated with higher step count.

Conclusions: People at high risk of CVD with depressive symptoms have lower levels of PA.

Trial registration: ISRCTN84864870; Pre-results.

Keywords: adult psychiatry; public health; sports medicine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cardiovascular Diseases / physiopathology*
Cardiovascular Diseases / psychology*
Cross-Sectional Studies
Depression / physiopathology*
Exercise / physiology*
Exercise / psychology*
Female
Humans
Life Style
London
Male
Middle Aged
Randomized Controlled Trials as Topic
Risk Factors

Grants and funding

10/62/03/DH_/Department of Health/United Kingdom