Physical Activity Linked to Reducing Depression Symptoms, Mediated by Pain

Michaela C. Pascoe, PhD

Credit: Victoria University

A recent study found physical activity engagement is inversely associated with reducing depression symptoms, and the association was stronger among people with greater pain.¹

“While the holistic benefits of exercise to individuals with [osteoarthritis] is not a novel finding in itself, the demonstration that the highest levels of pain were associated with the most potential benefit in terms of reduction in symptoms of depression from engaging in physical activity is of significance,” wrote investigators led by Michaela C. Pascoe, PhD, from the Institute for Health and Sport at Victoria University in Australia. “This suggests that those who have the highest pain and are the least likely to engage in physical activity may have the most to gain.”

Osteoarthritis, the leading cause of chronic pain, is linked to high rates of depression. Previous research found one-fifth of people with osteoarthritis experience symptoms of depression. According to the Centers for Disease Control and Prevention, depression symptoms is more prevalent among adults with arthritis than adults without (12.1% vs 4.7%).² Since physical activity reduces depression symptoms and pain levels, investigators wanted to see if physical activity is associated with reduced symptoms of depression, regardless of pain levels, in patients with osteoarthritis.¹

The team conducted a cross-sectional study to explore whether pain mediated or moderated the relationship between the amount of physical activity and depression symptoms. They recruited 552 individuals with osteoarthritis waiting for an orthopedic consultation at a public hospital in Melbourne, Australia. Approximately half were women (54.7%), and the mean age was 62.6 years.

Investigators collected data on age, gender, and affected joints from medical records. Data on depression symptoms, physical activity, and pain were self-reported from the Patient Health Questionnaire, the Active Australia Survey, and the 4-item pain intensity measurement, respectively.

The most common joints affected by osteoarthritis were the knee (44%), hip (15.5%), shoulder (14.4%), and foot (13%). Some participants had multiple joints affected (9%). In total, 33.9% of participants had moderate depression scores or greater; 18.8% reported a major depressive disorder and 10.8% reported another depressive syndrome.

Participants reported an average of 5.19 hours of total physical activity per day, and nearly half (47.8%) of participants were sufficiently active, based on the Australian Physical Activity Guidelines of ≥ 150 minutes of MVPA or 75 minutes of vigorous-intensity physical activity per week). However, 36.9% were insufficiently active, and 15.4% were sedentary with 0 minutes of MVPA per week. On average, participants reported a pain level of 27.70 out of 40.

The findings revealed an inverse association between physical activity and depression (P < .001) with pain as a moderator (P < .001). The association between physical activity and depression was stronger in people with greater pain (P = .043). The greatest pain levels were associated with the most benefit in physical activity reducing depression symptoms.

Investigators highlighted several limitations, such as the cross-sectional design not allowing for examination of long-term relationships, not examining potential confounders such as comorbidities, body mass index, medication, and disease duration, and using self-reported data. Additionally, data was collected during the COVID-19 pandemic which could have impacted levels of physical activity and depression symptoms.

Ultimately, participating in physical activity can help reduce symptoms of depression in individuals with osteoarthritis, especially those with greater pain levels.

“This [study] highlights the need for education of both health professionals and patients on the importance of regular physical activity for pain management and mental health and access to appropriate self-management or clinical interventions to increase and maintain engagement in physical activity,” investigators wrote. “The current work indicates the importance of appropriate care plans and approaches to support individuals, who avoid physical activity due to pain, to safely engage in beneficial physical activity.”

References

1. ^{Pascoe MC, Patten RK, Tacey A, et al. Physical activity and depression symptoms in people with osteoarthritis-related pain: A cross-sectional study. PLOS Glob Public Health. 2024;4(7):e0003129. Published 2024 Jul 18. doi:10.1371/journal.pgph.0003129}
2. ^{Symptoms of Anxiety and Depression Among Adults with Arthritis — United States, 2015–2017. Centers for Disease Control and Prevention. October 5, 2018. https://www.cdc.gov/mmwr/volumes/67/wr/mm6739a2.htm#:~:text=Among%20adults%20with%20arthritis%2C%20age,4.7%25%20among%20adults%20without%20arthritis. Accessed July 24, 2024.}