Depression, reduced physical activity and the risk of heart disease: a prospective cohort of European middle-aged and older adults

OBJECTIVE: To assess the impact of depression and physical activity (PA) of different intensities on the incidence of heart disease. METHODS: A prospective cohort study with 20 645 European middle-aged and older adults (mean baseline age 63 years; 55.1% women; median follow-up 9.5 years) was conducted using data from the Survey of Health, Ageing and Retirement in Europe. The EURO-D 12-item scale assessed depression. Moderate-intensity and vigorous-intensity PA and heart disease diagnoses were self-reported. We classified participants into the following four groups: (1) depression plus low PA, (2) no depression plus low PA, (3) depression plus moderate/high PA, (4) no depression plus moderate/high PA. Hazard ratio (HR) and 95% confidence interval (CI) were estimated using Cox proportional hazards models adjusted for confounders. RESULTS: Compared with having depression and low PA levels, adjusted HR for heart disease similarly decreased for participants with depression and moderate/high PA (moderate-intensity PA: HR=0.63, 95% CI=0.50, 0.78; vigorous-intensity PA: HR=0.69, 95% CI=0.53, 0.89) and participants without depression and low PA (moderate-intensity PA: HR=0.64, 95% CI=0.50, 0.82; vigorous-intensity PA: HR=0.68, 95% CI=0.58, 0.80). The greatest risk reduction was found in participants without depression and moderate/high PA (moderate-intensity PA: HR=0.46, 95% CI=0.37, 0.55; vigorous-intensity PA: HR=0.48, 95% CI=0.40, 0.58). CONCLUSION: Moderate-intensity and vigorous-intensity PA seems to counteract the increased risk for heart disease associated with depression. This highlights the importance of PA as a possible intervention strategy aiming to manage the risk of heart disease among people with depression.