title: Physical activity and depression: a large cross-sectional, population-based study across 36 low- and middle-income countries.
abstract: Physical activity (PA) is good for health, yet several small-scale studies have suggested that depression is associated with low PA. A paucity of nationally representative studies investigating this relationship exists, particularly in low- and middle-income countries (LMICs). This study explored the global association of PA with depression and its mediating factors.
  
  
  
  Participants from 36 LMICs from the World Health Survey were included. Multivariable logistic regression analyses were undertaken exploring the relationship between PA and depression.
  
  
  
  Across 178 867 people (mean ± SD age = 36.2 ± 13.5 years; 49.9% male), the prevalence of depression and the prevalence of low PA were 6.6% and 16.8% respectively. The prevalence of low PA was significantly higher among those with depression vs. no depression (26.0% vs. 15.8%, P < 0.0001). In the adjusted model, depression was associated with higher odds for low PA (OR = 1.42; 95% CI = 1.24-1.63). Mediation analyses demonstrated that low PA among people with depression was explained by mobility limitations (40.3%), pain and discomfort (35.8%), disruptions in sleep and energy (25.2%), cognition (19.4%) and vision (10.9%).
  
  
  
  Individuals with depression engage in lower levels of PA in LMICs. Future longitudinal research is warranted to better understand the relationships observed.
authors.affiliation: Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom.|Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
authors.forename: B
authors.initials: B
authors.lastname: Stubbs
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.|Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Koyanagi
authors.affiliation: Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
authors.forename: F B
authors.initials: FB
authors.lastname: Schuch
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
authors.forename: J
authors.initials: J
authors.lastname: Firth
authors.affiliation: Department of Exercise Physiology, School of Medical Sciences, University of New South Wales, Sydney, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Rosenbaum
authors.affiliation: Geriatrics Division, Department of Medicine-DIMED, University of Padova, Italy, Institute of clinical Research and Education in Medicine (IREM), Padova, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Veronese
authors.affiliation: Department of Neurosciences, University of Padova, Padova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Solmi
authors.affiliation: Kyambogo University, Kampala, Uganda.|Butabika National Referral and Mental Health Hospital, Kampala, Uganda.
authors.forename: J
authors.initials: J
authors.lastname: Mugisha
authors.affiliation: KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.|KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Vancampfort
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D003906:Developing Countries / Q000706:statistics & numerical data*; D015444:Exercise; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult
keywords: depression; exercise; major depression; physical activity