Restricted accessResearch articleFirst published online 2025
The Moderating Effect of Physical Activity on the Association Between Cognition and Depression Among Middle-Aged and Older Adults: A Differential Analysis by European Regions
This study aimed to investigate the moderating effect of moderate-to-vigorous physical activity (MVPA) on the association between cognition and depression in individuals aged 50 years or older living in 27 European countries and to explore differences between four European regions (West, North, South, East). Categorical moderation analysis was performed with 41,878 individuals using data from the SHARE database. The variables analyzed were depression (EURO-D scale), Cognition Index (CogId), and self-reported MVPA. Western and Northern European regions indicated higher CogId and MVPA scores and lower depression than those in the South and East. MVPA frequency proved to be a significant moderator on the association between cognition and depression, with notable differences between regions. Especially in Southern and Eastern Europe, it would be important to create strategies that promote MVPA, which is fundamental to the mental and cognitive health of middle-aged and older adult populations.
AhrenfeldtL. J.MöllerS. (2021). The reciprocal relationship between socioeconomic status and health and the influence of sex: A European SHARE-analysis based on structural equation modeling. International Journal of Environmental Research and Public Health, 18(9), 5045. https://doi.org/10.3390/ijerph18095045
2.
AhrenfeldtL. J.Scheel-HinckeL. L.KjærgaardS.MöllerS.ChristensenK.Lindahl-JacobsenR. (2019). Gender differences in cognitive function and grip strength: A cross-national comparison of four European regions. European Journal of Public Health, 29(4), 667–674. https://doi.org/10.1093/eurpub/cky266
3.
AikenL. S.WestS. G. (1991). Multiple regression: Testing and interpreting interactions. Sage Publications, Inc.
4.
Alizadeh PahlavaniH. (2024). Possible role of exercise therapy on depression: Effector neurotransmitters as key players. Behavioural Brain Research, 459(November 2023), Article 114791. https://doi.org/10.1016/j.bbr.2023.114791
5.
Arias-de la TorreJ.VilagutG.RonaldsonA.Serrano-BlancoA.MartínV.PetersM.AlonsoJ.DreganA. (2021). Prevalence and variability of current depressive disorder in 27 European countries: A population-based study. The Lancet, 6(10), e729–e738. https://doi.org/10.1016/S2468-2667(21)00047-5
6.
BarbosaR.MidãoL.AlmadaM.CostaE. (2021). Cognitive performance in older adults across Europe based on the SHARE database. Neuropsychology, Development, and Cognition. Section B, Aging, Neuropsychology and Cognition, 28(4), 584–599. https://doi.org/10.1080/13825585.2020.1799927
7.
BlackC. N.BotM.SchefferP. G.CuijpersP.PenninxB. W. J. H. (2015). Is depression associated with increased oxidative stress? A systematic review and meta-analysis. Psychoneuroendocrinology, 51, 164–175. https://doi.org/10.1016/j.psyneuen.2014.09.025
8.
BlodgettJ. M.NorrisT.Pinto PereiraS. M.HamerM. (2023). Does moderate to vigorous physical activity mediate the association between depression and physical function in midlife: Evidence from two British birth cohort studies. Journal of Affective Disorders, 326(December 2022), 206–215. https://doi.org/10.1016/j.jad.2022.12.084
9.
Börsch-SupanA.BrandtM.HunklerC.KneipT.KorbmacherJ.MalterF.ZuberS.StuckS.SHARE Central Coordination Team. (2013). Data resource profile: The survey of health, ageing and retirement in Europe (SHARE). International Journal of Epidemiology, 42(4), 992–1001. https://doi.org/10.1093/ije/dyt088
10.
BraamA. W.DelespaulP.BeekmanA. T. F.DeegD. J. H.PérèsK.DeweyM.CopelandJ. R. M.LawlorB. A.MagnússonH.MellerI.PrinceM. J.ReischiesF. M.RoelandsM.SazP.SchoeversR. A.SkoogI.TurrinaC.VersportenA. (2004). National context of healthcare, economy and religion, and the association between disability and depressive symptoms in older Europeans: Results from the EURODEP concerted action. European Journal of Ageing, 1(1), 26–36. https://doi.org/10.1007/s10433-004-0013-2
11.
BullF. C.Al-AnsariS. S.BiddleS.BorodulinK.BumanM. P.CardonG.WillumsenJ. F.ChaputJ. P.ChastinS.ChouR.DempseyP. C.DiPietroL.EkelundU.FirthJ.FriedenreichC. M.GarciaL.GichuM.JagoR.KatzmarzykP. T. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451–1462. https://doi.org/10.1136/bjsports-2020-102955
12.
BurmistrovD. E.GudkovS. V.FranceschiC.VedunovaM. V. (2024). Sex as a determinant of age-related changes in the brain. International Journal of Molecular Sciences, 25(13), 7122. https://doi.org/10.3390/ijms25137122
13.
CassilhasR. C.TufikS.de MelloM. T. (2016). Physical exercise, neuroplasticity, spatial learning and memory. Cellular and Molecular Life Sciences, 73(5), 975–983. https://doi.org/10.1007/s00018-015-2102-0
14.
ChoiK. W.ChenC. Y.SteinM. B.KlimentidisY. C.WangM. J.KoenenK. C.SmollerJ. W.Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium. (2019). Assessment of bidirectional relationships between physical activity and depression among adults. JAMA Psychiatry, 76(4), 399–408. https://doi.org/10.1001/jamapsychiatry.2018.4175
15.
Conde-SalaJ. L.Garre-OlmoJ.Calvó-PerxasL.Turró-GarrigaO.Vilalta-FranchJ. (2019). Course of depressive symptoms and associated factors in people aged 65+ in Europe: A two-year follow-up. Journal of Affective Disorders, 245(July 2018), 440–450. https://doi.org/10.1016/j.jad.2018.10.358
16.
CsajbókZ.SieberS.CullatiS.CermakovaP.ChevalB. (2022). Physical activity partly mediates the association between cognitive function and depressive symptoms. Translational Psychiatry, 12(1), 414. https://doi.org/10.1038/s41398-022-02191-7
17.
CunninghamC.O’SullivanR.CaserottiP.TullyM. A. (2020). Consequences of physical inactivity in older adults: A systematic review of reviews and meta-analyses. Scandinavian Journal of Medicine & Science in Sports, 30(5), 816–827. https://doi.org/10.1111/sms.13616
18.
Da SilvaJ. L.AgbanglaN. F.Le PageC.GhernoutW.AndrieuB. (2022). Effects of chronic physical exercise or multicomponent exercise programs on the mental health and cognition of older adults living in a nursing home: A systematic review of studies from the past 10 years. Frontiers in Psychology, 13(May), 1–9. https://doi.org/10.3389/fpsyg.2022.888851
19.
DėdelėA.ChebotarovaY.MiškinytėA. (2022). Motivations and barriers towards optimal physical activity level: A community-based assessment of 28 eu countries. Preventive Medicine, 164(June), Article 107336. https://doi.org/10.1016/j.ypmed.2022.107336
20.
de Maio NascimentoM.LamprakiC.MarquesA.GouveiaÉ. R.AdsuarJ. C.IhleA. (2024a). Longitudinal cross-lagged analysis of depression, loneliness, and quality of life in 12 European countries. BMC Public Health, 24(1), 1986. https://doi.org/10.1186/s12889-024-19463-0
21.
de Maio NascimentoM.IhleA.GouveiaÉ. R.MarquesA. (2024b). Dynamic associations between frailty and cognition over 4 years: A population-based study on adults aged ≥50 from 12 European countries. Journal of Affective Disorders, 354(February), 536–543. https://doi.org/10.1016/j.jad.2024.03.049
22.
De OliveiraJ. S.SherringtonC.RowlingL.TiedemannA. (2019). Factors associated with ongoing participation in structured exercise among people aged 50 years and older. Journal of Aging and Physical Activity, 27(5), 739–745. https://doi.org/10.1123/japa.2018-0231
23.
De SousaR. A. L.Rocha-DiasI.de OliveiraL. R. S.Improta-CariaA. C.Monteiro-JuniorR. S.CassilhasR. C. (2021). Molecular mechanisms of physical exercise on depression in the elderly: A systematic review. Molecular Biology Reports, 48(4), 3853–3862. https://doi.org/10.1007/s11033-021-06330-z
24.
DeweyM. E.PrinceM. J. (2005). Cogntive function. In Börsch-SupanA.BrugiaviniA.JürgesH.MackenbachJ.SiegristJ.WeberG. (Eds.), Health, ageing and retirement in Europe - first results from the survey of health, ageing and retirement in Europe (p. 352). Mannheim Research Institute.
25.
EricksonK. I.HillmanC.StillmanC. M.BallardR. M.BloodgoodB.ConroyD. E.PowellK. E.MarquezD. X.PetruzzelloS. J.For 2018 Physical Activity Guidelines Advisory Committee*. (2019). Physical activity, cognition, and brain outcomes: A review of the 2018 physical activity guidelines. Medicine and Science in Sports and Exercise, 51(6), 1242–1251. https://doi.org/10.1249/MSS.0000000000001936
26.
FormanekT.KagstromA.WinklerP.CermakovaP. (2019). Differences in cognitive performance and cognitive decline across European regions: A population-based prospective cohort study. European Psychiatry: The Journal of the Association of European Psychiatrists, 58, 80–86. https://doi.org/10.1016/j.eurpsy.2019.03.001
27.
FranseC. B.van GriekenA.QinL.MelisR. J. F.RietjensJ. A. C.RaatH. (2017). Socioeconomic inequalities in frailty and frailty components among community-dwelling older citizens. Plos One, 12(11), Article e0187946. https://doi.org/10.1371/journal.pone.0187946
28.
GallagherD.SavvaG. M.KennyR.LawlorB. A. (2013). What predicts persistent depression in older adults across Europe? Utility of clinical and neuropsychological predictors from the SHARE study. Journal of Affective Disorders, 147(1–3), 192–197. https://doi.org/10.1016/j.jad.2012.10.037
29.
GilmanS. E.SuchaE.KingsburyM.HortonN. J.MurphyJ. M.ColmanI. (2017). Depression and mortality in a longitudinal study: 1952-2011. Canadian Medical Association Journal, 189(42), E1304–E1310. https://doi.org/10.1503/cmaj.170125
GuoY.PaiM.XueB.LuW. (2023). Bidirectional association between depressive symptoms and mild cognitive impairment over 20 years: Evidence from the Health and Retirement Study in the United States. Journal of Affective Disorders, 338(January), 449–458. https://doi.org/10.1016/j.jad.2023.06.046
32.
HamadaS.SasakiY.SonB.-K.TanakaT.LyuW.Tsuchiya-ItoR.IijimaK.DreganA.HotopfM.IwagamiM. (2023). Association of coexistence of frailty and depressive symptoms with mortality in community-dwelling older adults: Kashiwa Cohort Study. Archives of Gerontology and Geriatrics, 119, Article 105322. https://doi.org/10.1016/j.archger.2023.105322
33.
HanF. F.WangH. X.WuJ. J.YaoW.HaoC. F.PeiJ. J. (2021). Depressive symptoms and cognitive impairment: A 10-year follow-up study from the survey of health, ageing and retirement in Europe. European Psychiatry: The Journal of the Association of European Psychiatrists, 64(1), Article e55. https://doi.org/10.1192/j.eurpsy.2021.2230
34.
HansenT.SlagsvoldB. (2017). The East–West divide in late-life depression in Europe: Results from the generations and gender survey. Scandinavian Psychologist, 4(1), 1–18. https://doi.org/10.15714/scandpsychol.4.e4
35.
HarsanyiS.KupcovaI.DanisovicL.KleinM. (2022). Selected biomarkers of depression: What are the effects of cytokines and inflammation?International Journal of Molecular Sciences, 24(1), 578. https://doi.org/10.3390/ijms24010578
36.
HayesA. F. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-basead approach. Guilford Press.
37.
HeroldF.TörpelA.SchegaL.MüllerN. G. (2019). Functional and/or structural brain changes in response to resistance exercises and resistance training lead to cognitive improvements – a systematic review. European Review of Aging and Physical Activity: Official Journal of the European Group for Research Into Elderly and Physical Activity, 16(1), 10. https://doi.org/10.1186/s11556-019-0217-2
38.
HuY.van LentheF. J.BorsboomG. J.LoomanC. W. N.BoppM.BurströmB.MackenbachJ. P.EkholmO.KlumbieneJ.LahelmaE.LeinsaluM.RegidorE.SantanaP.de GelderR. (2016). Trends in socioeconomic inequalities in self-assessed health in 17 European countries between 1990 and 2010. Journal of Epidemiology and Community Health, 70(7), 644–652. https://doi.org/10.1136/jech-2015-206780
39.
JutzR. (2020). Health inequalities in Eastern Europe. Does the role of the welfare regime differ from Western Europe?Social Science & Medicine, 267(September), Article 113357. https://doi.org/10.1016/j.socscimed.2020.113357
LenzenS.GannonB.RoseC. (2020). A dynamic microeconomic analysis of the impact of physical activity on cognition among older people. Economics and Human Biology, 39, Article 100933. https://doi.org/10.1016/j.ehb.2020.100933
42.
LinY. H.ChenY. C.TsengY. C.TsaiS.TsengY. H. (2020). Physical activity and successful aging among middle-aged and older adults: A systematic review and meta-analysis of cohort studies. Aging, 12(9), 7704–7716. https://doi.org/10.18632/aging.103057
43.
LivingstonG.HuntleyJ.SommerladA.AmesD.BallardC.BanerjeeS.MukadamN.BurnsA.Cohen-MansfieldJ.CooperC.CostafredaS. G.DiasA.FoxN.GitlinL. N.HowardR.KalesH. C.KivimäkiM.LarsonE. B.OgunniyiA. (2020). Dementia prevention, intervention, and care: 2020 report of the lancet commission. Lancet (London, England), 396(10248), 413–446. https://doi.org/10.1016/S0140-6736(20)30367-6
44.
LorenzoE. C.KuchelG. A.KuoC. L.MoffittT. E.DinizB. S. (2023). Major depression and the biological hallmarks of aging. Ageing Research Reviews, 83(October 2022), Article 101805. https://doi.org/10.1016/j.arr.2022.101805
45.
MarquesA.PeraltaM.MartinsJ.GouveiaÉ. R.ValeiroM. G. (2019). Cross-sectional and prospective relationship between low-to-moderate–intensity physical activity and chronic diseases in older adults from 13 European countries. Journal of Aging and Physical Activity, 27(1), 93–101. https://doi.org/10.1123/japa.2017-0403
MedinaC.JáureguiA.HernándezC.ShamahT.BarqueraS. (2021). Physical inactivity and sitting time prevalence and trends in Mexican adults. Results from three national surveys. Plos One, 16(7), Article e0253137. https://doi.org/10.1371/journal.pone.0253137
48.
MemonM. A.CheahJ.-H.RamayahT.TingH.ChuahF.ChamT. H. (2019). Moderation analysis: Issues and guidelines. Journal of Applied Structural Equation Modeling, 3(1), i–xi. https://doi.org/10.47263/JASEM.3(1)01
49.
MigeotJ.CalivarM.GranchettiH.IbáñezA.FittipaldiS. (2022). Socioeconomic status impacts cognitive and socioemotional processes in healthy ageing. Scientific Reports, 12(1), 6048. https://doi.org/10.1038/s41598-022-09580-4
50.
Moreno-AgostinoD.WuY.-T.DaskalopoulouC.HasanM. T.HuismanM.PrinaM. (2021). Global trends in the prevalence and incidence of depression:a systematic review and meta-analysis. Journal of Affective Disorders, 281(November 2020), 235–243. https://doi.org/10.1016/j.jad.2020.12.035
51.
NicolaeB.AmaliaJ. Ş. (2020). Study regarding the effects of demographic transition on labor market and public pension system in central and eastern Europe. Studies in Business and Economics, 15(1), 158–170. https://doi.org/10.2478/sbe-2020-0013
52.
NikitaraK.OdaniS.DemenagasN.RachiotisG.SymvoulakisE.VardavasC. (2021). Prevalence and correlates of physical inactivity in adults across 28 European countries. European Journal of Public Health, 31(4), 840–845. https://doi.org/10.1093/eurpub/ckab067
53.
OrsholitsD.CullatiS.GhislettaP.AartsenM. J.OrisM.StuderM.IhleA.PernaL.GouveiaÉ. R.GouveiaB. R.MarquesA.PeraltaM.MarconcinP.KliegelM. (2022). How welfare regimes moderate the associations between cognitive aging, education, and occupation. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 77(9), 1615–1624. https://doi.org/10.1093/geronb/gbac013
54.
OschwaldJ.GuyeS.LiemF.RastP.WillisS.RöckeC.MérillatS.MartinM.MérillatS. (2019). Brain structure and cognitive ability in healthy aging: A review on longitudinal correlated change. Reviews in the Neurosciences, 31(1), 1–57. https://doi.org/10.1515/revneuro-2018-0096
55.
PearceM.GarciaL.AbbasA.StrainT.SchuchF. B.GolubicR.WoodcockJ.KhanS.UtukuriM.LairdY.MokA.SmithA.TainioM.BrageS. (2022). Association between physical activity and risk of depression. JAMA Psychiatry, 79(6), 550–559. https://doi.org/10.1001/jamapsychiatry.2022.0609
56.
PellegrinoL. D.PetersM. E.LyketsosC. G.MaranoC. M. (2013). Depression in cognitive impairment. Current Psychiatry Reports, 15(9), 384. https://doi.org/10.1007/s11920-013-0384-1
57.
PrinceM. J.ReischiesF.BeekmanA. T.FuhrerR.JonkerC.KivelaS. L.CopelandJ. R.LoboA.MagnussonH.FichterM.van OyenH.RoelandsM.SkoogI.TurrinaC. (1999). Development of the EURO-D scale – a European, Union initiative to compare symptoms of depression in 14 European centres. The British Journal of Psychiatry: The Journal of Mental Science, 174(4), 330–338. https://doi.org/10.1192/bjp.174.4.330
58.
SamuelL. J.WrightR.GranbomM.TaylorJ. L.HuppC.LavigneL.SzantonS. L. (2021). Community-dwelling older adults who are low-income and disabled weathering financial challenges. Geriatric Nursing, 42(4), 901–907. https://doi.org/10.1016/j.gerinurse.2021.04.025
59.
SaniS. H. Z.FathirezaieZ.BrandS.PühseU.Holsboer-TrachslerE.GerberM.TalepasandS. (2016). Physical activity and self-esteem: Testing direct and indirect relationships associated with psychological and physical mechanisms. Neuropsychiatric Disease and Treatment, 12, 2617–2625. https://doi.org/10.2147/NDT.S116811
60.
SchenkerN.GentlemanJ. F. (2001). On judging the significance of differences by examining the overlap between confidence intervals. The American Statistician, 55(3), 182–186. https://doi.org/10.1198/000313001317097960
61.
SchuchF. B.VancampfortD.FirthJ.RosenbaumS.WardP. B.SilvaE. S.StubbsB.Ponce De LeonA.DunnA. L.DeslandesA. C.FleckM. P.CarvalhoA. F. (2018). Physical activity and incident depression: A meta-analysis of prospective cohort studies. The American Journal of Psychiatry, 175(7), 631–648. https://doi.org/10.1176/appi.ajp.2018.17111194
62.
SterniczukR.TheouO.RusakB.RockwoodK. (2015). Cognitive test performance in relation to health and function in 12 European countries: The Share study. Canadian Geriatrics Journal, 18(3), 144–151. https://doi.org/10.5770/cgj.18.154
63.
TinôcoM. A.NascimentoM. de M.MarquesA.GouveiaÉ. R.MiguelS.SantosF.IhleA. (2023). The relationship between physical fitness and cognitive functions in older people: A systematic review. Sustainability, 15(23), Article 16314. https://doi.org/10.3390/su152316314
64.
TrioloF.SjöbergL.Calderón-LarrañagaA.Belvederi MurriM.VetranoD. L.FratiglioniL.DekhtyarS. (2023). Late-life depression and multimorbidity trajectories: The role of symptom complexity and severity. Age and Ageing, 52(2), 1–9. https://doi.org/10.1093/ageing/afac315
65.
UebelackerL. A.EatonC. B.WeisbergR.SandsM.WilliamsC.CalhounD.TaylorT.DenburgN. L. (2013). Social support and physical activity as moderators of life stress in predicting baseline depression and change in depression over time in the Women’s Health Initiative. Social Psychiatry and Psychiatric Epidemiology, 48(12), 1971–1982. https://doi.org/10.1007/s00127-013-0693-z
66.
van den KommerT. N.ComijsH. C.AartsenM. J.HuismanM.DeegD. J. H.BeekmanA. T. F. (2013). Depression and cognition: How do they interrelate in old age?The American Journal of Geriatric Psychiatry, 21(4), 398–410. https://doi.org/10.1016/j.jagp.2012.12.015
67.
WanjauM. N.MöllerH.HaighF.MilatA.HayekR.LucasP.VeermanJ. L. (2023). Physical activity and depression and anxiety disorders: A systematic review of reviews and assessment of causality. AJPM Focus, 2(2), Article 100074. https://doi.org/10.1016/j.focus.2023.100074
WillekensF. (2015). Demographic transitions in Europe and the world. In Population change in Europe, the middle-east and North africa: Beyond the demographic divide (pp. 13–44). Farnham, Surrey, England: Ashgate. https://doi.org/10.4324/9781315601496-8
72.
ZhangS.XiangK.LiS.PanH.-F. (2021). Physical activity and depression in older adults: The knowns and unknowns. Psychiatry Research, 297(January), Article 113738. https://doi.org/10.1016/j.psychres.2021.113738
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
