Each month the Elsevier Atlas Award recognizes research that could significantly impact people's lives around the world.
Davy Vancampfort, Brendon Stubbs, James Mugisha, Joseph Firth, Felipe B. Schuch, and Ai Koyanagi
Journal of Affective Disorders, Volume 234, July 2018, Pages 97-104
We are too sedentary. We get up, sit on a train or in a car on the way to an office, where we sit for eight hours, then get back on the train or in the car and go home, to sit at the table for dinner and then sit in front of the television before going to bed. That’s a lot of sitting. And even if you work out a few times a week, that’s not enough to counteract the negative effects of that much sitting.
Sedentary behavior has been linked to a whole host of problems, from heart disease and stroke to diabetes and premature death, and it’s now clear that being inactive is also linked to depression. This is a growing issue in low- and middle-income countries, where sedentary behavior is increasing.
Having seen the link between depression and sedentary behavior in previous research, Dr. Davy Vancampfort, from KU Leuven in Belgium, wanted to find out what might be behind this increase in sedentary behavior, in order to reduce and even prevent depression. What he found suggests there are low-cost opportunities to make a big difference in low- and middle-income countries.
In their Atlas award-winning article in the Journal of Affective Disorders, Dr. Vancampfort and his colleagues around the world show that sedentary behavior in people with depression is linked to lower levels of social cohesion – they aren’t very involved in community and social activities.
“In communities where there are a lot of social activities, where people are stimulated to be involved in the community, there was a cross section association – people are less sedentary,” said Dr. Vancampfort. “We can't make any casual conclusions, but there was a strong link, which I think might be interesting to explore further in conventional studies and longitudinal studies.”
In a previous study, researchers looked at the impact of sedentary behavior on depression. They split participants into two groups: one group had to continue with their normal behavior, and the other group were asked to be sedentary for one week. In the group asked to be sedentary, the level of depression increased significantly; when they changed back to their normal active behavior, depression rates dropped immediately.
This led Dr.Vancampfort to the idea that addressing sedentary behavior would be an effective way to tackle depression. “We wanted to find out what factors are causing sedentary behavior, as we think reducing sedentary behavior could be a low-cost intervention for preventing depression in low- and middle-income countries,” he said.
Using data from the World Health Organization (WHO), the team studied 2,375 people with depression in six low- and middle-income countries. More than 11 percent of people were highly sedentary, meaning they were inactive for at least eight hours a day. Some of the factors significantly linked with sedentary behavior were older age and being unmarried, being male and being unemployed. Notably, one factor strongly associated was a lack of involvement in community and social activities. There was also a strong link between depression and sedentary behavior in more urban settings.
Being active doesn’t need to mean going for a run every day – the movement can be smaller, but it needs to be regular, like standing up and walking somewhere a few times an hour. This provides an opportunity to combine active behavior and community involvement to help tackle depression.
“We’re trying to invite people to join social activity programs in a non-stigmatized environment,” said Dr. Vancampfort. “I think one step is having more community activities in centers within big cities. There should be physical activities, sitting together, culture-sensitive activities, playing cards, playing games. I think that's the way forward.”
The next step for the research is to carry out longitudinal studies to determine whether sedentary behavior is causing depression or vice versa. Ultimately, Dr. Vancampfort’s aim is to promote a more holistic approach to healthcare in low- and middle-income countries, because of the strong link between mental and physical health.
“I think that in the future if we want more evidence-based healthcare in low-income countries, we need to bring these two different aspects of medicine together in a holistic health care model, which is currently absent in low-income countries,” he said.
A conversation with Dr. Davy Vancampfort
Depression is a big problem in low- and middle-income countries, and it’s linked to the rise in sedentary behavior. Could helping people be more active be a low-cost intervention to improve mental health in the developing world? Dr. Davy Vancampfort, from KU Leuven in Belgium, thinks so. In their Atlas award-winning paper in the Journal of Affective Disorders, Dr. Vancampfort and his colleagues around the world show what’s driving sedentary behavior in low- and middle-income countries, revealing a potential way to prevent depression.
In this podcast Dr. Davy Vancampfort talks about the link between sedentary behavior and depression in low- and middle-income countries, and what can be done to prevent both.
We all know that we need to move more but can you explain a bit what sedentary behavior is and why it's bad?
Nowadays sedentary behavior is considered the new smoking. That means that all activities in which you are not increasing your energy level above the normal metabolic rate – so the normal energy you need to survive, like your heartbeat, breathing – that's sedentary behavior.
If you look at current research, then being physically active, for example for one hour a day, can never compensate for eight hours of sedentary behavior. It's a matter of stimulating your body at least every 20 minutes next to being more active during the day – actually standing up. If you want a coffee, take a small walk to the kitchen and have your coffee there.
You looked at the link with depression, why did you investigate this?
In an earlier study, I looked at people in two groups – one group had to continue with their normal behavior, and the other group were asked to be sedentary for one week. In the sedentary group, the level of depression increased significantly, after just one week. Then I asked them to change to their normal behavior again, to be as active as they were before. Depression rates dropped immediately.
So there is a very strong link to sedentary behavior and depression. We wanted to find out what factors are causing sedentary behavior, as we think reducing sedentary behavior could be a low-cost intervention for preventing depression in lower middle-income countries.
Can you take us through what you did in the study?
We had access to a World Health Organization data set. We included all the people with depression and we looked at their sedentary behavior, and at which factors contributed to that sedentary behavior. We looked at social demographic factors: are women more sedentary than men? Does age play a role? But also physical health aspects.
The most interesting finding is actually the relationship between social cohesion in the community and the levels of sedentary behavior in people with depression. In communities where there are a lot of social activities, where people are stimulated to be involved in the community, there was a cross section association – people are less sedentary.
What sort of conclusions could you draw about how to tackle sedentary behavior and therefore, depression?
There was a strong link between physical health and mental health. I think that in the future if we want more evidence-based healthcare in low-income countries, we need to bring these two different aspects of medicine together in a holistic health care model. This is currently absent in low-income countries.
What sort of steps do you think can be taken at what levels to make that happen?
That's indeed the challenge for me to explore more. I think that what we are trying to do now in other settings as well, for example, people with post-traumatic stress disorder, is trying to invite them to join activity programs and social activity programs in a non-stigmatized environment.
There was also a strong link between depression and sedentary behavior in more urban settings, so I think another step is having more community activities in centers within big cities. There should be physical activities, sitting together, culture-sensitive activities, playing cards, playing games. I think that's the way forward.
You looked at low- and middle-income countries; is there a big difference from higher income countries or is this common across borders?
In low income countries, people with the highest socio-economic status are more sedentary, while in higher income countries it's the opposite – people with high socio-economic status are less sedentary.
In low-income countries, people are going to live more in cities, and they can afford a more sedentary lifestyle. The economic situation is improving, but that means people will become more sedentary: they have more sedentary jobs, they can afford motorized transport. So the sedentary issue will become a big problem, especially in cities in low- and middle-income countries.
What's next for your research?
This was a cross-section study, so we hope it might be a step up to more longitudinal research. That way we can explore the causal relationships and really can see if it’s the depression which is causing sedentary behavior or the sedentary behavior that is causing depression. From these longitudinal studies we can start intervention studies to find out if we have to focus especially on sedentary behavior or on other factors. And then the final step will be how do we implement low-cost interventions in challenging environments? We still have a long way to go.
About Journal of Affective Disorders
The Journal of Affective Disorders publishes research on depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and covers papers dealing with any aspect of affective disorders, including neuroimaging, genetics, experimental and clinical neurosciences, pharmacology, intervention and treatment trials.
- Dr. Vancampfort is involved with the charity A25RTH; its mission is to empower individuals and communities to achieve the highest attainable standard of physical and mental health. This will be achieved through the implementation and evaluation of culturally adapted initiatives that increase local capability – find out more on the website
- A previous study by Dr. Vancampfort showing a diagnosis of psychosis is associated with physical inactivity, especially among men: Science Daily/Oxford University Press USA (2016)
- Being physically fit could help cut the risk of death in half for men with depression, anxiety suicidal thoughts; read Dr. Vancampfort’s comments on this research in Reuters (2017)
- “Human development, occupational structure and physical inactivity among 47 low and middle income countries,” Preventive Medicine Reports (June 2016) – open access
- “Excess mortality in depression: a meta-analysis of community studies,” Journal of Affective Disorders (December 2002)
- “Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women,” The Lancet (September 2016)
- “A comparative cross-cultural study of the prevalence of late life depression in low and middle income countries,” Journal of Affective Disorders (January 2016) – open access
- “Sedentary behavior and medical multimorbidity,” Physiology & Behavior (November 2015)
- “Adult Sedentary Behavior: A Systematic Review,” American Journal of Preventive Medicine (March 2012)
- “Physical activity and sedentary behavior in people with major depressive disorder: A systematic review and meta-analysis,” Journal of Affective Disorders (March 2017)