https://doi.org/10.4082/kjfm.2018.39.3.185 • Korean J Fam Med 2018;39:185-190
Original Article eISSN: 2092-6715
Association between Physical Activity and Depressive Mood among Korean Adults with Chronic Diseases Seon-Young Park1, Kiheon Lee2,*, Yoo Jin Um2, Suekyoung Paek1, In Sun Ryou1 1
Department of Family Medicine, Seoul National University Hospital, Seoul, Korea Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
2
Background: This study aimed to investigate the association between physical activity and depressive mood among Korean adults with chronic diseases. Methods: This study analyzed the 2014 Korean National Health and Nutrition Examination Survey data. The study was restricted to participants aged ≥20 years who had completed the survey and were not diagnosed as having depression. After exclusion, 4,676 participants were included in the final analysis. Subjects were categorized according to their level of physical activity. Physical activity was assessed using the International Physical Activity Questionnaire. Patients were categorized into two groups according to depressive traits (normal and depressed) based on the 9-item Patient Health Questionnaire scores. Results: In univariate analysis, significant associations were observed between the level of physical activity and depressive mood in both chronic and healthy groups. Participants with higher levels of physical activity had lower risks of depressive mood than those with lower levels of physical activity, especially patients with chronic diseases (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.31–0.73). Similar trends were observed in multivariate logistic regression analysis (OR, 0.54; 95% CI, 0.34–0.88). Conclusion: Physical activity significantly decreased the development of depressive mood among Korean adults with chronic diseases compared with their healthy counterparts. Physical activity must be emphasized in patients with chronic diseases. Keywords: Exercise; Depression; Chronic Disease; Korean; Adult
Received: March 6, 2017, Revised: May 26, 2017, Accepted: July 11, 2017 *Corresponding Author: Kiheon Lee https://orcid.org/0000-0002-7139-2342 Tel: +82-31-787-7801, Fax: +82-31-787-4834, E-mail:
[email protected]
Copyright © 2018 The Korean Academy of Family Medicine This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Seon-Young Park, et al. • Physical Activity and Depressive Mood
INTRODUCTION
research on the relationship between physical activity and depression
Non-communicable diseases (NCDs), also known as chronic diseases,
lyzed the relationships between physical activity and depression, de-
are major causes of morbidity and mortality worldwide. According to
pression and chronic disease, and physical activity and chronic dis-
the 2014 cause-of-death statistics in Korea, 54.2% of Koreans died from
ease, there insufficient studies linking these aspects.
cancer, cardiovascular diseases, diabetes mellitus (DM), and chronic
The purpose of this study was to investigate the relationship be-
respiratory diseases.1) The prevalence of chronic diseases is likely to
tween physical activity and depressive mood among Korean adults
continue to increase and result in increased socioeconomic burden.
with chronic diseases. We hypothesized that the relationship between
Moreover, this burden will continue to increase due to an increasing
physical activity and depressive mood is more significant in people
elderly population.2,3)
with chronic illnesses than in their healthy counterparts.
in certain disease groups. Although most studies have separately ana-
According to the 2014 Korean National Health and Nutrition Examination Survey (KNHANES), 6.7% of Korean adults aged ≥20 years have an underlying depressive disorder. Depression is one of the most com-
METHODS
mon mental illnesses and a major public health concern worldwide.4)
1. Study Population
Furthermore, depression is often accompanied by chronic illnesses,
This study was conducted among Korean adults aged ≥20 years who
and the burden of disease among chronic patients is known to in-
participated in the 2014 KNHANES. Of the 5,976 participants, 265 who
crease with concomitant mental health disorders.5)
were already diagnosed with depression were excluded. Within the
Physical inactivity is among the 10 leading risk factors for death
limits of retrospective studies, it is best to exclude the deterioration of
worldwide and is a major risk factor for NCDs such as cardiovascular
physical activity due to depression. Participants with missing data (e.g.,
6)
diseases, DM, and some cancers. In addition, studies have discussed
no responses regarding biological, demographic, or socioeconomic
the relationship between physical activity and depression; it has been
status) were also excluded. In total, 4,676 participants were included in
reported that physical inactivity increases the risk of depression, and
the present study (1,643 patients with chronic diseases and 3,033 in
physical activity has been reported to have a therapeutic effect on de-
the control group) (Figure 1). Approval for the study was exempted by
7,8)
pression.
the Institutional Review Board of Seoul National University Bundang
In patients with chronic diseases, the chronic disease itself may in-
Hospital (IRB no., X-1703-388-901) because we analyzed publicly
crease the prevalence of depression. Furthermore, it is thought that the
available data.
lack of physical activity increases the risk of depression and adversely affects the course of the chronic disease due to the functional impair-
2. Variables and Measurement
ment and loss of productivity that accompany depression.9,10) Therefore, physical activity is not only important in managing the
1) Chronic disease and depressive mood
chronic disease itself, but also in reducing the adverse effects of dis-
The present study included the following chronic diseases of interest:
eases when accompanied by depression. However, there is a lack of
cancer, hypertension (HTN), DM, dyslipidemia, stroke, cardiovascular
2014 KNHANES (N=7,550)
Adults over 20 years old (N=5,976)
Excluded (N=1,300) 1. Subjects who were already diagnosed with depression (N=265) 2. Participants with missing data (e.g., no responses to the biological, demographic, or socioeconomic status) (N=1,035)
Included in analysis (N=4,676)
Chronic* (N=1,643)
Healthy (N=3,033)
Figure 1. Flow chart of the subjects included in study. KNHANES, Korean National Health and Nutrition Examination Surveys. *Chronic diseases were limited to cancer, hypertension, diabetes, dyslipidemia, stroke, cardiovascular disease, and asthma.
https://doi.org/10.4082/kjfm.2018.39.3.185
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Seon-Young Park, et al. • Physical Activity and Depressive Mood diseases, and asthma. Cardiovascular diseases included myocardial
adjusted for socioeconomic factors (education, residence, household
infarction and angina pectoris. Each chronic disease was diagnosed by
income, spouse status), and model C was adjusted for health behavior
a doctor. Depressive mood was assessed using the 9-item Patient
factors (smoking, alcohol use, BMI) in addition to all variables in mod-
Health Questionnaire (PHQ-9) scores and defined as a PHQ-9 score of
el A. Model D was adjusted for age, sex, socioeconomic factors, and
≥5.11) The PHQ-9 has been recommended for depression screening
health behavior factors. P
