Restricted accessResearch articleFirst published online 2025-3
Associations of Physical Activity and Sedentary Behavior With Mental Distress According to Caregiver Status: Analysis of the Health Information National Trends Survey,2022
To (1) examine how physical activity and sedentary behavior are related to mental distress and (2) identify and compare how various levels of sedentary behaviors may differentially predict mental distress after accounting for physical activity, among caregivers vs non-caregivers.
Design
Cross-sectional secondary data.
Setting
National Cancer Institute’s Health Information National Trends Survey Cycle 6 fielded online from March-November 2022.
Participants
U.S. adults aged 18 and older.
Measures
The Patient Health Questionnaire-4 was administered along with caregiving status, moderate weekly physical activity, sedentary behavior, and sociodemographic characteristics.
Analysis
After applying population weights, we conducted multiple adjusted logistic regression models and estimated predictive margins to understand whether a specific dose of sedentary behavior (hours/day) is associated with risk of mental distress, at different levels of physical activity.
Results
Caregivers (15.41% of sample) reporting 10-hour of daily sedentary behavior were significantly more likely to experience mental distress, than those reporting lower amounts of sedentary behavior (OR = 3.372, 95%CI = 1.968, 5.776, P < 0.001). Regardless of physical activity amount, 10 hours of sedentary behavior may be a risk factor for mental distress among non-caregivers. Just 6 hours of sedentary behavior may be related to mental distress among caregivers.
Conclusion
Physical activity interventions tailored to caregivers’ needs, responsibilities, and circumstances are required. Innovative methodologies are needed to understand caregivers’ daily behaviors and the intensity of their caregiving activities.
AARP, National Alliance for Caregiving. Caregiving in the United States 2020. Washington, DC: AARP, National Alliance for Caregiving, 2020.
2.
WolffJLSpillmanBCFreedmanVAKasperJD. A national profile of family and unpaid caregivers who assist older adults with health care activities. JAMA Intern Med. 2016;176(3):372-379. doi:10.1001/jamainternmed.2015.7664.
3.
ButtorffCRuderTBaumanM. Multiple chronic conditions in the United States. J Gen Intern Med. 2017;22(Suppl 3):391–395.
4.
CejalvoEMarti-VilarMMerino-SotoCAguirre-MoralesMT. Caregiving role and psychosocial and individual factors: a systematic review. Healthcare. 2021;9(12):1690.
5.
ChenM. The growing costs and burden of family caregiving of older adults: a review of paid sick leave and family leave policies. Gerontol. 2016;56(3):391-396.
6.
VictorCRRipponIQuinnC, et al.The prevalence and predictors of loneliness in caregivers of people with dementia: findings from the IDEAL programme. Aging Ment Health. 2021;25(7):1-7. doi:10.1080/13607863.2020.1753014.
7.
PeavyGMayoAMAvalosCRodriguezAShifflettBEdlandSD. Perceived stress in older dementia caregivers: mediation by loneliness and depression. Am J Alzheimers Dis Other Demen. 2022;37:15333175211064756. doi:10.1177/15333175211064756.
8.
SchulzRBeachSR. Caregiving as a risk factor for mortality: the caregiver health effects study. JAMA. 1999;282(23):2215-2219. doi:10.1001/jama.282.23.2215.
9.
PhillipsRDurkinMEngwardHCableGIancuM. The impact of caring for family members with mental illnesses on the caregiver: a scoping review. Health Promot Int. 2023;38(3):daac049.
10.
ZhouSOgunjesaBARajM. Mental Health Outcomes of Immigrant- and US-Born Caregivers: California Health Interview Survey, 2019–2020. Washington, D.C.: American Journal of Public Healthi; 2024.
11.
FeinbergLF. The dual pressures of family caregiving and employment. Washington, D.C.: AARP Public Policy Institute; 2016.
12.
LitzelmanK. Caregiver well-being and the quality of cancer care. Semin Oncol Nurs. 2019;35(4):348-353.
13.
MarconcinPWerneckAOPeraltaM, et al.The association between physical activity and mental health during the first year of the COVID-19 pandemic: a systematic review. BMC Publ Health. 2022;22(209):209.
14.
SmithPJMerwinRM. The role of exercise in management of mental health disorders: an integrative review. Annu Rev Med. 2021;72:45-62.
15.
Chodzo-ZajkoWSchwingelAParkCH. Successful aging: the role of physical activity. Am J Lifestyle Med. 2008;3(1): 1209-1214.
16.
PorterKJYouWEstabrooksPAZoellnerJM. Relationships among changes in physical activity, quality of life, and obesity-Status following a behavioral intervention for rural Appalachian adults. Prev Med Rep. 2022;29:101949.
17.
ZhaoMVeerankiSPMagnussenCGXiB. Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study. BMJ. 2020;370:2031.
18.
CurrierDLindnerRSpittalMJCvetkovskiSPirkisJEnglishDR. Physical activity and depression in men: increased activity duration and intensity associated with lower likelihood of current depression. J Affect Disord. 2020;260:426-431.
19.
MaherJPHevelDJReifsteckEJDrolletteES. Physical activity is positively associated with college students’ positive affect regardless of stressful life events during the COVID-19 pandemic. Psychol Sport Exerc. 2021;52:101826.
20.
DoyleKLToepferMBradfieldAF, et al.Systematic review of exercise for caregiver-care recipient dyads: what is best for spousal caregivers-exercising together or not at all?Gerontol. 2021;61(6):283-301.
21.
OliveiraDSousaLOrrellM. Improving health-promoting self-care in family carers of people with dementia: a review of interventions. Clin Interv Aging. 2019;14:515-523.
22.
MarquezDXBustamanteEEKozey-KeadleSKraemerJCarrionI. Physical activity and psychosocial and mental health of older caregivers and non-caregivers. Geriatr Nurs. 2012;33(5):358-365.
23.
EtkinCDProhaskaTRConnellCMEdelmanPHughesSL. Antecedents of physical activity among family caregivers. J Appl Gerontol. 2008;27(3):350-367.
24.
AhnSRomoRDCampbellCL. A systematic review of interventions for family caregivers who care for patients with advanced cancer at home. Patient Educ Counsel. 2020;103(8):1518-1530.
25.
EganKJHodgsonWImperatoreGDunlopMDMaguireRKirkA. Supporting physical activity for informal caregivers during and beyond COVID-19: exploring the feasibility, usability and acceptability of a digital health smartphone application, ‘CareFit’. Int J Environ Res Publ Health. 2022;19(19):12506.
26.
CollinsAMMolina-HidalgoCAghjayanSL, et al.Differentiating the influence of sedentary behavior and physical activity on brain health in late adulthood. Exp Gerontol. 2023;180:112246.
27.
HINTS. Health Information National Trends Survey. Bethesda: National Cancer Institute; 2023. https://hints.cancer.gov
28.
KroenkeKSpitzerRLWilliamsJBLoweB. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009;50(6):613-621.
29.
BullFCAl-AnsariSSBiddleS, et al.World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462.
30.
MatthewsCECarlsonSASaint-MauricePF, et al.Sedentary behavior in U.S. Adults: fall 2019. Med Sci Sports Exerc. 2021;53(12):2512-2519.
31.
KuPWSteptoeALiaoYHsuehMCChenLJ. A cut-off of daily sedentary time and all-cause mortality in adults: a meta-regression analysis involving more than 1 million participants. BMC Med. 2018;16(74):74.
32.
HeontaeKSeunghoRMinsooK. Daily sedentary time of less than six hours is beneficial for the prevention of obesity in US adults. Sport and Exercise Medicine Switzerland. 2023. https://sems-journal.ch/13002.
33.
PattersonRMcNamaraETainioM, et al.Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis. Eur J Epidemiol. 2018;33(9):811-829.
34.
EkelundUTarpJSteene-JohannessenJ, et al.Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ. 2019;366:l4570.
35.
DempseyPCBiddleSJHBumanMP, et al.New global guidelines on sedentary behaviour and health for adults: broadening the behavioural targets. Int J Behav Nutr Phys Activ. 2020;17(151):151.
36.
EkelundUSteene-JohannessenJBrownWJ, et al.Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. 2016;388(388):1302-1310.
37.
EkelundUTarpJFagerlandMW, et al.Joint associations of accelero-meter measured physical activity and sedentary time with all-cause mortality: a harmonised meta-analysis in more than 44 000 middle-aged and older individuals. Br J Sports Med. 2020;54(24):1499-1506.
38.
AdamsonBCYangYMotlRW. Association between compliance with physical activity guidelines, sedentary behavior and depressive symptoms. Prev Med. 2016;91:152-157.
39.
TenoSCSilvaMNJudicePB. Physical activity and sedentary behaviour-specific domains and their associations with mental health in adults: a systematic review. Advances in Mental Health. 2024:1-28. doi:10.1080/18387357.2024.2324099
40.
HuangYLiLGanY, et al.Sedentary behaviors and risk of depression: a meta-analysis of prospective studies. Transl Psychiatry. 2020;10(1):26.
41.
LeeIMShiromaEJKamadaMBassettDRMatthewsCEBuringJE. Association of step volume and intensity with all-cause mortality in older women. JAMA Intern Med. 2019;179(8):1105-1112.
42.
Ibáñez RománJEEkholmOAlgrenMH, et al.Mental wellbeing and physical activity levels: a prospective cohort study. Ment Health Phys Act. 2023;24:100498. doi:10.1016/j.mhpa.2022.100498
43.
Zager KocjanGAvsecAKavčičT. Feeling too low to be active: physical inactivity mediates the relationship between mental and physical health. Soc Sci Med. 2024;341:116546. doi:10.1016/j.socscimed.2023.116546
44.
HuMXTurnerDGeneraalE, et al.Exercise interventions for the prevention of depression: a systematic review of meta-analyses. BMC Publ Health. 2020;20(1):1255. doi:10.1186/s12889-020-09323-y
45.
HadgraftNTLynchBMClarkBKHealyGNOwenNDunstanDW. Excessive sitting at work and at home: correlates of occupational sitting and TV viewing time in working adults. BMC Publ Health. 2015;15(1):899. doi:10.1186/s12889-015-2243-y
46.
PrinceSASaundersTJGrestyKReidRD. A comparison of the effectiveness of physical activity and sedentary behaviour interventions in reducing sedentary time in adults: a systematic review and meta‐analysis of controlled trials. Obes Rev. 2014;15(11):905-919.
47.
ScheidJLWestSL. Opportunities of wearable technology to increase physical activity in individuals with chronic disease: an editorial. Int J Environ Res Publ Health. 2019;16(17):3124.
48.
ChungJBrakeyHRReederBMyersODemirisG. Community-dwelling older adults’ acceptance of smartwatches for health and location tracking. Int J Older People Nurs. 2022;18(1):e12490.
49.
GardnerBSmithLLorencattoFHamerMBiddleSJ. How to reduce sitting time? A review of behaviour change strategies used in sedentary behaviour reduction interventions among adults. Health Psychol Rev. 2016;10(1):89-112.
50.
KingARingelJBSaffordMM, et al.Association between caregiver strain and self-care among caregivers with diabetes. JAMA Netw Open. 2021;4(2):e2036676.
51.
LeiLLeggettANMaustDT. A national profile of sandwich generation caregivers providing care to both older adults and children. J Am Geriatr Soc. 2022;71:799-809.
52.
MenengiçKNBülbülNGDoğanIAKendirliSŞahinerTAÇınarN. Association between perceived social support and physical activity level of alzheimer family caregivers. Alzheimer's Dementia. 2023;19(S5): e064907. doi:10.1002/alz.064907
53.
del-Pino-CasadoRFrías-OsunaAPalomino-MoralPARuzafa-MartínezMRamos-MorcilloAJ. Social support and subjective burden in caregivers of adults and older adults: a meta-analysis. PLoS One. 2018;13(1):e0189874. doi:10.1371/journal.pone.0189874
54.
LambertSDDuncanLRKapellasS, et al.A descriptive systematic review of physical activity interventions for caregivers: effects on caregivers’ and care recipients’ psychosocial outcomes, physical activity levels, and physical health. Ann Behav Med. 2016;50(6):907-919. doi:10.1007/s12160-016-9819-3
55.
BrownHEAtkinAJPanterJWongGChinapawMJMvan SluijsEMF. Family‐based interventions to increase physical activity in children: a systematic review, meta‐analysis and realist synthesis. Obes Rev. 2016;17(4):345-360. doi:10.1111/obr.12362
56.
LatommeJMorganPJChastinSBrondeelRCardonG. Effects of a family-based lifestyle intervention on co-physical activity and other health-related outcomes of fathers and their children: the ‘Run Daddy Run’ intervention. BMC Publ Health. 2023;23(1):342. doi:10.1186/s12889-023-15191-z
57.
MarquezDXNeighborsCJBustamanteEE. Leisure time and occupational physical activity among racial or ethnic minorities. Med Sci Sports Exerc. 2010;42:1086-1093.
58.
AguinagaSMarquezDX. Impact of Latin dance on physical activity, cardiorespiratory fitness, and sedentary behavior among latinos attending an adult day center. J Aging Health. 2017;31(3):397-414.
59.
KandulaNRDaveSDe ChavezPJ, et al.An exercise intervention for south asian mothers with risk factors for diabetes. Transl J Am Coll Sports Med. 2016;1(6):52-59.
60.
ConnVSChanKBanksJRupparTMScharffJ. Cultural relevance of physical activity intervention research with underrepresented populations. Int Q Community Health Educ. 2014;34(4):391-414. doi:10.2190/IQ.34.4.g
61.
MarquezDXWilburJHughesS, et al.BAILA: a randomized controlled trial of Latin dancing to increase physical activity in Spanish-speaking older latinos. Ann Behav Med. 2022;56(12):1231-1243. doi:10.1093/abm/kaac009
62.
Fernández SánchezHHernándezCBESidaniSOsorioCHContrerasECMendozaJS. Dance intervention for Mexican family caregivers of children with developmental disability: a pilot study. J Transcult Nurs. 2020;31(1):38-44. doi:10.1177/1043659619838027
63.
LiSYinZLesserJ, et al.Community health worker-led mHealth-enabled diabetes self-management education and support intervention in rural latino adults: single-arm feasibility trial. JMIR Diabetes. 2022;7(2):e37534.
64.
SchwingelAGalvezPLinaresDSebastiaoE. Using a mixed-methods RE-AIM framework to evaluate community health programs for older latinas. J Aging Health. 2016;29(4):551-593.
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