
==== Front
Heliyon
Heliyon
Heliyon
2405-8440
Elsevier

S2405-8440(24)12316-X
10.1016/j.heliyon.2024.e36285
e36285
Research Article
Isotemporal substitution of sedentary behavior with physical activity and its influence on depressive symptoms among adults with overweight/obesity in the United States: A cross-sectional study
Wu Chao a
Liu Yubo b
Hong Feng a
Korivi Mallikarjuna mallik.k5@gmail.com
mallik@zjnu.edu.cn
b⁎
a Department of Sports Operation and Management, Jinhua University of Vocational Technology, Jinhua 321000, China
b Institute of Human Movement and Sports Engineering, College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua 321000, China
⁎ Corresponding author. Institute of Human Movement and Sports Engineering, College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua 321004, Zhejiang, China. mallik.k5@gmail.commallik@zjnu.edu.cn
16 8 2024
30 8 2024
16 8 2024
10 16 e3628527 3 2024
12 8 2024
13 8 2024
© 2024 The Authors
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).
Objective

This cross-sectional study examined the influence of sedentary behavior (SB) time substitution with physical activity (PA) on depressive symptoms among adults with overweight/obesity. SB time was replaced with equal amount of walking/bicycling or leisure-time moderate-to-vigorous PA (MVPA).

Methods

Data of the 18344 adults, who were overweight and obesity was obtained from the National Health and Nutrition Examination Survey 2006–2018. PA of participants was measured by the Global Physical Activity Questionnaire. Depressive symptoms, including overall, somatic, and cognitive depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9). Isotemporal substitution model based on weighted multiple linear regression was used to assess the association of SB time substitution with PA on depressive symptoms.

Results

Independent model analysis showed that 30 min/day SB time was significantly associated with higher PHQ-9 depressive symptoms, while engage in walking/bicycling or leisure-time MVPA for 30 min/day was associated with lower depressive symptoms. Isotemporal substitution analyses revealed that replacing 30 min/day SB time with equal amount of walking/bicycling or leisure-time MVPA was associated with significant lower PHQ-9 total scores (walking/bicycling: β = −0.088, 95%CI = −0.129, −0.047, P < 0.01; MVPA: β = −0.160, 95%CI = −0.185, −0.134, P < 0.01). Moreover, cognitive depressive symptoms (walking/bicycling: β = −0.035, 95%CI = −0.058, −0.013, P < 0.01; MVPA: β = −0.074, 95%CI = −0.088, −0.060, P < 0.01), and somatic depressive symptoms (walking/bicycling: β = −0.053, 95%CI = −0.075, −0.030, P < 0.01; MVPA: β = −0.085, 95%CI = −0.100, −0.071, P < 0.01) were also significantly lower after replacing SB time with either walking/bicycling or MVPA. However, replacing 30 min/day PA with SB time represented with higher depressive symptoms.

Conclusions

Replacing SB time with walking/bicycling or MVPA is beneficial in lowering the depressive symptoms among overweight/obese adults. Owing to the benefits of PA on depression, strategies promoting PA participation, are necessary for better social/mental well-being and healthy society.

Highlights

• SB time associated with higher depressive symptoms in overweight/obese adults.

• Substitution of SB time with PA is associated with lower total depressive symptoms.

• SB time replaced with PA is associated with lower cognitive depressive symptom.

• SB time replaced with PA is associated with lower somatic depressive symptom.

• Substitution of PA time with SB time is associated with higher depressive symptoms.

Keywords

Physical activity
walking
Depression
Sedentary behavior
Obesity
==== Body
pmc1 Introduction

Depression is a common mental illness that causes a major disability and premature mortality among all age groups of people [1,2]. According to the World Health Organization (WHO), approximately 280 million adults suffers from depression worldwide [3]. The prevalence of depression has been increased in the USA in recent decades, and the increasing trend was varied by demographic characteristics [[4], [5], [6]]. During 2020, about 18 % of US adults (age-standardized) reported to have depression, and the prevalence was higher among women, younger adults (18–24 years), non-Hispanic whites and adults with lower education levels [6]. Depression can impair executive functioning, working memory, processing speed and reaching goals. These impairments eventually impact the quality of life [2,7]. There is an increased financial burden in the US due to increased number of adults with more-severe form of depression [8]. In addition, adults living in a depression household earned less annual income and had poor quality of life than adults living in a no-depression household in the US [9]. Several studies have linked depression to cardiovascular diseases (CVDs), including acute myocardial infarction, heart failure, and stroke [10,11].

Obesity is a major public health concern around the world. A notable association between obesity and depression has been established [12]. Findings from a cross-sectional study of 4573 Chinese adults revealed that individuals who were overweight or with abdominal obesity had a greater susceptibility to depression in comparison to those with normal weight. Subsequent sensitivity analysis revealed that overweight is a significant risk factor for depression [13]. Another study conducted on the Mexican population highlighted that, women with obesity had a greater likelihood of experiencing depression in comparison to those with normal weight [14]. According to a meta-analysis, there is a higher likelihood of depressive symptoms in obese children and adolescents compared to their non-obese children and adolescents [15]. Another systematic review and meta-analysis determined that depression in obese girls could be a potential risk factor that persisted into adulthood [16].

Physical activity (PA) is a beneficial lifestyle behavior that considered as a “complementary and alternative therapy” to promote health and overall well-being of individuals [17]. The American College of Sports Medicine (ACSM) recommends a 150-min of moderate-intensity or 75-min of vigorous-intensity PA per week for people aged 18–65 years [18]. Despite the well-known physiological benefits of exercise, many studies have emphasized the beneficial effects of exercise on psychological disorders, including depression. For instance, a prospective cohort study on adolescents revealed a positive correlation between increased sedentary time and increased severity of depressive symptoms, whereas increased engagement in mild PA is associated with less severity of depressive symptoms [19]. A cross-sectional investigation revealed that higher volumes of PA are strongly associated with lower rates of depression [20]. A study conducted in the United States revealed that nearly all forms of physical activities are linked with decreased prevalence of depression [21]. Most of these studies examined the distinct associations between specific forms of PA, sedentary behaviors (SB), and depressive symptoms. However, these studies did not investigate the potential reciprocal influence of each behavior on another, particularly on depressive symptoms among adults with overweight and/or obesity.

Isotemporal substitution model is a novel statistical method in epidemiological studies that can effectively identify the potential association among health outcomes after substitution of one type of activity (e.g., SB) time with another type of activity (e.g., PA) time, and it is easy to implement in clinical practice [[22], [23], [24]]. The association between PA and health outcomes have been widely explored using isotemporal substitution models [[24], [25], [26], [27]]. Particularly, mutual replacing of SB time (30 min/day) with vigorous PA is associated with less depression among Chinese occupational groups [28]. Another study reported that substitution of SB with moderate to vigorous PA (MVPA) is associated with a lower risk of depression in anemic population [29]. However, yet no study adopted the isotemporal substitution model to examine the correlations between SB time replacing strategy and depressive symptoms particularly among overweight and/or obesity adults in the USA. Since depression and obesity are strongly associated with financial burden, social impairments and poor quality of life [8,9,30], it is crucial to shed light on alternative and cost-effective therapies to alleviate depressive symptoms and improve quality of life of adults. Therefore, the aim of this cross-sectional study was to examine the influence of SB time replacing strategy with equal amount of PA on depressive symptoms among adults with overweight and obesity. Using an isotemporal substitution model, SB time of adults was replaced with walking/bicycling or leisure-time MVPA, and the influence of this substitution strategy on depressive symptoms was evaluated.

2 Material and methods

2.1 Data source and study population

In this cross-sectional study, we used datasets from the National Health and Nutrition Examination Survey (NHANES), a large demographic study assesses the health and nutrition status of adults and children in the USA [31]. The survey focuses on clinical aspects of medical, dental, and physiological evaluations. The NHANES collects reliable and high-quality data through interviews and physical examinations, using modern equipment and validated protocols. This nationally representative data of non-institutionalized civilian population were collected through a multistage, stratified, closeted probability sampling method. The ethics review board of the Centers for Disease Control and Prevention (Atlanta, Georgia) approved the protocols. As required by the National Center for Health Statistics (NCHS) Ethics Review Board (ERB) approval, the written informed consent has been obtained from all participants. The datasets from the NHANES are open and publicly available for researchers. Further information regarding the NHANES data can be obtained from its official website (http://www.cdc.gov/nchs/nhanes.htm).

2.2 Inclusion criteria and selection of participants

The dataset for this study consisted of six consecutive NHANES cycles spanning from 2006 to 2007 to 2017–2018. The inclusion criteria were as follows: (1) Participants are adults with BMI >25 kg/m2 (2) Participants should have at least minimal depressive symptoms, irrespective of their race/ethnicity or demographic characteristics. (3) Demographics (race/ethnicity, BMI, gender, marital status, education levels, income) and covariates (smoking, alcoholism, blood pressure, CVDs) of participants should be reported and (4) Lifestyle behavior of civilians should include any type of sedentary behavior or physical activity. For the analyses, initially there were a total of 59842 participants. During the initial screening based on inclusion criteria for the eligibility, a total of 25072 participants under the age of 20 years were excluded that results 34770 participants. We then excluded 9478 participants whose BMI was below 25 kg/m2, which gives a total of 25,292. Next, another 163 participants who had incomplete PA data were excluded. Additionally, 3629 participants without information on depression were excluded. Following the exclusion of participants with unreported covariates, the final analysis contained a total of 18344 participants (Fig. 1).Fig. 1 Flowchart of selection of participants from the NHANES.

Fig. 1

2.3 Measurement of demographic characteristics and covariates

Demographic characteristics of the enrolled population, including age, gender, race/Hispanic origin, educational qualifications, marital status, income and BMI were assessed. In addition, health status or existence of covariates, such as smoking, alcoholism, hypertension, and CVDs were recorded as described in previous studies [32,33]. The methods or tools used to collect the demographics and covariates of participants in the NHANES were summarized as supplementary data (Supplementary Table 1). The age groups of population were ranged from 20 to 44, 45–64, and above 65 years of male and female. The NHANES questionnaire classified the race/Hispanic origin as non-Hispanic white, non-Hispanic black, Mexican-American, and other or multiracial. The educational levels were included less than high school graduate, high school graduate or equivalent, and some college or above. Marital status was divided into married or living with partner, divorced, separated, or widowed, and never married. The federal poverty income ratio (PIR) value of 1.3 or less represents low income, PIR 1.3 to < 3.5 refers to intermediate/middle income, and PIR ≥3.5 belongs to high income [32]. Smoking status was categorized into non-smokers, former smokers, and current smokers. Hypertension was determined based on three tests with systolic blood pressure ≥140 mmHg and/or diastolic ≥90 mmHg. Alcoholism was categorized based on 4–5 drinks a day [32]. Congestive heart failure, coronary heart disease, angina, myocardial infarction, and stroke are doctor-diagnosed CVDs.

2.4 Measurement of PA of participants

The NHANES used the standard Global Physical Activity Questionnaire (GPAQ) to assess the PA of participants. The reliability and validity of GPAQ tool has been documented [34]. The GPAQ assess the PA levels of participants by asking 16 questions about the type, frequency and duration of physical activity, including leisure activities, walking/bicycling for transportation, work activities and duration of SB. For our analyses, we obtained the data include daily duration of SB time, moderate and vigorous activities, walking/bicycling for transportation, and leisure time moderate to vigorous PA. Vigorous work activities encompass a range of activities that elicit a substantial elevation in respiratory or heart rate for a minimum of 10 consecutive minutes. These include hauling or lifting heavy weight, excavation or building work. Vigorous leisure activities characterized by high-intensity exercise, fitness activities, or leisure activities that significantly increase breathing or heart rate, such as jogging or playing basketball. Moderate work activities are defined as any activity that causes a slight increase in breathing or heart rate, such as brisk walking or continuous weight bearing for at least 10 min. Moderate leisure activities encompass activities that elicit a modest elevation in respiratory or heart rate for a minimum duration of 10 min, such as swimming or participating in volleyball. Walking/bicycling for transportation is defined as a continuous 10 -minute journey to and from school/work or shopping. Leisure-time MVPA was formed by combining moderate and vigorous leisure activities. Work PA was deemed non-modifiable and excluded from the overall time calculation.

2.5 Measurement of depressive symptoms

The depressive symptoms of participants were determined by the Patient Health Questionnaire-9 (PHQ-9), which has good internal consistency, identification sensitivity, and specificity for depression disorder [35,36]. The validity and reliability of PHQ-9 has been proven in previous studies [37,38]. The PHQ-9 scale contains a total of 9 questions, namely” Little interest or pleasure in doing things?”, “Feeling down, depressed, or hopeless?”, " Trouble falling or staying asleep, or sleeping too much?”, " Feeling tired or having little energy?”, " Poor appetite or overeating? ", " Feeling bad about yourself—or that you are a failure or have let yourself or your family down?”, " Trouble concentrating on things, such as reading the newspaper or watching TV?”, " Moving or speaking so slowly that other people could have noticed? Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual?”, and " Thoughts that you would be better off dead or hurting yourself in some way?” [35,39].

These nine elements evaluated on a four-point scale, with 0 represents “not at all” and 3 represents “nearly every day”. The total score of PHQ-9 scale spans from 0 to 27, wherein elevated scores correspond to the heightened levels of depressive symptoms. Precisely, the scores ranging from 1 to 4 means minimal, 5 to 10 means mild, 10 to 14 indicates moderate, 15 to 19 means moderately severe and 20 to 27 indicates severe depression [35]. Among the nine items assessed, cognitive depressive symptoms were measured by item 1 (lack of interest), item 2 (depressed mood), item 6 (worthlessness), item 7 (concentration problems), and item 9 (suicide ideation). Somatic depressive symptoms were measured by item 3 (sleep difficulties), item 4 (fatigue), item 5 (appetite problems), and item 8 (psychomotor agitation or retardation). The main result of this study was the total score of the PHQ-9. The calculation of cognitive and somatic depression symptoms was done based on the previous studies [40,41].

2.6 Statistical analysis

In this study, we used R software 4.3.1 and IBM SPSS Statistics 27.0 for statistical analyses. Continuous variables were expressed as mean ± standard errors. Categorical variables were expressed as counts (percentages). Three weighted multiple linear regression models, including an independent model, a partition model, and an isotemporal substitution model were conducted to examine the association of SB time, walking/bicycling or leisure-time MVPA with depressive symptoms. In accordance with previous reports [42,43], we divided the duration of SB time, walking/bicycling, and leisure-time MVPA into a consistent unit of 30 min before implementing the mode. The total time was the sum of time for SB, walking/bicycling, or leisure-time MVPA. The independent model investigated the association between the behavioral activities of participants and the dependent variable while accounting for covariates. However, it does not account for other types of activities and does not take into account the substitution of activities. The independent model (in case of SB) is shown as follows: The PHQ-9 total score = (β1) SB + (β5) covariates. Without taking total time into account, the partition model examined all the types of activities simultaneously. The partition model (in the case of SB) is shown as follows: The PHQ-9 total score= (β1) SB + (β2) walking/bicycling + (β3) leisure-time MVPA + (β5) covariates. The coefficient for one type of activity represents the effect of increasing this type of activity while holding the other activities constant in this model. The isotemporal substitution model estimated the substitutional associations between replacing one activity type with an equal amount of another activity (e.g. replacement SB with leisure-time MVPA, by removing SB from the model). The isotemporal substitution model (in case of SB) is shown as follows: The PHQ-9 total score = (β2) walking/bicycling + (β3) leisure-time MVPA + (β4) total time + (β5) covariates. The coefficients β2 and β3 in this model represent the association on PHQ-9 total score, when SB time (30 min) replaced with one of the activity types (walking/bicycling or leisure-time MVPA). A statistically significant was considered when P value are less than 0.05. The isotemporal substitution model has been widely used in clinical/research studies and proved to be efficient and feasible approach [29,43].

3 Results

3.1 Characteristics of the study population

This study comprised 18344 adults who were overweight or obese, and 50.3 % of them were males. About the age distribution, we found that 38.6 % of the participants were aged between 20 and 44, 37.2 % were aged between 45 and 64, and 24.2 % were aged 65 years or more. Other demographic characteristics, including education level, race/Hispanic origin, marital status, income status, and covariates were presented in Table 1. The mean score of PHQ-9 cognitive depressive symptom was 1.4 ± 0.02, somatic depressive symptom was 2.0 ± 0.02, and the PHQ-9 total score was 3.4 ± 0.03 (Table 1).Table 1 Characteristics of the study population (N = 18344).

Table 1Variables	Mean ± SE or N (%)	
Gendera	
 Male	9221 (50.3 %)	
 Female	9123 (49.7 %)	
Age (years)a	
 20–44 years old	7079 (38.6 %)	
 45–64 years old	6825 (37.2 %)	
 ≥65 years old	4440 (24.2 %)	
Race/Hispanic origina	
 Non-Hispanic White	7857 (42.8 %)	
 Non-Hispanic Black	4039 (22.0 %)	
 Mexican American	3067 (16.7 %)	
 Other or multiracial	3381 (18.4 %)	
Educational levela	
 Less than high school graduate	4364 (23.8 %)	
 High school graduate or equivalent	4316 (23.5 %)	
 Some college or above	9664 (52.7 %)	
Marital statusa	
 Married or living with partner	11222 (61.2 %)	
 Divorced, separated, or widowed	4217 (23.0 %)	
 Never married	2905 (15.8 %)	
Income statusa	
 Low income	5790 (31.6 %)	
 Middle income	7060 (38.5 %)	
 High income	5494 (29.9 %)	
Body mass indexa	
 Overweight	8329 (45.4 %)	
 Obese	10015 (54.6 %)	
Smoking statusa	
 Never	10014 (54.6 %)	
 Former	4957 (27.0 %)	
 Current	3373 (18.4 %)	
Hypertensiona	
 No	15303 (83.4 %)	
 Yes	3041 (16.6 %)	
Alcoholisma	
 No	16650 (90.8 %)	
 Yes	1694 (9.2 %)	
Cardio vascular diseasesa	
 No	16142 (88.0 %)	
 Yes	2202 (12.0 %)	
PHQ-9 depressive symptoms	
 Cognitive depressive symptom scoreA	1.4 ± 0.02	
 Somatic depressive symptom scoreA	2.0 ± 0.02	
 Total scorea	3.4 ± 0.03	
Life style behavior	
 SB time (30 min/day)A	12.0 ± 0.05	
 Walking/bicycling (30 min/day)A	0.5 ± 0.01	
 Leisure-time MVPA (30 min/day)A	1.3 ± 0.02	
Note.

a : continuous variable.

a : categorical variable; SE: standard error.

3.2 Independent models

Table 2 shows the results of independent models after adjusting for covariates. We found that 30 min/day SB time was significantly associated with higher PHQ-9 somatic depressive symptom (β = 0.029; 95 % CI: 0.024, 0.034; P < 0.01), cognitive depressive symptom (β = 0.021; 95 % CI: 0.016, 0.025; P < 0.01) and total depressive score (β = 0.049; 95%CI: 0.041, 0.058; P < 0.01) in adults with overweight and obesity. Inversely, adults spent 30 min/day on walking/bicycling activities were represented with significantly lower PHQ-9 somatic depressive symptom (β = −0.041; 95 % CI: −0.064, −0.018; P < 0.01), cognitive depressive symptom (β = −0.028; 95%CI: −0.050, −0.006; P < 0.05) and total depressive score (β = −0.069; 95%CI: −0.110, −0.029; P < 0.01). Similarly, 30 min/day spent on leisure-time MVPA was also associated with significantly lower PHQ-9 somatic depressive symptom (β = −0.065; 95%CI: −0.079, −0.051; P < 0.01), cognitive depressive symptom (β = −0.060; 95%CI: −0.073, −0.046; P < 0.01) and PHQ-9 overall depressive score (β = −0.125; 95%CI: −0.150, −0.100; P < 0.01) in adults with overweight/obesity (Table 2).Table 2 Independent models examine the effect sedentary behavior (SB) time (30 min/day), walking/bicycling (30 min/day) and leisure-time MVPA (30 min/day) on depressive symptoms among overweight/obese adults.

Table 2PHQ-9	SB
β (95 % CI)	walking/bicycling
β (95 % CI)	leisure-time MVPA
β (95 % CI)	
Somatic depressive symptom score	0.029 (0.024, 0.034)c	−0.041 (−0.064, −0.018)c	−0.065 (−0.079, −0.051)c	
Cognitive depressive symptom score	0.021 (0.016, 0.025)c	−0.028 (−0.050, −0.006)b	−0.060 (−0.073, −0.046)c	
Total score	0.049 (0.041, 0.058)c	−0.069 (−0.110, −0.029)c	−0.125 (−0.150, −0.100)c	
Note: CI: confidence interval; SB: sedentary behavior; MVPA: moderate-to-vigorous physical activity.

b represents P < 0.05.

c represents P < 0.01.

3.3 Partition models

Table 3 shows the results of partition models after adjusting for covariates and other activity components. While keeping other activity compounds unchanged, 30 min/day SB was independently associated with higher PHQ-9 somatic depressive symptom scores (β = 0.027; 95%CI: 0.022, 0.032; P < 0.01), cognitive depressive symptom scores (β = 0.019; 95%CI: 0.014, 0.024; P < 0.01), and PHQ-9 total scores (β = 0.046; 95%CI: 0.037, 0.054; P < 0.01) in adults with overweight/obesity. However, increasing 30 min/day walking/bicycling, while keeping other activity compound unchanged, was significantly correlated with lower PHQ-9 somatic depressive symptom scores (β = −0.026; 95%CI: −0.049, −0.003; P < 0.05), and total depressive scores (β = −0.042; 95%CI: −0.083, −0.002; P < 0.05), but not associated with cognitive depressive symptom scores (P > 0.05). In addition, increasing 30 min/day on leisure-time MVPA, while keeping other activity compounds stable, was related with lower PHQ-9 somatic depressive symptom (β = −0.059; 95%CI: −0.073, −0.045; P < 0.01), cognitive depressive symptom (β = −0.055; 95%CI: −0.069, −0.042; P < 0.01) and total score (β = −0.114; 95%CI: −0.139, −0.089; P < 0.01) in adults with overweight/obesity (Table 3).Table 3 Partition models examine the effect of 30 min/day SB time, walking/bicycling and leisure-time MVPA on depressive symptoms scores among overweight/obese adults.

Table 3PHQ-9	SB
β (95 % CI)	walking/bicycling
β (95 % CI)	leisure-time MVPA
β (95 % CI)	
Somatic depressive symptom score	0.027 (0.022, 0.032)b	−0.026 (−0.049, −0.003)a	−0.059 (−0.073, −0.045)b	
Cognitive depressive symptom score	0.019 (0.014, 0.024)b	−0.017 (−0.039, 0.005)	−0.055 (−0.069, −0.042)b	
Total score	0.046 (0.037, 0.054)b	−0.042 (−0.083, −0.002)a	−0.114 (−0.139, −0.089)b	
Note: CI: confidence interval; SB: sedentary behavior; MVPA: moderate-to-vigorous physical activity.

a represents P < 0.05.

b represents P < 0.01.

3.4 Isotemporal substitution models

Fig. 2, Fig. 3, Fig. 4 shows the results of the isotemporal substitution models after adjusting for covariates, other activity components and total activity time of participants. Analysis revealed that replacing of 30 min/day SB time with 30 min/day walking/bicycling was associated with significantly lower PHQ-9 somatic depressive symptom scores (β = −0.053; 95%CI: −0.075, −0.030, P < 0.01, Fig. 2), cognitive depressive symptom scores (β = −0.035; 95%CI: −0.058, −0.013, P < 0.01, Fig. 3), and total depressive scores (β = −0.088; 95%CI: −0.129, −0.047, P < 0.01, Fig. 4) among adults with overweight/obesity. Similarly, 30 min/day SB time replaced with 30 min/day leisure-time MVPA was associated with notable lower PHQ-9 somatic depressive symptom scores (β = −0.085; 95%CI: −0.100, −0.071, P < 0.01, Fig. 2), cognitive depressive symptom scores (β = −0.074; 95%CI: −0.088, −0.060, P < 0.01, Fig. 3), and total depressive score (β = −0.160; 95%CI: −0.185, −0.134, P < 0.01, Fig. 4) among adults with overweight/obesity.Fig. 2 Isotemporal substitution models examining the association of SB time (30 min/day) replaced with equal amount of PA (walking/bicycling or leisure-time MVPA) and PA time replaced with equal amount SB time on PHQ-9 somatic depressive symptom scores among overweight/obese adults. CI: confidence interval; SB: sedentary behavior; PA: physical activity; MVPA: moderate-to-vigorous physical activity. * represents P < 0.05; ** represents P < 0.01.

Fig. 2

Fig. 3 Isotemporal substitution models examining the association of SB time (30 min/day) replaced with equal amount of PA (walking/bicycling or leisure-time MVPA) and PA time replaced with equal amount SB time on PHQ-9 cognitive depressive symptom scores among overweight/obese adults. CI: confidence interval; SB: sedentary behavior; PA: physical activity; MVPA: moderate-to-vigorous physical activity. * represents P < 0.05; ** represents P < 0.01.

Fig. 3

Fig. 4 Isotemporal substitution models examining the association of SB time (30 min/day) replaced with equal amount of PA (walking/bicycling or leisure-time MVPA) and PA time replaced with equal amount SB time on PHQ-9 total depressive scores among overweight/obese adults. CI: confidence interval; SB: sedentary behavior; PA: physical activity; MVPA: moderate-to-vigorous physical activity. * represents P < 0.05; ** represents P < 0.01.

Fig. 4

We then examined the interactive effect of PA by replacing with another PA type or SB time on depressive symptoms. We found that replacing of 30 min/day walking/bicycling activity with equal amount of leisure-time MVPA was correlated with lessened all PHQ-9 variables, including, somatic depressive symptom (β = −0.033; 95%CI: −0.060, −0.006, P < 0.05, Fig. 2), cognitive depressive symptom (β = −0.039; 95%CI: −0.065, −0.012, P < 0.01, Fig. 3), and total depressive scores (β = −0.072; 95%CI: −0.120, −0.023, P < 0.01, Fig. 4) in adults with overweight/obesity. In contrast, replacing of 30 min/day walking/bicycling or leisure-time MVPA with equal amount of SB time was associated with higher somatic depressive symptom (Fig. 2), cognitive depressive symptom (Fig. 3) and overall depressive symptoms (Fig. 4) among adults with overweight/obesity.

4 Discussion

To the best of our knowledge, this is the first cross-sectional study to use isotemporal substitution models to assess the associations among SB time, PA, and depressive symptoms in adults with overweight/obesity. According to our independent model results, walking/bicycling and leisure time-MVPA were associated with lower PHQ-9 overall depressive symptoms, cognitive depressive symptoms, and somatic depressive symptoms. The partition model revealed that engaging in leisure time-MVPA was associated with fewer overall depressive symptoms, cognitive depressive symptoms, and somatic depressive symptoms. Furthermore, participants engaged in walking/bicycling were represented with improved overall depressive symptoms and somatic depressive symptoms, but not cognitive depressive symptoms. We then adopted the isotemporal substitution models to reveal the replacing strategy effect on depressive symptoms. The novelty of this study is that replacing 30 min/day SB time with an equivalent amount of walking/bicycling or leisure-time MVPA was correlated with a lower overall depressive symptoms, cognitive depressive symptoms, and somatic depressive symptoms among overweight and obese US population. In contrast, replacing of either type of PA time with equal amount of SB time was associated with higher depressive symptoms (overall, cognitive and somatic depression) in adults with overweight and obesity.

Overweight and/or obesity is strongly correlated with increased risk of depression disorder among adults [14,44,45]. Therefore, it is crucial to study the alternative treatments that can lower the depression in adults with overweight or obesity. Several studies addressed the importance of PA on lowering the depression among people. A study on Australian population reported that, high amount of PA was associated with fewer depressive symptoms in healthy or overweight adults, while moderate and high amount of PA was associated with fewer depressive symptoms in obese adults [46]. Another cross-sectional study on US population objectively assessed the association between PA and depression that showed a significant linear trend between MVPA duration and the incidence of depression, which indicates longer MVPA leads lower depression risk among adults with overweight or obesity [47]. A recent study on 26849 participants from the NHANES also identified the inverse correlation between higher PA and lower risk of depression in adults [48]. Likewise, our results from the independent and partition models on a largescale population of the nationally representative survey revealed that both leisure-time MVPA and walking/bicycling behaviors were significantly correlated with fewer depressive symptoms among participants with overweight or obesity. These results suggests that PA may be a potential non-pharmacological intervention to attenuate or improve the overall depressive symptoms in adults with overweight/obesity.

Isotemporal substitution model uses a novel statistical technique that keeps total and other activity times constant, while exchanging the time of one behavior with another [23]. Isotemporal substitution model has been extensively employed in epidemiological studies, and explored the effect of substituting SB with PA on various health-related outcomes [[49], [50], [51]]. Results from our analyses revealed a significant correlation of substituting SB time with walking/bicycling or leisure-time MVPA on lowering all depressive symptoms among adults with overweight or obesity. In contrast, substituting either type of PA with SB was correlated with higher depressive symptoms. These novel findings suggests that SB time is negatively and PA is positively affecting the depression levels in adults with overweight and/or obesity, as they engage in their lifestyle behaviors. Consistent with our findings, a study conducted on Chinese occupational groups (10656 participants) revealed that substituting daily SB time with walking, moderate or vigorous PA was negatively associated with the risk of depressive tendencies [28]. A cross-sectional analysis on the US older adults (60 years or above) reported that substituting SB with walking/bicycling or MVPA was associated with lower depressive symptoms [52]. Similarly, another cross-sectional study on South American (Argentina, Brazil, Chile) population showed that replacing 10 min/day of either screen exposure or non-screen sitting time with any intensity of PA was associated with lower depressive symptoms [53]. In contrast, a cross-sectional study on Japanese older adults (65–85 years) demonstrated that replacing SB with low-intensity PA was beneficial on depression, while substituting SB with MVPA did not exhibit favorable association on depression [42]. A latest study on Chinese university students revealed that substituting 30 min of SB with MVPA was associated with improved depressive symptoms [54]. The disparities might be attributed to the variations in age and/or demographics of participants. Nevertheless, our findings are comprehensive as we primarily focused on adults with overweight or obesity, and addressed the changes in depressive domines in response to substitution strategies.

Moreover, depression is a multifaceted psychiatric condition that encompasses both physical and mental symptoms [55,56]. We examined the correlations between PA and somatic depressive symptoms as well as cognitive depressive symptoms in people who are overweight or obese. A study on the US elderly people also reported that replacing SB with walking/bicycling or MVPA was associated with lower somatic and cognitive depressive symptoms [52]. A connection between decreased PA and severity of somatic depressive symptoms was also identified among US Iraq and Afghanistan veterans [57]. Our findings provide strong evidence for the association between PA and somatic depressive symptoms or cognitive depressive symptoms in adults with overweight or obesity, using isotemporal substitution approach. Lower somatic depressive symptoms in substitution models perhaps explain that overweight/obese adults prevailed over the sleep difficulties, appetite issues, fatigue and psychomotor agitation. Similarly, lower cognitive depressive symptoms explain improvement of sub-domines, including depressed mood, lack of interest, concentration problem and suicide ideation. PA has been shown to ameliorate subscales of somatic and cognitive depression in adults with depression disorders, and these beneficial changes possibly associated with improved inflammatory system [[58], [59], [60]].

In the clinical context, body weight of an individual is important, not only for physical fitness but also for psychological wellbeing and social esteem. However, a systematic review and meta-analysis reported the bidirectional association between obesity and depression. Obese persons showed increased risk of developing depression, while depressed individuals showed increased risk of becoming obese over time [61]. In many countries, including the US, thinness considered a beauty ideal whereas obesity increase the body dissatisfaction and decrease self-esteem, which are the risk factors of depression [61]. On the other hand, unhealthy dietary patterns, lack of motivation to engage in PA, fatigue or antidepressants usage among depressed individuals may contribute to weight gain over a period of time [61,62]. In view of these, we cannot ruled-out the multidirectional relationships between sedentary lifestyle, PA, overweight/obesity, and depressive symptoms.

The details on physiological and psychosocial mechanisms behind the positive effects of PA on depressive symptoms could further strengthen the significance of our study. Physiologically, obesity is associated with neuroinflammation, decreased white matter integrity and cognitive decline. Circulating lipopolysaccharide binding protein, which elevates in obesity, negatively impact brain white matter integrity and working memory/short-term verbal memory in middle-aged obese adult [63]. Another study demonstrated that elevated putative inflammatory marker in the striatum relates to the increased waist circumference, BMI, and BMI z-scores indicating a correlation between weight gain and increased neuroinflammation [64]. In addition, disruption of neuroinflammation can result in cognitive decline, thereby impacts memory formation and emotional regulation, ultimately contribute to developing of neurological disorders, including depression [65]. The regulation of pro-inflammatory cytokine expression by PA has been found to positively ameliorate the depressive symptoms [66]. Furthermore, chronic depression or stress are associated with detrimental effects on oxidative stress in various tissues, including brain. PA can regulate the oxidative stress and antioxidant capacity, thereby mitigate the oxidative stress-mediated adverse effects in brain and improve the depressive symptoms [67,68]. According to the psychosocial theories, PA can help alleviate depressive symptoms by boosting people's self-esteem or physical self-concept. Furthermore, PA might augment self-efficacy and bolster social support, which could alleviate depressive symptoms [69]. However, there are social or structural hurdles to access PA facilities, including lack of equipment, socioeconomic status of family and neighborhood. A study has shown that both neighborhood and household socioeconomic adversities were independently associated with white matter development in children, and these associations were explained by obesity and poor cognitive performance [70].

5 Limitations

Despite the above strength of our findings, there are some limitations in our study. This is a cross-sectional study, and cannot directly infer a cause-and-effect relationship among PA, SB, and depressive symptoms. Family history of depression or psychological disorders may influence the depressive symptoms in adults, who are overweight or obese. In our analyses, we did not include the family history of depression and other psychological disorders as covariates to exclude the influence of this confounding factor on the results. Living environment and clinical environment of participants has not been stated clearly. The reported depressive symptoms were not assessed through direct interaction with participants or not clinically diagnosed. In addition, we determined PA levels based on self-reported answers to the questionnaires, rather than using a more accurate objective accelerometer. Due to the COVID-19 pandemic restrictions, the NHANES could not collect data for the recent years, and therefore we are unable to include latest data for the analysis. Future studies are needed to address these limitations by designing randomized controlled trials and/or assessing the PA levels using accelerometers that objectively measure the PA.

6 Conclusion

Isotemporal substitution models demonstrate that replacing 30 min/day SB time with an equal amount of either walking/bicycling or leisure-time MVPA is associated with lower depressive symptoms in adults with overweight and/or obesity. Practically our findings emphasized that engaging in different PA programs and avoiding SB could improve the psychological disorders and promote physical fitness of adults. Such improvements of mental health, particularly among overweight or obese individuals further led to promote social well-being and overall quality of life. Therefore, greater societal or community efforts on expanding PA access, encouraging PA participation and organizing PA events are necessary for healthy society.

Ethical approval and consent to participate

The design and protocols used in this study were from the NHANES, which were approved by the NCHS Ethics Review Board for the period from 2006 to 2007 to 2017–2018 cycles. As the protocols were already approved and informed consent forms were obtained, further need of approval is waived for this analysis.

Data availability

The data presented in this study are available from the corresponding authors on reasonable request.

Funding

This research did not receive any specific grant from any funding agencies in the public, commercial, or not-for-profit sectors.

CRediT authorship contribution statement

Chao Wu: Writing – original draft, Investigation, Data curation, Conceptualization. Yubo Liu: Data curation, Conceptualization. Feng Hong: Writing – original draft, Methodology, Data curation, Conceptualization. Mallikarjuna Korivi: Writing – review & editing, Supervision.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Appendix A Supplementary data

The following is/are the supplementary data to this article.Multimedia component 1

Multimedia component 1

Acknowledgements

None.

Appendix A Supplementary data to this article can be found online at https://doi.org/10.1016/j.heliyon.2024.e36285.
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