Physical Activity Mediated the Relationship Between Depressive Symptoms and Physical Frailty and Among Community-dwelling Older Adults in Indonesia
Main Article Content
Abstract
Introduction: Frailty is characterized by a deterioration in function and a diminished physiological reserve capacity for homeostasis, increasing the risk of disease and hospitalization. Frailty and depression are common among Indonesia's older adult population, but few studies have examined the significance of physical exercise in this association. Objectives: This study aimed to explore the mediating effect of physical activity on the relationship between depressive symptoms and physical frailty among community-dwelling older adults in Indonesia. Materials and methods: A cross-sectional study was conducted in Cirebon, West Java Province, Indonesia from January to May 2023. A total of 550 older people aged above 65 years participated. The FRAIL scale, Geriatric Depression Scale-5 (GDS-5), and International Physical Activity Questionnaire (s-IPAQ) were used. Path analysis was used to assess mediation. Results: The average age was 68.3 years (SD = 3.56). Frailty was positively associated with depressive symptoms (r = 0.420, p < 0.001), while physical activity was negatively associated with both frailty and depressive symptoms (r = –0.455 and r = –0.460, p < 0.001). Physical activity partially mediated the relationship between depressive symptoms and frailty (direct effect β = –0.65). Conclusion: Physical activity partially mediated the relationship between depressive symptoms and frailty. Future studies should determine whether physical activity could reduce the risk of frailty in individuals with depressive symptoms.
Downloads
Article Details
References
World Health Organization. Ageing. 2020.
Kim CO. Frailty and geriatric syndrome. In: The Korean Association of Internal Medicine Fall Proceedings: Symposium on Geriatric Internal Medicine; Seoul, Republic of Korea. The Korean Association of Internal Medicine; 2019. p. 716–8. [https://doi.org/10.3390/ijerph20010670](https://doi.org/10.3390/ijerph20010670).
You HS, Kwon YJ, Kim S, Kim YH, Kim YS, Kim Y, et al. Clinical practice guideline for frailty applicable in primary care setting. *Korean J Fam Pract.* 2021;11(4):223–35. [https://doi.org/10.21215/kjfp.2021.11.4.223](https://doi.org/10.21215/kjfp.2021.11.4.223).
Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. *J Gerontol A Biol Sci Med Sci.* 2004;59(3):M255–63. [https://doi.org/10.1093/gerona/59.3.m255](https://doi.org/10.1093/gerona/59.3.m255).
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. *J Gerontol A Biol Sci Med Sci.* 2001;56(3):M146–57. [https://doi.org/10.1093/gerona/56.3.m146](https://doi.org/10.1093/gerona/56.3.m146).
Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. *J Am Geriatr Soc.* 2012;60(8):1487–92. [https://doi.org/10.1111/j.1532-5415.2012.04054.x](https://doi.org/10.1111/j.1532-5415.2012.04054.x).
Rizka A, Indrarespati A, Dwimartutie N, Muhadi M. Frailty among older adults living in nursing homes in Indonesia: prevalence and associated factors. *Ann Geriatr Med Res.* 2021;25(2):93. [https://doi.org/10.4235/agmr.21.0033](https://doi.org/10.4235/agmr.21.0033).
Setiati S, Laksmi PW, Aryana IGP, Sunarti S, Widajanti N, Dwipa L, et al. Frailty state among Indonesian older adult: prevalence, associated factors, and frailty state transition. *BMC Geriatr.* 2019;19(1):1–10. [https://doi.org/10.1186/s12877-019-1198-8](https://doi.org/10.1186/s12877-019-1198-8).
Handajani YS, Schröder-Butterfill E, Hogervorst E, Turana Y, Hengky A. Depression among older adults in Indonesia: prevalence, role of chronic conditions and other associated factors. *Clin Pract Epidemiol Ment Health.* 2022;18. [https://doi.org/10.2174/17450179-v18-e2207010](https://doi.org/10.2174/17450179-v18-e2207010).
Brown PJ, Roose SP, Fieo R, Liu X, Rantanen T, Sneed JR, et al. Frailty and depression in older adults: a high-risk clinical population. *Am J Geriatr Psychiatry.* 2014;22(11):1083–95. [https://doi.org/10.1016/j.jagp.2013.04.010](https://doi.org/10.1016/j.jagp.2013.04.010).
Pegorari MS, Tavares DMS. Factors associated with the frailty syndrome in older adult individuals living in the urban area. *Rev Lat Am Enfermagem.* 2014;22:874–82. [https://doi.org/10.1590/0104-1169.0213.2493](https://doi.org/10.1590/0104-1169.0213.2493).
Almeida OP, Hankey GJ, Yeap BB, Golledge J, Norman PE, Flicker L. Depression, frailty, and all-cause mortality: a cohort study of men older than 75 years. *J Am Med Dir Assoc.* 2015;16(4):296–300. [https://doi.org/10.1016/j.jamda.2014.10.023](https://doi.org/10.1016/j.jamda.2014.10.023).
Lakey SL, LaCroix AZ, Gray SL, Borson S, Williams CD, Calhoun D, et al. Antidepressant use, depressive symptoms, and incident frailty in women aged 65 and older: the Women’s Health Initiative Observational Study. *J Am Geriatr Soc.* 2012;60(5):854–61. [https://doi.org/10.1111/j.1532-5415.2012.03940.x](https://doi.org/10.1111/j.1532-5415.2012.03940.x).
Jibson MD. Second-generation antipsychotic medications: Pharmacology, administration, and side effects. *UpToDate.* 2017.
World Health Organization. WHO guidelines on physical activity and sedentary behaviour. 2020. Available from: [https://iris.who.int/bitstream/handle/10665/337001/9789240014886-eng.pdf](https://iris.who.int/bitstream/handle/10665/337001/9789240014886-eng.pdf).
Landi F, Abbatecola AM, Provinciali M, Corsonello A, Bustacchini S, Manigrasso L, et al. Moving against frailty: does physical activity matter? *Biogerontology.* 2010;11:537–45. [https://doi.org/10.1007/s10522-010-9296-1](https://doi.org/10.1007/s10522-010-9296-1).
Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, et al. Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review. *JBI Database Syst Rev Implement Rep.* 2018;16(1):140. [https://doi.org/10.11124/JBISRIR-2017-003382](https://doi.org/10.11124/JBISRIR-2017-003382).
Huisingh-Scheetz M, Wroblewski K, Kocherginsky M, Huang E, Dale W, Waite L, et al. The relationship between physical activity and frailty among US older adults based on hourly accelerometry data. *J Gerontol A Biol Sci Med Sci.* 2018;73(5):622–9. [https://doi.org/10.1093/gerona/glx208](https://doi.org/10.1093/gerona/glx208).
Savela SL, Koistinen P, Stenholm S, Tilvis RS, Strandberg AY, Pitkälä KH, et al. Leisure-time physical activity in midlife is related to old age frailty. *J Gerontol A Biol Sci Med Sci.* 2013;68(11):1433–8. [https://doi.org/10.1093/gerona/glt029](https://doi.org/10.1093/gerona/glt029).
Kementerian Kesehatan Republik Indonesia. Analisis Lansia di Indonesia. Jakarta: Kementerian Kesehatan Republik Indonesia; 2017.
Abdulah R, Insani WN, Destiani D, Rohmaniasari N, Mohenathas N, Barliana MI. Polypharmacy leads to increased prevalence of potentially inappropriate medication in the Indonesian geriatric population visiting primary care facilities. *Ther Clin Risk Manag.* 2018;14:1591–7. [https://doi.org/10.2147/TCRM.S170475](https://doi.org/10.2147/TCRM.S170475).
Cohen LE, Felson M, Land KC. Property crime rates in the United States: a macrodynamic analysis, 1947–1977; with ex ante forecasts for the mid-1980s. *Am J Sociol.* 1980;86(1):90–118.
Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle-aged African Americans. *J Nutr Health Aging.* 2012;16:601–8. [https://doi.org/10.1007/s12603-012-0084-2](https://doi.org/10.1007/s12603-012-0084-2).
Hoyl MT, Alessi CA, Harker JO, Josephson KR, Pietruszka FM, Koelfgen M, et al. Development and testing of a five-item version of the Geriatric Depression Scale. *J Am Geriatr Soc.* 1999;47(7):873–8. [https://doi.org/10.1111/j.1532-5415.1999.tb03848.x](https://doi.org/10.1111/j.1532-5415.1999.tb03848.x).
Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. *Med Sci Sports Exerc.* 2003;35(8):1381–95. [https://doi.org/10.1249/01.MSS.0000078924.61453.FB](https://doi.org/10.1249/01.MSS.0000078924.61453.FB).
Satake S, Arai H. The revised Japanese version of the cardiovascular health study criteria (revised J-CHS criteria). *Geriatr Gerontol Int.* 2020;20(10):992–3. [https://doi.org/10.1111/ggi.14005](https://doi.org/10.1111/ggi.14005).
Nguyen T, Cumming RG, Hilmer SN. A review of frailty in developing countries. *J Nutr Health Aging.* 2015;19:941–6. [https://doi.org/10.1007/s12603-015-0503-2](https://doi.org/10.1007/s12603-015-0503-2).
Çakmur H. Frailty among older adults in a rural area of Turkey. *Med Sci Monit.* 2015;21:1232. [https://doi.org/10.12659/MSM.893400](https://doi.org/10.12659/MSM.893400).
Park JH, Kim KW, Kim MH, Kim MD, Kim BJ, Kim SK, et al. A nationwide survey on the prevalence and risk factors of late life depression in South Korea. *J Affect Disord.* 2012;138(1–2):34–40. [https://doi.org/10.1016/j.jad.2011.12.038](https://doi.org/10.1016/j.jad.2011.12.038).
Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global physical activity levels: surveillance progress, pitfalls, and prospects. *Lancet.* 2012;380(9838):247–57. [https://doi.org/10.1016/S0140-6736(12)60646-1](https://doi.org/10.1016/S0140-6736%2812%2960646-1).
Spiteri K, Broom D, Bekhet AH, de Caro JX, Laventure B, Grafton K. Barriers and motivators of physical activity participation in middle-aged and older adults—a systematic review. *J Aging Phys Act.* 2019;27(6):929–44. [https://doi.org/10.1123/japa.2018-0343](https://doi.org/10.1123/japa.2018-0343).
Cao W, Li L, Zhou X, Zhou C. Social capital and depression: evidence from urban older adults in China. *Aging Ment Health.* 2015;19(5):418–29. [https://doi.org/10.1080/13607863.2014.948805](https://doi.org/10.1080/13607863.2014.948805).
Buigues C, Padilla-Sánchez C, Garrido JF, Navarro-Martínez R, Ruiz-Ros V, Cauli O. The relationship between depression and frailty syndrome: a systematic review. *Aging Ment Health.* 2015;19(9):762–72. [https://doi.org/10.1080/13607863.2014.967174](https://doi.org/10.1080/13607863.2014.967174).
Soysal P, Veronese N, Thompson T, Kahl KG, Fernandes BS, Prina AM, et al. Relationship between depression and frailty in older adults: a systematic review and meta-analysis. *Ageing Res Rev.* 2017;36:78–87. [https://doi.org/10.1016/j.arr.2017.03.005](https://doi.org/10.1016/j.arr.2017.03.005).
Fugate Woods N, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, et al. Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. *J Am Geriatr Soc.* 2005;53(8):1321–30. [https://doi.org/10.1111/j.1532-5415.2005.53405.x](https://doi.org/10.1111/j.1532-5415.2005.53405.x).
Lohman MC, Mezuk B, Dumenci L. Depression and frailty: concurrent risks for adverse health outcomes. *Aging Ment Health.* 2017;21(4):399–408. [https://doi.org/10.1080/13607863.2015.1102199](https://doi.org/10.1080/13607863.2015.1102199).
Rodríguez Gómez I. Relationship between physical performance and frailty syndrome in older adults: the mediating role of physical activity, sedentary time and body composition. *Int J Environ Res Public Health.* 2021;18(1):1–12. [https://doi.org/10.3390/ijerph18010203](https://doi.org/10.3390/ijerph18010203).
Jing Z, Li J, Wang Y, et al. The mediating effect of psychological distress on cognitive function and physical frailty among the elderly: evidence from rural Shandong, China. *J Affect Disord.* 2020;268:88–94. [https://doi.org/10.1016/j.jad.2020.03.012](https://doi.org/10.1016/j.jad.2020.03.012).
Zhao M, Gao J, Li M, Wang K. Relationship between loneliness and frailty among older adults in nursing homes: the mediating role of activity engagement. *J Am Med Dir Assoc.* 2019;20(6):759–64. [https://doi.org/10.1016/j.jamda.2018.11.007](https://doi.org/10.1016/j.jamda.2018.11.007).
Akita M, Otaki N, Yokoro M, Yano M, Tanino N, Fukuo K. Relationship between social activity and frailty in Japanese older women during restriction on outings due to COVID-19. *Can Geriatr J.* 2021;24(4):320–4. [https://doi.org/10.5770/cgj.24.507](https://doi.org/10.5770/cgj.24.507).
O’Donovan A, Hughes BM, Slavich GM, Lynch L, Cronin MT, O’Farrelly C, et al. Clinical anxiety, cortisol and interleukin-6: evidence for specificity in emotion–biology relationships. *Brain Behav Immun.* 2010;24(7):1074–7. [https://doi.org/10.1016/j.bbi.2010.03.003](https://doi.org/10.1016/j.bbi.2010.03.003).
Dorfman TA, Levine BD, Tillery T, Peshock RM, Hastings JL, Schneider SM, et al. Cardiac atrophy in women following bed rest. *J Appl Physiol.* 2007;103(1):8–16. [https://doi.org/10.1152/japplphysiol.01162.2006](https://doi.org/10.1152/japplphysiol.01162.2006).
Chen F, Liu G, Mair CA. Intergenerational ties in context: grandparents caring for grandchildren in China. *Soc Forces.* 2011;90(2):571–94. [https://doi.org/10.1093/sf/sor012](https://doi.org/10.1093/sf/sor012).