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Published in final edited form as: Ment Health Phys Act. 2023 Feb 1;24:100505. doi: 10.1016/j.mhpa.2023.100505

Physical activity may buffer against depression and promote resilience after major life stressors

Kristin L Szuhany a, Matteo Malgaroli a, George A Bonanno b
PMCID: PMC9979856  NIHMSID: NIHMS1875302  PMID: 36875320

Abstract

As many individuals experience potentially traumatic or stressful life events, understanding factors that are likely to promote resilience is imperative. Given the demonstrated efficacy of exercise for depression treatment, we examined if exercise buffers against the risk of developing psychiatric symptoms following life stressors. 1405 participants (61% female) from a longitudinal panel cohort experienced disability onset (43%), bereavement (26%), heart attack (20%), divorce (11%), and job loss (3%). They reported time spent exercising and depressive symptoms (Center for Epidemiologic Studies Depression scale) across three time points collected in two-year intervals: T0 (pre-stressor), T1 (acutely post-stressor), and T2 (post-stressor). Participants were classified in previously identified heterogeneous depression trajectories pre- to post-life stressor: resilient (69%), emerging (11.5%), chronic (10%), and improving (9.5%). Multinomial logistic regression found that more T0 exercise predicted likelihood of classification in resilient versus other groups (all p<.02). Controlling for covariates, only the higher likelihood of classification in resilient versus improving remained (p=.03). Follow-up repeated measures general linear model (GLM) assessed whether trajectory was associated with exercise at each time, controlling for covariates. GLM indicated significant within-subjects effects for time (p=.016, partial η2=.003) and time*trajectory (p=.020, partial η2=.005) on exercise and significant between-subjects effects of trajectory (p<.001, partial η2=.016) and all covariates. The resilient group showed consistent high exercise levels. The improving group had consistent moderate exercise. The emerging and chronic groups were associated with lower exercise post-stressor. Pre-stressor exercise may buffer against depression and ongoing exercise may be associated with lower depression levels following a major life stressor.

Keywords: exercise, resilience, depression, stress, physical activity, trajectory

Introduction

Many individuals experience potentially stressful life events, with high incidences of loss-related or medical stressors in older populations (Hardy et al., 2002). Stressful life events are associated with poorer mental health outcomes, including increased risk for depression (Su et al., 2022), and increased suicidal ideation (Howarth et al., 2020). However, it is well-established that individuals do not react to stressful events in the same manner. Rather, they follow heterogeneous trajectories in which the majority are resilient while others show divergent patterns of enduring psychiatric symptoms (Bonanno, 2004; Galatzer-Levy et al., 2018). Therefore, understanding factors that are likely to buffer against negative effects of stressful events is imperative.

Previous studies demonstrate the contribution of exercise to lower acute depression levels and lower likelihood of future depression and anxiety onset. Prospective studies demonstrate that more exercise is associated with lower odds of developing depression (Schuch et al., 2018) or anxiety disorders (Schuch et al., 2019). Consistent exercise, in particular, may reduce depression symptoms. For example, a population study of 140,000 older adults found that consistent engagement in moderate or vigorous exercise at least once per week was associated with less current depression and predicted lower likelihood of depression onset four years later (Marques et al., 2020). Interestingly, those who demonstrated inconsistent exercise (e.g., started with weekly exercise, then stopped) did not differ from those who were consistently less active (Marques et al., 2020). Additionally, in 2,673 older adults, only those consistently exercising, even at low frequency (15min 3x per week), showed lower depression risk longitudinally (Chang et al., 2017).

Exercise is also a well-established intervention for psychiatric sequelae associated with stressful events, including depression (Schuch, Vancampfort, Richards, et al., 2016) and anxiety (Ramos-Sanchez et al., 2021). Further, exercise has been shown to improve quality of life, including in older adults (Raafs et al., 2020) and depressed populations (Schuch, Vancampfort, Rosenbaum, et al., 2016). This suggests that exercise may buffer against the effects of stressful events on mental health.

Given the association between consistent exercise and depression prevention, it is important to examine this association prospectively and longitudinally to identify strategies to prevent long-term negative impact, especially following major life stressors. Advanced computational methods, such as latent growth mixture modeling, have been utilized to identify heterogeneous depression trajectories from pre- to post-stressor (e.g., Galatzer-Levy & Bonanno, 2014). In a study using data from the Health and Retirement Study (HRS), four heterogeneous trajectories of depression symptoms were identified, with most individuals falling into the resilient, or stable low depression, category (79.1%; Schultebraucks et al., 2021). The current study aimed to build upon this research by examining whether exercising more prior to a stressor buffered against higher levels of depression symptoms. We hypothesized that the resilient group would exercise more and more consistently across all time points and that higher baseline exercise would buffer against the effects of stressful events.

Methods

Design

Data from the HRS, a longitudinal prospective study of a cohort of older adults (50+) in the US born between 1931 and 1947 with data collected once every 2 years between 2004 and 2016, was used for this secondary analysis. The HRS is sponsored by the National Institute on Aging (grant: NIA U01AG009740) and conducted by the University of Michigan. All participants provided written informed consent prior to completing study procedures. From the available HRS sample (n=128,908), we restricted our analyses to individuals who experienced at least one stressor: child/spousal bereavement, myocardial infarction (MI), divorce, job loss, or disability. Sample selection procedures are further described in Shultebraucks et al. (2021). Depressive symptom trajectories were identified using latent growth mixture modeling with a floating baseline method centered on the year of the stressor. Time 0 (T0) represents the assessment time point immediately preceding the stressor. Time 1 (T1) represents the time point immediately following the stressor and Time 2 (T2) the follow-up time point 2 years after T1.

Participants

1405 participants had exercise data for all time points (improving: n=133, 9.5%; chronic: n=141, 10%; emerging: n=161, 11.5%; resilient: n=970, 69%). Baseline (T0) demographic and clinical characteristics, including distribution of stressors, are summarized in Table 1.

Table 1.

Baseline characteristics by depression trajectory

Resilient
(n=970)		 Chronic
(n=141)		 Emerging
(n=161)		 Improving
(n=133)
Age (M,SD) 70.1(11.2) 62.6(9.9) 68.7(12.4) 65.9(12.0)
Gender (% female, n) 56.7(550) 73(103) 67.1(108) 69.9(93)
Race (%, n)
 White/Caucasian 81.3 (789) 65.2 (92) 77 (124) 73.7 (98)
 Black/African American 18.7 (181) 34.8 (49) 23 (37) 26.3 (35)
Education years (M,SD) 12.3(3.2) 10.8(3.8) 11.2(3.5) 11.7(3.2)
Stressor (%, n)
 Bereavement 29.1 (282) 13.5 (19) 22.4 (36) 19.5 (26)
 Disability 37.7 (366) 61.0 (86) 54.0 (87) 53.4 (71)
 Divorce 10.9 (106) 9.9 (14) 11.2 (18) 12.8 (17)
 Job loss 3.4 (33) 1.4 (2) 1.9 (3) 6.8 (9)
 MI 21.0 (204) 23.4 (33) 16.8 (27) 12.0 (16)
 Cancer 0 (0) 0 (0) 0 (0) 0 (0)
T0 CES-D (M,SD) 0.9(1.1) 6.1(1.6) 2.0(1.5) 4.9(1.7)
T0 Exercise (M,SD) 14.5(9.6) 11.2(9.2) 12.6(8.0) 11.6(9.2)
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Note. MI=myocardial infarction, T0=pre-stressor, CES-D=Center for Epidemiologic Studies Depression scale

Measures

Trajectories.

Trajectories were based on depression symptoms measured by the 10-item Center for Epidemiologic Studies Depression scale (CES-D) at 2-year intervals. Previously defined trajectories included: 1) resilient: stable low depression symptoms; 2) improving: initial clinically elevated symptoms that steadily decrease following the stressor; 3) emerging: low to moderate depression symptoms that increase to clinically significant following the stressor; and 4) chronic: stable clinically elevated depression symptoms.

Exercise.

Light, moderate, and vigorous intensity exercise over the past year was measured at each time point using a self-report Likert scale from 1 (never) to 5 (every day). Aligned with previous HRS exercise research (Wen et al., 2014), we created weighted variables for each exercise intensity that were summed to create a total exercise variable. Activity weights assigned to vigorous and light exercise were similar to previous research (Wen et al., 2014). Moderate intensity was not previously used; therefore, we assigned activity weights between vigorous and light. Activity weights were as follows for vigorous exercise: 0: never, 2: 1–3x/month, 6: 1x/week, 12: >1x/week, and 24: every day. Moderate weights were 0, 1.5, 4.5, 9, and 18, and light weights were 0, 1, 3, 6, and 12, respectively.

Data Analysis

All participants categorized in 1 of 4 previously identified depression trajectories who had exercise data available at all time points were included in analyses (Figure 1). Stepwise regressions predicting exercise at each point were utilized to identify significant covariates (e.g., demographics, body mass index (BMI), mobility, comorbid medical conditions) for multinomial logistic regression and follow-up analyses.

Figure 1.

Figure 1.

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Previously identified depression trajectories for the current sample

Primary analysis was a multinomial logistic regression to examine whether baseline total weighted exercise predicted likelihood of classification in different trajectory groups, with resilient trajectory as the reference group. A follow-up repeated measures general linear model (GLM) was conducted to examine associations of trajectory groups with exercise over time. The model included main effects of time and trajectory covarying for significant covariates identified in stepwise regressions and interactions. Follow-up ANCOVAs, with significant covariates, were conducted to further clarify differences between groups on exercise at each time point. Estimated marginal means were compared using post-hoc LSD. Analyses were conducted in SPSS Version 25. Significance tests were two-tailed with significance values at .05.

Results

Baseline exercise prediction of depression trajectory

Age (β=−.207 to −.083, all p<.001), race (β=−.073 to −.055, all p<.005), T0 mobility (β=−.350 to −.203, all p<.001), and years of education (β=.083 to .105, all p<.001) were significantly associated with exercise at each time point and included as covariates. Other predictors (e.g., BMI, stroke) were only associated at 1 or 2 time points, therefore, were not included in follow-up analyses.

In a multinomial logistic regression, higher baseline exercise predicted greater likelihood of being in the resilient group compared to all other groups: chronic (B=−0.04(0.1), 95%CI [0.94,0.98], p<.001), emerging (B=−0.02(0.01), 95%CI [0.96,0.99], p=.02), and improving (B=−0.04(0.01), 95%CI [0.95,0.99], p=.001). However, when controlling for significant covariates, higher baseline exercise only predicted resilient vs. improving group membership (B=−0.03(0.01), 95%CI [0.95,0.997], p=.03).

Associations between exercise and trajectory group at each time point

In repeated measures GLM, there were significant within subjects effects for time (F(2,2794)=4.11, p=.016, partial η2=.003) and its interactions with trajectory (F(6,2794)=2.52, p=.020, partial η2=.005) and two covariates (age: p<.001; mobility, p=.002) on total exercise. There were significant between-subjects effects of trajectory (F(3,1397)=7.75, p<.001, partial η2=.016) and all covariates (all p<.001, partial η2 from .009 to .104). (Figure 2).

Figure 2.

Figure 2.

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Average exercise over time by depression trajectory group accounting age, race, mobility, and education (relevant covariates). T0=pre-stressor; T1=immediately post-stressor; T2=2 years post-T1.

In a follow-up ANCOVA, controlling for aforementioned covariates, at T0, the overall model was not significant (F(3,1397)=2.21, p=.09). Follow-up pairwise comparisons demonstrated only significant differences between resilient and improving groups (mean difference(MD)=1.85(0.82), 95%CI [0.25,3.45], p=.024). At T1, groups did significantly differ (F(3,1397)=6.29, p<.001). Resilient and emerging groups differed (MD=3.48(0.85), 95%CI [1.81,5.13], p<.001) with trend level differences between resilient and both chronic (MD=1.65(0.95), 95%CI [−0.20,3.51], p=.081) and improving (MD=1.59(0.93), 95%CI [−0.22,3.41], p=.085) groups. At T2, groups differed (F(3,1397)=7.69, p<.001). Resilient significantly differed from chronic (MD=3.09(0.91), 95%CI [1.30,4.88], p<.001) and emerging groups (MD=3.21(0.82), 95%CI [1.61,4.80], p<.001), but no longer from the improving group (MD=0.91(0.89), 95%CI [−0.84,2.65], p=.31). Emerging and improving groups significantly differed (MD=2.30(1.11), 95%CI [0.12,4.49], p=.04). There was a borderline difference between chronic and improving groups (MD=2.12(1.16), 95%CI [−0.09,4.45], p=.059).

Discussion

As many experience stressful life events, which are associated with increased depression risk, understanding protective factors that may reduce severity of psychiatric sequelae is essential. Meta-analyses demonstrate widespread mood and health benefits of exercise (e.g., Ramos-Sanchez et al., 2021; Schuch, Vancampfort, Richards, et al., 2016); however, few studies have prospectively and longitudinally examined the impact of prior exercise on depression following stressful life events. In our large (n=1405) longitudinal sample, baseline total exercise was predictive of resilient group membership as compared to the three other groups. The resilient group consistently completed more exercise than other groups including at baseline. This participation in exercise may have buffered against development of depression symptoms following a stressful life event.

Further, depression group was associated with varying levels of exercise at each individual time point. The resilient group, which had lower depression levels at all time points, performed consistently high amounts of exercise. Interestingly, the improving group, which showed high depression symptoms at T0, but a continual decrease in symptoms after the stressor (T1) and at T2 (2 years later), was associated with a moderate amount of mean exercise that appeared relatively stable at each time point. The chronic and emerging groups, those showing worse depression immediately (T1) and 2 years post-stressor (T2), were associated with lower mean exercise at both T1 and T2, following the stressor. These associations may suggest that both pre-stressor exercise and post-stressor exercise maintenance may be important to buffer against depressive symptoms both acutely and in the long-term.

Though the link between regular exercise and depression prevention is well-established, to our knowledge, no research has examined the impact of pre-stressor exercise in relation to diverse trajectories of depression. Cross-sectionally, exercise may be beneficial to reduce grief, including depression (Williams et al., 2021), following bereavement, and prospectively may be preventative of depression following divorce, especially for women who remain consistently active (Wang et al., 2011). Though job loss (Mandal et al., 2011) and MI (Thombs et al., 2006) have been associated with increased depression, few longitudinal studies have investigated how exercise may play a role in buffering against these stressors.

Consistent exercise, including prior to stressful life events, may contribute to reduced likelihood of depression onset (Chang et al., 2017; Marques et al., 2020; Schuch et al., 2018). It is also likely that ongoing exercise following a stressor may continue to improve mood acutely, contributing to multiple pathways by which exercise can influence depression. This may also explain continued decreasing depression scores in our improving group. Indeed, acute exercise can improve mood immediately (e.g., within 5–30 minutes), including in depressed populations (Bartholomew et al., 2005). This mood improvement may be associated with increase in brain-derived neurotrophic factor (BDNF) released acutely following exercise (Szuhany et al., 2015), also demonstrated in depression (e.g., Gustafsson et al., 2009). However, there is conflicting evidence as to whether exercise reliably increases BDNF in patients with depression (Dinoff et al., 2018), perhaps because of the small effects of chronic exercise on resting BDNF (Szuhany et al., 2015).

Our findings underscore the importance of promoting exercise engagement, especially prior to life stressors, but also the potential importance of exercise maintenance following stressors, which may contribute to decreasing depression over time. Given that only approximately 23% of adults meet weekly exercise recommendations for cardiovascular health (Blackwell & Clarke, 2018) and the lack of mental health guidelines, identifying and disseminating exercise engagement strategies is of utmost importance. Attending to useful contingencies, such as immediate mood benefits following exercise (Otto & Smits, 2011), and promoting enjoyment (Rhodes & Kates, 2015) may increase exercise engagement. Longitudinal, prospective studies using novel methods, such as ecological momentary assessment or passive data collection, may better elucidate the relationship among exercise, depression, and stressors to understand the potential buffering effects of consistent exercise and the acute, real-time changes in depression with exercise following a stressor.

Though this study has many strengths including its prospective design, large sample, and well-characterized trajectory groups using advanced computational methods, there are some limitations. First, the exercise measure did not include frequency or duration, limiting analyses to intensity. Therefore, metabolic equivalents, the gold-standard for combining exercise intensities, could not be calculated; however, we used a method previously utilized for this public dataset (Wen et al., 2014). Second, as data were collected every 2 years, we are unable to determine the exact timing of the stressor relative to T1 assessment. As such, timing may have an effect on depression or exercise reported. Third, it is possible that the stressor itself may have an impact on exercise. For example, MI may limit exercise in its immediate aftermath (T1), though many standard guidelines recommend exercise following MI (Moraes-Silva et al., 2017), so impact on T2 may be less likely. Fourth, due to the dynamic relationship between depression and exercise, it is possible that pre-existing depression impacted exercise; however, changes in depression in the improving group alongside apparent stable mean exercise may suggest an association between exercise and lower depression levels. Finally, other factors may contribute to the relationship between depression and exercise; however, we attempted to reduce confounding bias by using a stepwise regression to identify associated covariates.

Overall, our data suggest that more exercise prior to a stressor may buffer against effects of the stressor and reduce likelihood of depression. Further, exercise following a stressor was associated with resilient and improving groups providing initial suggestions that exercise maintenance or ongoing exercise in the aftermath of a stressor may buffer against its effects. Reduced exercise following a stressor appeared to be associated with high and increasing levels of depression across time. These results provide initial evidence for the importance of promoting exercise in general (pre-stressors) and exercise maintenance following stressors to reduce potential impact on depression symptoms.

Highlights.

  • Baseline exercise predicted resilience following a stressor

  • Resilient group had higher exercise levels pre- to post-stressor

  • Improving depression group had consistent moderate exercise levels

  • Increasing depression group reduced exercise following a stressor

  • Stable high depression group reduced exercise following a stressor

Footnotes

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Declaration of interests

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.

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