Large-scale data reveal disparate associations between leisure time physical activity patterns and mental health

Abstract

Background: Leisure time physical activity (LTPA) is known to be associated with a lower risk for mental health burden, while whether the underlying mechanisms vary across populations is unknown. We aimed to explore the disparate associations between LTPA and mental health based on large-scale data.

Methods: In this study, we analyzed data including 711,759 individuals aged 15 years or above from the latest four rounds (2003, 2008, 2013, and 2018) of the National Health Service Survey (NHSS) in China. We used multiple logistic regression models adjusted for potential confounders to investigate associations between LTPA and mental health in the total population and subgroups by measuring a diverse set of activity frequencies, intensities, and types. To examine the dose-response associations between total activity volume and mental health, we conducted restricted cubic splines to investigate possible nonlinearity.

Results: LTPA was associated with remarkably lower self-reported mental health burden (OR 0.56, 95% CI 0.54-0.58). The dose-response relationship between total activity volume and mental health was highly nonlinear (p < 0.001), presenting L-shaped with first 1200 metabolic equivalents of task (METs)-min/week for significant risk reduction (OR 0.58, 95% CI 0.56-0.60). Notably, merely exercising 3-5 times per week with moderate swimming was significantly associated with lower mental health burden among younger people, while the association was strongly large in older adults aged 60 years or above doing 55-min moderate apparatus exercise at least six times a week.

Conclusions: In a large Chinese sample, LTPA was meaningfully and disparately associated with mental health burden across different people. Policy targeted at prompting activity may be effective for reducing mental health burden, but importantly, tailored strategies are needed based on population contexts.

Fig. 1. The associations between different forms of leisure time physical activity with mental health in the total population (N = 711,759).

Models were adjusted for geographical regions, urbanization, gender, age, marital status, education, employment, income, smoking, alcohol consumption, and year. Bars and ribbons show 95% CIs. OR odds ratio, MET metabolic equivalent of task.

Fig. 2. The associations between leisure time physical activity with mental health in different people (N = 711,759).

Models were adjusted for geographical regions, urbanization, gender, age, marital status, education, employment, income, smoking, alcohol consumption, and year. Chronic diseases must be diagnosed by doctors and defined as having a newly diagnosed chronic condition in the past six months or having a diagnosed chronic condition before six months but suffering from disease symptoms and receiving treatments during the past six months. Inactive (no) is the reference group. Insufficient active = 0–600 MET-min per week. Active ≥ 600 MET-min per week. Bars show 95% CIs. Red bars indicate values of compared groups between active and inactive individuals, and blue bars indicate values of compared groups between insufficient active and inactive individuals. OR odds ratio, MET metabolic equivalent of task. Exact p-values for this figure can be found in Supplementary Data 4.

Fig. 3. Different forms of leisure time physical activity and mental health in different groups people (N = 711,759).

Models were adjusted for geographical regions, urbanization, gender, age, marital status, education, employment, income, smoking, alcohol consumption, and year. Chronic diseases must be diagnosed by doctors and defined as having a newly diagnosed chronic condition in the past six months or having a diagnosed chronic condition before six months but suffering from disease symptoms and receiving treatments during the past six months. Bars and ribbons show 95% CIs. OR odds ratio, MET metabolic equivalent of task.