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Effects of an exercise program linked to primary care on depression in elderly: fitness as mediator of the improvement

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Abstract

Purpose

The present study aimed to analyse the effects of 12 months of participation in a public physical activity program linked to primary care on depression level and fitness, and to determine which fitness components were responsible for the improvement in depression using mediation analysis.

Methods

Participants of this program were 2768 middle-aged and older adults from 67 municipalities throughout the Spanish region of Extremadura. In the analysis only participants with depression and without any missing values for fitness variables were included. This sample was 303 for exercise group and 74 for control group. Socio-demographic data, Geriatric Depression Scale and some fitness tests were applied at baseline and 1 year later. Exercise group performed the program 3 days/week for 50–60 min per session involving brisk walking with intermittent flexibility, strength and balance activities/exercises. Socializing within the group was encouraged in all sessions. Data analysis included analysis of covariance, chi-squared and effect size statistics. Additionally, a parallel model of mediation analysis was performed to determine the indirect effect of the participation in the exercise program on depression through improvements in fitness.

Results

A considerable reduction from mild, moderate or severe depression to non-depression were obtained for exercise group (68%) P-value < .05. The parallel mediation analysis showed that flexibility (sit-and-reach [β − 0.04 (− 0.07 to − 0.01)], back scratch [β − 0.06 (− 0.12 to − 0.02)]) and cardiorespiratory fitness (6-min walk [β − 0.09 (− 0.15 to − 0.04)]) were mediators of the reduction in depression.

Conclusion

This exercise program was effective in improving depression in older adults. Integrating aerobic and flexibility exercises in a group-based program of physical activity programs could improve the severity of depression in this population.

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Acknowledgements

The authors would like to thank the participating general practitioners for referring study participants and the test administrators for collecting the study data. The authors especially wish to thank the study participants for their cooperation. This study was supported by the Regional Ministries of Presidency (DG Sports) and Health & Social Policies (DG Public Health) of the Regional Government of Extremadura and Foundation of Youth & Sport through the “Exercise Looks After You” program.

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Authors and Affiliations

  1. Faculty of Education, Psychology and Sport Sciences, Universidad de Huelva, Av. de las Fuerzas Armadas, S/N, 21007, Huelva, Spain

    Miguel A. Perez-Sousa

  2. Instituto de Actividad Física y Salud, Universidad Autonoma de Chile, 5 y Medio Norte 1670, Talca, Chile

    Pedro R. Olivares

  3. Geriatric Unite, Hospital of Cáceres, Cáceres, Spain

    Jose L. Gonzalez-Guerrero

  4. Faculty of Sport Sciences, Universidad de Extremadura, Campus Universitario, Av. de la Universidad, S/N, 10003, Cáceres, Spain

    Narcis Gusi

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  1. Miguel A. Perez-Sousa
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  2. Pedro R. Olivares
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  3. Jose L. Gonzalez-Guerrero
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  4. Narcis Gusi
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Correspondence to Pedro R. Olivares.

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Perez-Sousa, M.A., Olivares, P.R., Gonzalez-Guerrero, J.L. et al. Effects of an exercise program linked to primary care on depression in elderly: fitness as mediator of the improvement. Qual Life Res 29, 1239–1246 (2020). https://doi.org/10.1007/s11136-019-02406-3

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