Introduction
Depression is known to increase the risk of recurrence after an acute coronary syndrome (ACS). Lower levels of physical activity among patient with depression may be partly responsible for this poor prognosis. This study aims to assess whether depression and its changes over one year after ACS influence physical activity levels.
Methods
We analyzed the data of 1249 participants from the SPUM-ACS study, a large prospective multicenter cohort study of patients hospitalized with acute coronary syndrome (ACS) across four Swiss university centers. Depression was assessed using the Center for Epidemiologic Studies Depression scale (CES-D) at baseline and one year post-ACS, and patients were classified in four categories: non-depressive, developed depression post-ACS, improved depression post-ACS, and persistent depression. Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ) one year after ACS, and healthy level of physical activity was defined as more than or equal to 600 MET-min per week. Multivariate logistic regression models were used to analyze associations between depression status and healthy level of physical activity, after accounting for age, sex, body mass index, education, living status, smoking status and alcohol use.
Results
In the year after ACS, 10.3% of patients improved their depression, 12.9% developed a new depression, and 20.0% had persistent depression. Patients with persistent depression had lower median physical activity level (1737 MET-min/week) at one-year, and a reduced likelihood of reaching a healthy physical activity level compared to non-depressive patients (3024 MET- min/week; multivariate adjusted OR 0.38; 95% CI 0.26-0.56). However, this association was not found in patients who improved depression or those who developed depression post discharge compared to patients without depression (multivariate adjusted OR 0.79; 95% CI 0.46-1.44, and 0.64; 95% CI 0.40-1.06 respectively).
Conclusion
Persistent depression after ACS was associated with lower levels of physical activity at one year. To achieve an optimal lifestyle after ACS, depression should be screened and treated appropriately, particularly in case of persistence.