title: Physical inactivity, depression, and risk of cardiovascular mortality.
abstract: OBJECTIVE
  Studies indicate that depression may increase risk of cardiovascular disease (CVD) in addition to classical risk factors. One of the hypotheses to explain this relation is that depressed subjects become physically inactive. We set out to determine the role of physical inactivity in the relation between depressive symptoms and cardiovascular mortality.
  
  
  METHODS
  Data were used from the population-based prospective Finland, Italy, and the Netherlands Elderly (FINE) Study. Depressive symptoms were measured with the Zung Self-Rating Depression Scale in 909 elderly men, aged 70-90 yr, free of CVD and diabetes at baseline in 1990. Physical activity was assessed with a questionnaire for retired men. Hazard ratios (HR) for 10-yr cardiovascular mortality were calculated, adjusting for demographics and cardiovascular risk factors.
  
  
  RESULTS
  At baseline, men with more depressive symptoms were less physically active (722 min.wk; 95% confidence interval (CI), 642-802) than men with few depressive symptoms (919 min.wk; 95% CI, 823-1015). During 10 yr of follow-up, 256 (28%) men died from CVD. The adjusted HR of cardiovascular mortality for a decrease of 30 min.d in physical activity was 1.09 (95% CI, 1.04-1.14). An increase in depressive symptoms with one standard deviation was associated with a higher cardiovascular mortality risk (HR = 1.42; 95% CI, 1.26-1.60). After additional adjustment for physical activity the risk decreased (9%), but an independent risk remained (HR = 1.37; 95% CI, 1.21-1.56). The excess risk on cardiovascular mortality attributable to the combined effect of depressive symptoms with inactivity was 1.47 (95% CI, -0.17 to 3.11).
  
  
  CONCLUSIONS
  In the present study, the increased risk of depressive symptoms on cardiovascular mortality could not be explained by physical inactivity. However, our results suggest that depressive symptoms and physical inactivity may interact to increase cardiovascular mortality risk.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands. m.kamphuis@umcutrecht.nl
authors.forename: Marjolein H
authors.initials: MH
authors.lastname: Kamphuis
authors.forename: Mirjam I
authors.initials: MI
authors.lastname: Geerlings
authors.forename: Marja A R
authors.initials: MA
authors.lastname: Tijhuis
authors.forename: Simona
authors.initials: S
authors.lastname: Giampaoli
authors.forename: Aulikki
authors.initials: A
authors.lastname: Nissinen
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Daan
authors.initials: D
authors.lastname: Kromhout
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D003863:Depression / Q000453:epidemiology* / Q000503:physiopathology; D023381:Endpoint Determination; D005060:Europe / Q000453:epidemiology; D015444:Exercise; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires