ArticleBMC medicine2025
Cross-national differences in the association between estimated cardiorespiratory fitness and depressive symptoms among older adults: findings from three nationwide cohort studies.
Article in BMC medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Divergent associations of estimated cardiorespiratory fitness with cognitive trajectories in Chinese and U.S. middle-aged and older adults: A descriptive cross-national comparison from CHARLS and HRS.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2026Observational
- Article
- Associations between adverse childhood experiences and progression to incident psychiatric disorders in older adults: A 22-year cohort study.Translational psychiatry · 2026Article
- Association of the C-reactive protein-triglyceride-glucose (CTI) index and its central obesity-modified derivatives with incident cardiometabolic multimorbidity: results from two prospective cohorts in China and England.Cardiovascular diabetology · 2026Article
- Association between intrinsic capacity and chronic lung disease among middle-aged and older adults: evidence from CHARLS and ELSA.BMC public health · 2026Article
- Estimated Cardiorespiratory Fitness and Risk of Incident Frailty in Middle-Aged and Older Adults: A Cross-National Longitudinal Cohort Study.Healthcare (Basel, Switzerland) · 2026Article
- Obesity trajectories based on the European association for the study diagnostic framework and their associations with cardiovascular disease: evidence from two longitudinal cohorts.BMC public health · 2026Article
- Association between estimated cardiorespiratory fitness and arthritis in older adults: evidence from four large cohorts.Clinical rheumatology · 2026Article
- Demographic, Environmental and Clinical Factors Associated with Life-Space Mobility Among Community-Dwelling Older Adults with Cardiovascular Disease: Findings from the International Mobility in Aging Study (IMIAS).Clinical interventions in aging · 2026Article
- Cross-national associations between adulthood stressful life events and incident heart disease: a multicohort harmonized analysis.Frontiers in cardiovascular medicine · 2026Article
- Association between six anthropometric indices and incident arthritis: prospective findings from the English Longitudinal Study of Ageing.Frontiers in nutrition · 2026Article
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Authors and funding
10 authors.
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Abstract
backgroundCardiorespiratory fitness (CRF) is a modifiable risk factor for chronic diseases, but its association with depressive symptoms remains unclear, particularly across different populations. We aimed to investigate the link between estimated CRF (eCRF) and incident depressive symptoms among individuals over 50 years old, and to explore potential cross-country variations in this association.
methodsData were retrieved from three national cohorts: the Health and Retirement Study (HRS, United States), the English Longitudinal Study of Ageing (ELSA, England), and the China Health and Retirement Longitudinal Study (CHARLS, China). eCRF was estimated using sex-specific algorithms and categorized into low (quintiles 1), moderate (quintiles 2-3), and high (quintiles 4-5) levels. Depressive symptoms were measured using the 8-item Center for Epidemiological Studies Depression Scale (CESD-8) (cutoff ≥ 3) in HRS and ELSA, and the 10-item version (CESD-10) (cutoff ≥ 10) in CHARLS. Cox proportional hazard models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders.
resultsThis study included 13,680 participants (4195 from HRS, 5421 from ELSA, and 4064 from CHARLS) with median follow-ups of 9.78, 12.11, and 5.73 years, respectively. Depressive symptoms incidence was 22.79% in HRS, 22.15% in ELSA, and 40.58% in CHARLS. Per 1-SD increase in eCRF was associated with 9% lower risk of depressive symptoms in HRS (HR = 0.91; 95% CI, 0.87-0.96), 8% lower in ELSA (HR = 0.92; 95% CI, 0.87-0.97), but 6% higher in CHARLS (HR = 1.06; 95% CI, 1.01-1.16). Compared with the low eCRF level group, high eCRF level was associated with decreased risk of depressive symptoms in HRS (HR = 0.69; 95% CI, 0.55-0.85) and ELSA (HR = 0.62; 95% CI, 0.48-0.79), but increased risk in CHARLS (HR = 1.27; 95% CI, 1.01-1.61). Subgroup analyses revealed that the associations were modified by smoking status (HRS), by gender and presence of diabetes (ELSA), and by the presence of hypertension (CHARLS) (P for interaction < 0.05).
conclusionsA higher level of eCRF was associated with reduced depressive symptoms risk in the US (HRS) and England (ELSA) older adults but with increased risk in China (CHARLS), emphasizing the need for nation-specific public health strategies.
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