Higher cardiorespiratory fitness at midlife appears linked to a lower risk of depression in later life. In addition, higher midlife fitness is associated with a lower risk of cardiovascular mortality when depression preceded CVD death, according to a retrospective study published in JAMA Psychiatry.
“These findings ... should encourage physicians to consider fitness and physical activity in promoting healthy aging,” wrote Benjamin L. Willis, MD, MPH, of the Cooper Institute in Dallas, and his associates.
The study included 17,989 participants from the Cooper Center Longitudinal Study and linked data from those participants with a depression diagnosis based on Medicare claims and cardiovascular disease (CVD) mortality rates based on the National Death Index.
The participants were mostly men (80.2%), and their mean age at midlife assessment was 50 years. The participants’ treadmill time at midlife was used to categorize them into age- and sex-specific quintiles, with quintile 1 representing low fitness, quintiles 2 and 3 representing moderate fitness, and quintiles 4 and 5 representing high fitness.
After 117,218 person-years of follow-up, the investigators observed 2,701 depression diagnoses, 610 deaths tied to cardiovascular disease without prior depression, and 231 deaths associated with CVD after depression.
In addition, Dr. Willis and his associates found that (hazard ratio, 0.84; 95% confidence interval, 0.74-0.95), compared with participants with a low level of fitness. Participants with a high level of fitness also had a 61% lower risk of death from CVD without depression (HR, 0.39; 95% CI, 0.31-0.48), compared with those who had low fitness levels. Participants with a high fitness level who received a depression diagnosis had a 56% lower risk of death from CVD (HR, 0.44; 95% CI, 0.31-0.64), compared with those who had a low level of fitness.
The researchers pointed out that cardiovascular disease mortality is higher following depression but that cardiorespiratory fitness at midlife is a modifiable risk factor for both depression and CVD mortality.
Dr. Willis and his associates cited several limitations. Among them was the unavailability of information about participants’ use of medication that could influence either the presence or absence of a depression diagnosis.
Nevertheless, they said, the results provide lessons for clinicians and patients.
“This study shows that being fit at midlife is associated with a lower risk of later-life depression and subsequent CVD mortality, even in the presence of depression,” they wrote. “These findings suggest the importance of fitness in primary prevention of heart disease and associated CVD mortality in older aging adults.”
The investigators reported no conflicts of interest.
SOURCE: Willis BL et al. JAMA Psychiatry. 2018 Jun 27. doi: 10.1001/jamapsychiatry.2018.1467.