The association between cardio-respiratory fitness and incident depression: The Maastricht Study

Vincenza Gianfredi, Annemarie Koster, Simone J.P.M. Eussen, Anna Odone, Andrea Amerio, Carlo Signorelli, Coen D.A. Stehouwer, Hans H.C.M. Savelberg, Anke Wesselius, Sebastian Köhler, Miranda T. Schram, Nicolaas C. Schaper

Research output: Contribution to journalArticlepeer-review


Background: Moderate to vigorous physical activity (MVPA) can help to prevent depression, but identification of the most important psycho-biological pathways involved is unclear. The improvement of cardio-respiratory fitness (CRF) in response to MVPA can vary markedly, we therefore examined the association between CRF and the incidence of depressive symptoms. Methods: We used data from The Maastricht Study, a large population-based prospective-cohort study. CRF was estimated at baseline from a graded submaximal exercise protocol and MVPA was measured with accelerometry. Depressive symptoms were assessed using the validated Dutch version of the 9-item Patient Health Questionnaire, both at baseline and during annual follow-up over five years. Cox proportional hazards models were used. Results: A total of 1,730 individuals without depressive symptoms at baseline were included in the analysis. During the 5-year follow-up, n = 166 (9.6%) of individuals developed depressive symptoms. Compared to individuals with a low CRF, those with a moderate-to-high CRF had a significantly lower risk of developing depressive symptoms, independent of MVPA (medium CRF: HR = 0.49 (95%CI = 0.33–0.72); high CRF: HR = 0.48 (95% CI = 0.30–0.75). These associations were adjusted for age, sex, level of education, diabetes status, smoking status, alcohol use, energy intake, waist circumferences and antidepressant medications. Limitations: PHQ-9 is a validated screening instrument, but it is not a diagnostic tool of depression. Conclusions: Higher CRF was strongly associated with a lower risk of incident depressive symptoms over 5-year follow-up, independent of the level of MVPA at baseline, suggesting that interventions aimed at improving CRF could reduce the risk of depression.

Original languageEnglish
Pages (from-to)484-490
Number of pages7
JournalJournal of Affective Disorders
Publication statusPublished - Jan 15 2021


  • Cardiorespiratory fitness
  • Cohort Studies
  • depression
  • incidence
  • Prospective Studies
  • prospective study

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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