The objective of this study was to examine the association between accelerometer-derived moderate-to-vigorous physical activity (MVPA) and depressive symptoms in hemodialysis patients with and without type 2 diabetes mellitus (T2DM).
This cross-sectional study finally included 450 maintenance hemodialysis patients from seven dialysis centers in Shanghai, China.Physical activity(PA) was measured using the triaxial accelerometer (ActiGraph GT3X+, Pensacola, FL, USA). We measured depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9) (PHQ-9⩾10). We categorized physical activity into quartile groups (Q1 through Q4), with the first quartile defined as low engagement and the remaining quartiles defined as moderate to high engagement. We used logistic regression and trend test to analyze the relationship between quartile groups and depressive symptoms. The analyses in this study adjusted for a range of confounders.
The prevalence of depression was higher in patients with hemodialysis combined with T2DM . In diabetic patients, MVPAQ4 was negatively associated with depression after adjusting for covariates [OR=0.074; 95% confidence interval (CI)=0.009-0.638, p=0.018]. However, in non-diabetic hemodialysis patients, no significant association was found between MVPAQ1-Q4 and depression after adjusting for covariates (p > 0.05).
In addition, further analyses demonstrated the relationship between Q4 in MVPA quartiles and depression in the T2DM group. This study provides preliminary evidence to support more weekly moderate to vigorous physical activity training to improve physical health in T2DM combined hemodialysis patients. Further longitudinal studies are needed in the future to confirm the direction of causality.
In addition, exercise can stimulate the reconstruction of neural structures related to depression and reduce chronic inflammation . Meanwhile, physical exercise improves the function of the neuroendocrine system, increases the breakdown of anabolic muscle components and improves body functions. In addition, habitual moderate-intensity physical activity in hemodialysis patients can also reduce the side effects of medications taken. In the future, much greater attention must be paid to mental health during the renal rehabilitation,especially in depressed patients with comorbid T2DM, with early intervention for depressive symptoms.
Accelerometer
moderate-to-vigorous physical activity
