Domain-Specific Paradox of Physical Activity and Depression Among Patients With Cardiovascular Disease or Related Conditions

Abstract

Background: Domain-specific physical activity (PA) may relate differently to depressive symptoms in adults with cardiovascular disease. We examined associations of work, transport, and leisure PA with depressive symptoms and assessed modification by sex and income. Methods: We analyzed cross-sectional data from 5788 adults with cardiovascular disease or related conditions in the Korean National Health and Nutrition Examination Survey (2016-2020). PA was measured using the Global Physical Activity Questionnaire and categorized by weekly metabolic equivalent task minutes. Depressive symptoms were defined as Patient Health Questionnaire-9 >= 11. Multivariable logistic regression estimated adjusted odds ratio (OR) and 95% CI. Results: Compared with no work PA, low (1-600 metabolic equivalent task-min/week) and high (>= 600 metabolic equivalent task-min/week) work PA were associated with higher odds of depressive symptoms (OR, 2.61 [95% CI, 1.57-4.36]; OR, 3.17 [95% CI, 2.03-4.95]). High leisure PA was associated with lower odds (OR, 0.45 [95% CI, 0.28-0.72]), and high transport PA showed a modest protective association (OR, 0.73 [95% CI, 0.54-0.98]). Associations between work PA and depressive symptoms were stronger in women, whereas the protective association of leisure PA was stronger in high-income individuals (P for interaction <0.001). Conclusions: In adults with cardiovascular disease, work PA was positively, whereas leisure PA was inversely, associated with depressive symptoms, supporting the PA paradox and highlighting the need for domain-specific PA strategies.