A new study, published in the Journal of the American Medical Association Psychiatry, investigates the effects of fitness on cardiovascular disease (CVD) and depression. The research is the product of a collaboration between UT Southwestern and The Cooper Institute and was led by Benjamin L. Willis, director of Epidemiology at The Cooper Institute. The results suggest that those with higher levels of cardiorespiratory fitness in middle age were significantly less likely to meet criteria for depression or die from heart disease in later life, boosting evidence of the long-term benefits of exercise maintained throughout the lifespan.

“Midlife fitness is associated with a lower risk of later-life depression, CVD mortality, and CVD mortality after incident later-life depression. These findings suggest the importance of midlife fitness in primary prevention of depression and subsequent CVD mortality in older age and should encourage physicians to consider fitness and physical activity in promoting healthy aging,” the researchers write.

Depression, one of the most commonly diagnosed mental health conditions in America, is associated with cardiovascular disease (CVD) and linked to CVD mortality. Research reports that as many as 1 in 5 individuals with CVD may also meet criteria for depression.

“Depression and Cardiovascular Disease are the most common causes of disability in the developed nations of the world, a connection between depression and Cardiovascular Disease has been recognized for a number of years, and a higher prevalence of depression has been found in patients with myocardial infarction, stroke, and heart failure.”

Well known mediating and preventative factors for both depression and CVD are fitness and exercise. “Fitness is inversely associated with all-cause and CVD mortality and a lower incidence of depression and physician visits concerning depression,” the researchers of the current study write. However, it can be challenging to maintain levels of fitness during periods of depression or in the instance of CVD.

The purpose of the current study was to investigate the effects of exercise during midlife as a preventative measure for depression and CVD in later life. Almost 18,000 participants from the Cooper Center Longitudinal Study, excluding those with a history of depression or CVD, were included in the study. Several measures from archival data starting in 1971 were taken from participants at a mean age of 50.0.

Data included information from a preventive medical examination including body mass index, blood pressure, cardiorespiratory fitness, treadmill time, depression level, and self-reported medical and lifestyle history. Individuals were placed in one of five quantiles: quantile 1 represented low fitness, 2 and 3 represented moderate fitness, and quantiles 4 and 5 represented high fitness. Participants were followed up with until death or the end of data collection in 2009. Results of the extensive study found midlife fitness to be a significant preventive factor in a number of areas.

“In a large, generally healthy cohort of men and women, higher midlife fitness was associated with lower risk of a depression diagnosis after 65 years of age.” Additionally, “not only was higher midlife fitness associated with a lower risk of CVD mortality, but importantly, it was also associated with a lower risk of CVD mortality when CVD death was preceded by depression.”

Madhukar Trivedi, a physician and co-author of the current study, indicates that these findings are just as relevant to younger age groups: “[College] is the age where we typically see physical activity drop off because they’re not involved in school activities and sports,” Dr. Trivedi says, “The earlier you maintain fitness, the better chance of preventing depression, which in the long run will help lower the risk of heart disease.”

Although it is well known that fitness and exercise are important preventative factors for common mental health conditions, the current study points to the importance of developing and maintaining a fitness regime throughout the lifespan, not just during incidents of depression, when it may be the most difficult to establish. The authors conclude:

“Fitness can be improved in most individuals by aerobic training, which need not be complicated or expensive. Despite this finding, surveys indicate that only about 50% of adults meet aerobic exercise guidelines and far fewer meet muscle-strengthening and aerobic guidelines.”

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Willis BL, Leonard D, Barlow CE, Martin SB, DeFina LF, Trivedi MH. Association of Midlife Cardiorespiratory Fitness With Incident Depression and Cardiovascular Death After Depression in Later Life. JAMA Psychiatry. Published online June 27, 2018. doi:10.1001/jamapsychiatry.2018.1467 (Link)