Association of leisure-time physical activity with depressive symptoms in adults at risk for Type 2 Diabetes Mellitus in Kerala, India

Abstract

Depression is one of the most prevalent and burdensome mental disorders globally but remains undertreated especially in low- and middle-income countries. A growing body of research suggests that physical activity is beneficial in the promotion of mental health as well as prevention and treatment of depression, which supports the use of lifestyle interventions addressing physical activity behaviour as complementary or alternative to first line treatment especially in settings lacking resources. However, majority of the research on the benefits of physical activity on mental health and depression has been conducted in high-income countries leaving a wide research gap in low- and middle-income countries. This study aimed to determine the effectiveness of a 12- month long peer-led group-based lifestyle intervention addressing multiple health behaviours in increasing moderate to vigorous leisure-time physical activity as well as the association of moderate to vigorous leisure-time physical activity with the risk of experiencing and severity of depressive symptoms in adults at risk for Type 2 Diabetes Mellitus in Kerala, India.

The study utilized data from the Kerala Diabetes Prevention Program that is a longitudinal cluster randomized controlled trial. The study included 1007 participants at baseline and the data was collected at four time points: baseline, 12-month, 24-month, and 9-year follow-up. Physical activity was measured with the Global Physical Activity Questionnaire, while depressive symptoms were measured with the Patient Health Questionnaire. A chi-square test of independence was used to examine the association of study arms with moderate to vigorous leisure-time physical activity and depressive symptoms, whereas Generalized Estimating Equations and logistic regression were used to examine the association of moderate to vigorous leisure-time physical activity with the risk of experiencing and severity of depressive symptoms with a sub-group analysis for sex.

The results show low participation in moderate to vigorous leisure-time physical activity in the study population and even lower participation among women compared to men at all time points. The intervention was effective in increasing moderate to vigorous leisure-time physical activity and in reducing depressive symptoms in short-term among women, but not among men. Moderate to vigorous leisure-time physical activity was not associated with the risk of experiencing depressive symptoms, but it was associated with reduced severity of depressive symptoms at some time points among women and men as well as over time among women. The findings of this study support the use of peer-led group-based lifestyle interventions in increasing moderate to vigorous leisure-time physical activity in short-term and the potential of moderate to vigorous leisure-time physical activity in reducing the severity of depressive symptoms especially in long-term among women in Kerala, but further research is required to generalize the findings to all of India as well as to determine the association of other forms of physical activity with depression in the country.