Isotemporal substitution analysis of time between sleep, sedentary behavior, and physical activity on depressive symptoms in older adults: a cross-sectional study
Keywords:
Public health, Aging, Health behavior, Statistical Models, Epidemiology, Sedentary behavior, Sitting time, Elderly, Isotemporal substitution model, Physical exerciseAbstract
BACKGROUND: Compared to young individuals, older adults participate more in sedentary behavior (SB) and less in physical activity (PA). These behaviors are associated with numerous adverse health factors.
OBJECTIVE: The purpose of the study was to examine the hypothetical effects of substituting time spent sleeping, performing SB, and performing moderate-to-vigorous physical activity (MVPA) on depressive symptomatology in older adults.
DESIGN AND SETTING: An analytical cross-sectional study employing exploratory survey methods was conducted in the city of Alcobaça in the state of Bahia, Brazil
METHODS: The study included 473 older adults who answered a structured questionnaire during an interview. Exposure time to SB and PA level were assessed using the International Physical Activity Questionnaire, and depressive symptoms were analyzed using the short version of the Geriatric Depression Scale. An isotemporal replacement model was used to evaluate the effects of different SB sessions on depressive symptomatology.
RESULTS: An increase in the risk of depressive symptoms was observed when MVPA and sleep time were substituted for the same SB time at all times tested, with maximum values of 40% and 20%, respectively. Opposite substitution of MVPA and sleep time increments reduced the risk of depressive symptomatology by 28% and 17%, respectively.
CONCLUSIONS: The results of the present study indicate that replacing SB with the same amount of sleep or MVPA may reduce depressive symptoms. The longer the reallocation time, the greater are the benefits.
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References
World Health Organization. Depression and other common mental disorders global health estimates. Geneva: World Health Organization; 2017. Available from: https://apps.who.int/iris/handle/10665/254610. Accessed in 2023 (May 5).
Fiske A, Wetherell JL, Gatz M. Depression in older adults. Annu Rev Clin Psychol. 2009;5:363-89. PMID: 19327033; https://doi.org/10.1146/ annurev.clinpsy.032408.153621.
Prince MJ, Wu F, Guo Y, et al. The burden of disease in older people and implications for health policy and practice. Lancet. 2015;385(9967):54962. PMID: 25468153; https://doi.org/10.1016/s0140-6736(14)61347-7.
Zivin K, Llewellyn DJ, Lang IA, et al. Depression among older adults in the
United States and England. Am J Geriatr Psychiatry. 2010;18(11):103644. PMID: 20808088; https://doi.org/10.1097/jgp.0b013e3181dba6d2.
Ho CSh, Feng L, Fam J, et al. Coexisting medical comorbidity and depression: multiplicative effects on health outcomes in older adults.
Int Psychogeriatr. 2014;26(7):1221-9. PMID: 24735786; https://doi. org/10.1017/s1041610214000611.
Corrêa VP, Confortin SC, d’Orsi E, et al. Depressive symptoms as an independent risk factor for mortality. Braz J Psychiatry. 2021;43(3):247-53. PMID: 32876136; https://doi.org/10.1590/1516-4446-2019-0749.
Fang H, Tu S, Sheng J, Shao A. Depression in sleep disturbance: a review on a bidirectional relationship, mechanisms and treatment. J Cell Mol Med. 2019;23(4):2324-32. PMID: 30734486; https://doi.org/10.1111/ jcmm.14170.
Schuch F, Vancampfort D, Firth J, et al. Physical activity and sedentary behavior in people with major depressive disorder: a systematic review and meta-analysis. J Affect Disord. 2017;210:139-50. PMID: 28033521; https://doi.org/10.1016/j.jad.2016.10.050.
Sun Y, Shi L, Bao Y, et al. The bidirectional relationship between sleep duration and depression in community-dwelling middle-aged and elderly individuals: evidence from a longitudinal study. Sleep Med. 2018;52:221-9. PMID: 29861378; https://doi.org/10.1016/j.sleep.2018.03.011.
Pearce M, Garcia L, Abbas A, et al. Association between physical activity and risk of depression: a systematic review and meta-analysis. JAMA Psychiatry. 2022;79(6):550-9. PMID: 35416941; https://doi.org/10.1001/ jamapsychiatry.2022.0609.
Tremblay MS, Aubert S, Barnes JD, et al. Sedentary Behavior Research Network (SBRN) - Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act. 2017;14(1):75. PMID: 28599680; https://doi. org/10.1186/s12966-017-0525-8.
Chaput JP, Carson V, Gray CE, Tremblay MS. Importance of all movement behaviors in a 24 hour period for overall health. Int J Environ Res Public Health. 2014;11(12):12575-81. PMID: 25485978; https://doi.org/10.3390/ ijerph111212575.
Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Heal. 2015;1(1):40-3. PMID: 29073412; https://doi. org/10.1016/j.sleh.2014.12.010.
World Health Organization. WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020. PMID: 33369898; Available from: https://www.who.int/publications/i/ item/9789240015128. Accessed in 2023 (May 8).
Dogra S, Ashe MC, Biddle SJH, et al. Sedentary time in older men and women: an international consensus statement and research priorities. Br J Sports Med. 2017;51(21):1526-32. PMID: 28724710; https://doi.org/10.1136/bjsports-2016-097209.
Copeland JL, Ashe MC, Biddle SJ, et al. Sedentary time in older adults: a critical review of measurement, associations with health, and interventions. Br J Sports Med. 2017;51(21):1539. PMID: 28724714; https://doi.org/10.1136/bjsports-2016-097210.
Mekary RA, Willett WC, Hu FB, Ding EL. Isotemporal substitution paradigm for physical activity epidemiology and weight change.
Am J Epidemiol. 2009;170(4):519-27. PMID: 19584129; https://doi. org/10.1093/aje/kwp163.
Grgic J, Dumuid D, Bengoechea EG, et al. Health outcomes associated with reallocations of time between sleep, sedentary behaviour, and physical activity: a systematic scoping review of isotemporal substitution studies. Int J Behav Nutr Phys Act. 2018;15(1):69. PMID: 30001713; https://doi.org/10.1186/s12966-018-0691-3.
Stamatakis E, Rogers K, Ding D, et al. All-cause mortality effects of replacing sedentary time with physical activity and sleeping using an isotemporal substitution model: a prospective study of 201,129 midaged and older adults. Int J Behav Nutr Phys Act. 2015;12:121. PMID: 26419654; https://doi.org/10.1186/s12966-015-0280-7.
Mekary RA, Lucas M, Pan A, et al. Isotemporal substitution analysis for physical activity, television watching, and risk of depression. Am J Epidemiol. 2013;178(3):474-83. PMID: 23785112; https://doi.org/10.1093/aje/kws590.
Rethorst CD, Moncrieft AE, Gellman MD, et al. Isotemporal analysis of the association of objectively measured physical activity with depressive symptoms: results from hispanic community health study/study of latinos (HCHS/SOL). J Phys Act Health. 2017;14(9):733-9. PMID: 28422609; https://doi.org/10.1123/jpah.2016-0648.
Yasunaga A, Shibata A, Ishii K, Koohsari MJ, Oka K. Cross-sectional associations of sedentary behaviour and physical activity on depression in Japanese older adults: an isotemporal substitution approach. BMJ Open. 2018;8(9):e022282. PMID: 30257848; https://doi.org/10.1136/ bmjopen-2018-022282.
Wei J, Xie L, Song S, Wang T, Li C. Isotemporal substitution modeling on sedentary behaviors and physical activity with depressive symptoms among older adults in the U.S.: the national health and nutrition examination survey, 2007-2016. J Affect Disord.
;257:257-62. PMID: 31301629; https://doi.org/10.1016/j. jad.2019.07.036.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician.
J Psychiatr Res. 1975;12(3):189-98. PMID: 1202204; https://doi. org/10.1016/0022-3956(75)90026-6.
Almeida OP, Almeida SA. Confiabilidade da versão brasileira da escala de depressão em geriatria (GDS) versão reduzida. Arq Neuropsiquiatr. 1999;57(2B):421-6. PMID: 10450349; https://doi.org/10.1590/s0004282x1999000300013.
Bertolazi AN, Fagondes SC, Hoff LS, et al. Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med. 2011;12(1):70-5. PMID: 21145786; https://doi.org/10.1016/j. sleep.2010.04.020.
Benedetti TRB, Antunes PC, Rodriguez-Añez CR, Mazo GZ, Petroski ÉL. Reprodutibilidade e validade do Questionário Internacional de Atividade Física (IPAQ) em homens idosos. Rev Bras Med Esporte. 2007;13(1):11-6. https://doi.org/10.1590/S1517-86922007000100004.
Benedetti TRB, Mazo GZ, Barros MVG. Aplicação do Questionário Internacional de Atividades Físicas para avaliação do nível de atividades físicas de mulheres idosas: validade concorrente e reprodutibilidade teste-reteste. Rev Bras Ciência Mov. 2004;12(1):25-34. https://doi.org/10.18511/rbcm.v12i1.538.
Galvão LL, Silva RR, Tribess S, Santos DAT, Virtuoso Junior JS. Physical activity combined with sedentary behaviour in the risk of mortality in older adults. Rev Saúde Pública. 2021;55:60. https://doi.org/10.11606/ s1518-8787.2021055003461.
Diaz KM, Howard VJ, Hutto B, et al. Patterns of sedentary behavior in US middle-age and older adults: The REGARDS Study. Med Sci Sports Exerc. 2016;48(3):430-8. PMID: 26460633; https://doi.org/10.1249/ mss.0000000000000792.
Malta DC, Andrade SSCA, Stopa SR, et al. Estilos de vida da população brasileira: resultados da Pesquisa Nacional de Saúde, 2013. Epidemiol Serv Saúde. 2015;24(2):217-26. https://doi.org/10.5123/S1679497420150002000004.
Tsutsumimoto K, Makizako H, Doi T, et al. Prospective associations between sedentary behaviour and incident depressive symptoms in older people: a 15-month longitudinal cohort study. Int J Geriatr Psychiatry. 2017;32(2):193-200. PMID: 26988851; https:// doi.org/10.1002/gps.4461.
Yasunaga A, Shibata A, Ishii K, et al. Associations of sedentary behavior and physical activity with older adults’ physical function: an isotemporal substitution approach. BMC Geriatr. 2017;17(1):280. PMID: 29212458; https://doi.org/10.1186/s12877-017-0675-1.
Taylor D. Physical activity is medicine for older adults. Postgrad Med J. 2014;90(1059):26-32. PMID: 24255119; https://doi.org/10.1136/ postgradmedj-2012-131366.
Paulo TRS, Tribess S, Sasaki JE, et al. A cross-sectional study of the relationship of physical activity with depression and cognitive deficit in older adults. J Aging Phys Act. 2016;24(2):311-21. PMID: 26439455; https://doi.org/10.1123/japa.2014-0253.
Vancampfort D, Stubbs B, Firth J, Van Damme T, Koyanagi A. Sedentary behavior and depressive symptoms among 67,077 adolescents aged 12-15 years from 30 low- and middle-income countries. Int J Behav Nutr Phys Act. 2018;15(1):73. PMID: 30089487; https://doi. org/10.1186/s12966-018-0708-y.
Mammen G, Faulkner G. Physical activity and the prevention of depression: a systematic review of prospective studies. Am J Prev Med. 2013;45(5):649-57. PMID: 24139780; https://doi.org/10.1016/j.amepre.2013.08.001.
McDowell CP, Dishman RK, Hallgren M, MacDonncha C, Herring MP. Associations of physical activity and depression: Results from the Irish Longitudinal Study on Ageing. Exp Gerontol. 2018;112:68-75. PMID: 30217663; https://doi.org/10.1016/j.exger.2018.09.004.
Rhyner KT, Watts A. Exercise and depressive symptoms in older adults: a systematic meta-analytic review. J Aging Phys Act. 2016;24(2):234-46. PMID: 26372020; https://doi.org/10.1123/japa.2015-0146.
Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and metaregression. Sleep Med. 2017;32:246-56. PMID: 27743803; https:// doi.org/10.1016/j.sleep.2016.08.006.
Jike M, Itani O, Watanabe N, Buysse DJ, Kaneita Y. Long sleep duration and health outcomes: a systematic review, meta-analysis and metaregression. Sleep Med Rev. 2018;39:25-36. PMID: 28890167; https:// doi.org/10.1016/j.smrv.2017.06.011.
da Silva AA, de Mello RGB, Schaan CW, et al. Sleep duration and mortality in the elderly: a systematic review with meta-analysis. BMJ Open. 2016;6(2):e008119. PMID: 26888725; https://doi.org/10.1136/ bmjopen-2015-008119.
Zhai L, Zhang H, Zhang D. Sleep duration and depression among adults: a meta-analysis of prospective studies. Depress Anxiety. 2015;32(9):664-70. PMID: 26047492; https://doi.org/10.1002/ da.22386.
Buman MP, Winkler EAH, Kurka JM, et al. Reallocating time to sleep, sedentary behaviors, or active behaviors: associations with cardiovascular disease risk biomarkers, NHANES 2005-2006. Am J Epidemiol. 2014;179(3):323-34. PMID: 24318278; https://doi. org/10.1093/aje/kwt292.
Bouwmans MEJ, Beltz AM, Bos EH, et al. The person-specific interplay of melatonin, affect, and fatigue in the context of sleep and depression. Pers Individ Dif. 2018;123:163-70. https://doi. org/10.1016/j.paid.2017.11.022.
Eckel RH, Depner CM, Perreault L, et al. Morning circadian misalignment during short sleep duration impacts insulin sensitivity.
Curr Biol. 2015;25(22):3004-10. PMID: 26549253; https://doi. org/10.1016/j.cub.2015.10.011.
Li Y, Wu Y, Zhai L, et al. Longitudinal association of sleep duration with depressive symptoms among middle-aged and older Chinese. Sci Rep. 2017;7(1):11794. PMID: 28924238; https://doi.org/10.1038/ s41598-017-12182-0.
Shrestha N, Grgic J, Wiesner G, et al. Effectiveness of interventions for reducing non-occupational sedentary behaviour in adults and older adults: a systematic review and meta-analysis. Br J Sports Med. 2019;53(19):1206-13. PMID: 29331992; https://doi.org/10.1136/ bjsports-2017-098270.
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