Association between trajectories of physical activity and depressive symptoms among Chinese older adults with chronic disease: evidence from the Chinese Longitudinal Healthy Longevity Survey.

BACKGROUND: Physical activity (PA) has been associated with depressive symptoms (DS), yet most evidence relies on single time-point assessments and general populations. It remains unclear whether long-term trajectories of PA are associated with the odds of DS among older adults with chronic disease (participants with at least one chronic disease), including those with multimorbidity (participants with two or more chronic diseases). Therefore, this study aimed to examine the association between trajectories of PA and DS with chronic disease.
METHODS: A total of 854 older adults (≥ 65 years) with chronic disease (participants with at least one chronic disease) derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in three waves 2011-2012, 2014, and 2017-2018. PA trajectories were identified using group-based trajectory modeling across three waves. Participants who were free of DS at baseline were followed up at the third wave to assess DS status. Multivariable-adjusted binary logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for demographic, socioeconomic, lifestyle, and health-related covariates. Subgroup analyses were conducted among individuals with multimorbidity and specific chronic diseases.
RESULTS: Three distinct PA trajectories were identified: low level and decreasing, moderate level and decreasing, and high level and decreasing. Compared with the low level and decreasing trajectory, both moderate level and decreasing and high level and decreasing trajectories were associated with lower odds of DS. These associations were generally consistent among individuals with multimorbidity. For specific chronic diseases, statistically significant associations were observed in participants with hypertension, lung disease, stroke, and arthritis, while similar trends were noted but did not reach statistical significance in other conditions.
CONCLUSIONS: Maintaining favorable long-term patterns of PA, even with gradual decline, is associated with reduced odds of DS among older adults with chronic diseases. These findings support PA as a potentially cost-effective strategy for secondary prevention and highlight the importance of sustained behavioral patterns in mitigating mental health risks in aging populations.