BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
Fitbit-walking intervention improves body function satisfaction and decreases
depressive symptoms in women
Senior Thesis
Presented to
The Faculty of the School of Arts and Sciences
Brandeis University
Undergraduate Program in Psychology
Idelle Vaynberg, Jutta Wolf
In partial fulfillment of the requirements for the degree of Bachelor of Science
by
Idelle Vaynberg
May 2017
Copyright by
Idelle Vaynberg
Committee members:
Name: Ellen Wright, PhD
Name: Natalie J. Sabik, PhD
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
2
Abstract
Aging is associated with physical limitations, body function satisfaction declines, and depressive
symptom increases. Physical activity interventions have been related to increases in body
function satisfaction and decreases in depressive symptoms. However, little is known about the
extent to which improvements in function satisfaction are tied to increases in physical ability,
physical activity, and mental health benefits. Forty-eight sedentary women (59 ± 6.5 yrs.) were
enrolled in a 12-week walking intervention. Participants self-reported on physical function
satisfaction, physical ability, depressive symptoms, and recorded daily steps with Fitbits during
weeks 1 and 12. Across the intervention, we observed improvements in physical activity and
body function satisfaction, as well as decreases in depressive symptoms (t(47) = -7.89; t(47) =
1.83, ps<.08, respectively). Improvements in depressive symptoms were stronger for older
women, relative to younger woman, but improvements in physical function satisfaction, step
counts, and physical limitations were independent of participants’ age. Body function
satisfaction did not contribute to the observed depressive symptom reduction, nor was it
dependent upon increases in steps. The intervention increased individuals’ daily step count and
was associated with changes in mental and physical health. Although physical ability did not
change, participants showed improvements in body function satisfaction, indicating the
importance of differentiating subjective feelings of one’s physical functions from physical ability.
These findings highlight the benefits of a manageable and low-impact walking intervention with
tailored goals for each participant.
2
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
3
Fitbit-walking intervention improves body function satisfaction and decreases
depressive symptoms in women
Fitbit-walking intervention improves body function satisfaction and decreases depressive
symptoms in women Depression in the older population is a major health concern due to its high
prevalence (Penninx, 1999). More specifically, many studies have shown that depressive
symptoms increase with age and have a significant impact on well-being and quality of life
(Singh A, 2009; Thielke, 2010). From early old age onward, women show increasingly more
depressive symptoms than men, thereby making older women an at-risk population for the
development of depressive symptoms that may lead into clinical depression (Chui, Gerstorf,
Hoppmann, & Luszcz, 2015). This emphasizes the need to identify preventative measures
specifically for middle-aged to older women. Many studies have shown that physical activity is
effective in improving health in a clinical and subclinical range, which may provide a means of
alleviating depression symptoms; however, little is known whether this is true for older adults as
well and for women in particular. The purpose of the present study was thus to examine whether
and how physical activity may provide mental health benefits in middle and older-aged women.
To date, the majority of research has examined the benefits of exercise and physical
activity in clinical populations. For example, Rethorst reviewed the effect of exercise on
depressive symptoms in 58 randomized trials, confirming a significant effect of moderate to
vigorous exercise (aerobic or resistant) on reduction of depressive symptoms. In addition to
more intense and targeted strength exercises, a recent review of eight randomized controlled
trials suggest that walking interventions as well are successful at reducing depressive
symptoms in clinical populations (Roberston, 2012). In contrast to the strong literature
concerning clinical populations, fewer studies have assessed the effect of exercise and physical
activity in individuals with subclinical depression symptoms. However, two studies have
identified decreases in subclinical depressive symptoms in the context of physical activity
interventions (Lindwall, Larsman, & Hagger, 2011; Martinsen, 2008). Similar findings were
3
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
4
reported for a population of older adults with subclinical symptoms undergoing an aerobic and
low-intensity exercise intervention as well as for individuals over the age of 55 taking part in a
walking intervention ( King, Taylor, & Haskell, 1993; Blake, Mo, Malik S., & Thomas, 2009;
Vallance J, 2016).
In summary, physical activity interventions appear to improve depression symptoms not
only across varying exercise intensity levels, but also across symptom severity levels, that is,
from clinical to subclinical depression. As walking interventions provide a less vigorous and
more easily implementable activity, these latter findings are particularly interesting for older
populations facing increases in physical limitations. However, while in some instances studies
investigated older adults, age was not considered as a potential moderator. Hence, it is not
clear whether walking interventions are similarly effective across age.
One reason why physical activity interventions may be less successful in older age are
age-related declines in physical ability. In more detail, limited physical ability has been shown to
be linked to reduced physical activity as well as more depressive symptoms ( Brach et al., 2004;
Wolinsky, Stump, & Clark, 1995; Paterson & Warburton, 2010; Kaplan, Newsom, McFarland, &
Lu, 2001; Gayman, Turner, & Cui, 2008; Hybels, Pieper, & Blazer, 2009). Hence, limited
physical ability may interfere with mental health benefits of physical activity interventions.
Furthermore, physical interventions often may increase physical ability, which then may
contribute to mental health improvements over and above beneficial physical activity effects.
Indeed, previous studies have emphasized the importance of physical activity aiding in
preserving physical function in individuals over the age of 50 (Hillsdon, Brunner, Guralnik, &
Marmot). Furthermore, Fisher and Li reported that a walking intervention for adults over the age
of 65 improved both mental well-being and physical functioning (Fisher & Li, 2004). These
studies suggest that physical activity interventions may facilitate mental health changes in part
by improving an individual’s physical abilities.
4
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
5
As pointed out earlier, however, as age increases, this pathway may become less likely.
That is, for older individuals, increasing physical activity at some point may no longer be
sufficient to decrease physical limitations. This raises the question which other mechanisms
may be able to support mental health improvements following physical activity interventions in
older age.
One promising candidate is an individual’s satisfaction with his or her physical ability.
Indeed, physical function satisfaction has been shown to be closely tied to well-being in older
adults, including reduced depressive symptom severity ( Rejeski et al., 2008; Umstattd, 2011).
Furthermore, one recent study suggest that despite functional limitations, older women are not
less satisfied with their body function, which indicates a potential decoupling of function
limitations and function satisfaction (de Souto Barreto, Ferrandez, & Guihard-Costa, 2011).
Hence, the ability to improve physical function satisfaction beyond physical limitations may
provide an important pathway to improve mental health in older age.
The current study investigated this pathway by implementing a 12-week Fitbit-assisted
walking intervention in middle-aged and older women. The aims of the study were to address
the following questions. 1) Is a 12-week walking intervention effective in increasing function
satisfaction as well as decreasing depressive symptoms in middle-aged and older women? 2)
Are these potential intervention effects comparable across age? 3) Are improvements in
function satisfaction dependent on increases in physical activity and is this effect influenced by
initial physical ability or physical ability improvements? 4) Are improvements in physical function
satisfaction linked to decreases in depressive symptoms over and above increases in physical
activity, initial physical ability / limitations, or physical ability improvements?
Method
Participants
5
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
6
One hundred middle-aged and older adults took part in this study. The nine male
participants were excluded from the analysis due to an insufficient number of recruited males.
Thirty of the participants were excluded, as they did not complete the final questionnaire
package. Ten participants missed more than one question in the MOS-SF 36 and they were
excluded, six participants missed more than one question in the BES, three missed more than
one question in the CESD-R, and two did not record their steps in the diary. This yielded a final
valid sample size of N = 49 women. The mean age was 59 years old with a standard deviation
of 6.5 years.
Measures
Steps. One-week step counts were assessed using a Fitbit One. During the first week,
participants were instructed to wear the Fitbit for one week and were told not to modify their
behavior during this week, in order to obtain their current activity level. During the initial week
one, steps were used to determine a goal baseline for implementation in weeks 2 and beyond.
Every other week there were 15% increases in steps over the baseline goal resulting in roughly
a doubling of steps. Participants were required to record their step counts at the end of each
day in weekly diaries provided by the study staff. The average and standard deviation of steps
from the baseline week 1 and weeks 10 and 11 were calculated to assess changes over the
course of the study in this activity.
Body function satisfaction. Body-esteem measures were used to capture satisfaction
with body function.
Body-Esteem Scale. The Body-Esteem Scale (BES) is a 29-item measure that
assesses how people feel about various body parts and functions (e.g., “physical stamina;”
“physical coordination”), with responses ranging from “1-Strong negative feelings” to “5-Strong
positive feelings” (Franzoi & Shields, 1984). Higher scores indicate more positive body-esteem.
In this study, only responses assessing physical functions (items 18 through 29) were included
6
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
7
in analysis to contrast with the self-reported physical limitations (MOS SF-36). A body
satisfaction change score was computed by subtracting the baseline satisfaction score from the
post-intervention score with more positive change scores indicating a greater increase in
function satisfaction. Cronbach’s alpha for the body function satisfaction scale was found to be
highly reliable (12 items; α = .837).
Physical function. Physical function measures were used to capture physical function
limitations based upon reported health status.
Medical Outcomes Study Questionnaire Short Form 36 (MOS SF-36). The MOS SF36 is a 36-item measure that is used as a generic indicator of health. The MOS is scored from 0
to 100, with 0 indicating the least favorable possible health state and 100 indicating the best
possible health state (Ware & Sherbourne, 1992). In this study, responses were assessed for
five scales: physical functioning, role-physical, bodily pain, general health, and vitality (25 items;
α = .901).
Mental Health. The self-reported depression scale was used to capture mental health
through changes in depressive symptoms.
Center for Epidemiological Studies Depression Scale Revised (CESD-R). The
CESD-R is a 20-item measure on which subjects rate frequency of depressive symptoms on a
5-point scale, with total scares calculated via summation (Radloff, 1977). Scores of 16 or higher
are associated with clinical depression. Cronbach’s alpha for the depressive symptom scale
was found to be highly reliable (20 items; α = .92).
Procedure
As part of a 12-week physical activity intervention, middle-aged and older adults were
recruited from across northeastern Massachusetts through flyers, in-person recruitment efforts
at events (e.g., farmer’s markets), and online postings. Interested individuals called the lab and
they were given an overview of the study and a brief phone screening. In order to be eligible,
7
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
8
participants were required to be 50 to 75, sedentary, have been unsuccessful in implementing
behavior change, and experience high pressure to increase their physical activity levels by
friends, family, and doctors. Individuals who have been told to not participate in physical activity
or who are not able to walk for several minutes without pain were excluded.
Eligible participants were scheduled for two in-person meetings, one week apart. At the
first meeting, participants were given a Fitbit One step tracker, a one-week diary in which to
record their steps, and a package of questionnaires. After one week, participants returned to the
lab with a record of their steps and their completed questionnaire packages. After the first week,
participants were split into either low or high informational support groups based on gender,
education, and ethnicity. The high informational support group, in addition to recording the Fitbit
data and mailing in information, also received additional individualized information on how to
increase their step count and medical information about the positive health outcomes of
increased physical activity. Additionally, all the questionnaires were given again during the last
visit post-intervention. The Brandeis University Institutional Review Board approved the study.
Analytic Plan
First, associations between study variables and age were assessed by bivariate
correlations. To assess the change in variables over the course of the intervention (aim 1),
paired samples T-tests were analyzed. To determine age-dependent effects of the intervention
(aim 2), linear regressions were computed with baseline scores entered on the first level and
age entered on the second level. Outcome variables were the post-intervention scores.
To address aim 3, regression models were computed to test for associations between
increases in steps and body function satisfaction improvements. Baseline body function
satisfaction, age (centered), step count changes (centered), and the interaction between age
and step count changes were entered as predictors. Final visit body function satisfaction scores
were entered as the outcome variable. To control for change in steps, baseline physical
8
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
9
limitations, or change in physical limitations, the regression analysis was repeated including the
respective variable as predictor.
To test for associations between increases in body function satisfaction and reduction in
depressive symptoms (aim 4), a similar set of regressions models with final visit depressive
symptom scores as outcome variable were computed. In more detail, baseline depressive
symptoms, age (centered), change in body function satisfaction (centered), and the interaction
between age and change in body function satisfaction were entered as predictor variables.
Similar to above, the regression analysis was repeated including baseline physical limitations or
change in physical limitations.
Results
Descriptive statistics
Participants’ functional limitation scores improved from their initial visit (M = 72.9 ± 15.1)
to the final visit (M = 74.7 ± 13.1) with an increase indicating fewer physical limitations.
Depressive symptom scores decreased over the course of the intervention with decreases
indicating fewer depressive symptoms (initial: M = 12.4 ± 10.9; final: M = 10.6 ± 8.3).
Additionally, body function satisfaction scores improved over the course of the intervention with
participants reporting greater satisfaction at the final visit (M = 37.5 ± 7.8) than at the initial visit
(M = 35.3 ± 7.14).
Correlations
To test for associations between study variables and age, simple correlations were used
(see Table 1). Contrary to predictions, age was not correlated with any of the variables of
interest, neither at baseline nor post-intervention (all p > .06). As expected, individuals with
higher baseline body function satisfaction had fewer baseline physical limitations (r = .452, p =
.001). Furthermore, body function satisfaction and physical limitations were both associated with
depressive symptoms, such that individuals with higher depressive symptoms reported to be
less satisfied with body function satisfaction and had greater physical limitations (r = .415, p =
.003; r = -.509, p <.001, respectively). Similar associations were observed for the post
9
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
10
intervention assessment: Individuals with higher body function satisfaction reported fewer
physical limitations (r = .417, p = .003) and tended to have fewer depressive symptoms (r = -.28,
p =.054). Additionally, physical limitations remained associated with depressive symptoms (r = .487, p < .001).
Aim 1: Intervention effects
To address aim 1, paired samples t-tests were computed to assess the effects of the
walking intervention. As expected, participants walked significantly more at weeks 10 and 11
than at their baseline week 1 (t(47) = -7.89, p < .001) with a mean increase of 2227 steps per
day (SD = 1953 steps). Interestingly, while physical limitations did not improve over the course
of the study, we observed improvements in body function satisfaction (t(47) = -1.06, p =.294;
t(47) = -2.63, p =.012, respectively). Furthermore, participants showed a trend to decreases in
depressive symptoms over the course of the study (t(47) = 1.83, p = .073). Means and standard
errors are shown in Figure 1.
Aim 2: Age-dependent effects on the intervention
To investigate how changes in depressive symptoms, body function satisfaction, daily
steps and physical limitations differ across age, linear regressions were computed. Interestingly,
contrary to the hypothesis that with increasing age, mental health benefits may be reduced,
improvements in depressive symptoms tended to be stronger for older women (β = -.16, p =
.082). For none of the other variables did changes across the intervention differ by age. That is,
improvements in physical function satisfaction, step counts and physical limitations were all
independent of participants’ age (β = .159, p = .12; β = .011, p = .92; β = 0.223, p = .872,
respectively).
Aim 3: Regression models with change in steps predicting final body function
satisfaction increases across age
10
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
11
In order to examine step changes as a potential determinant of body function
satisfaction, linear hierarchical regressions were computed. Changes in steps did not predict
changes in body function satisfaction (main effect of age: β = .157, p = .134; main effect of step
change: β = .046, p = .650; interaction (age x steps): β = -.043, p = .677). Additionally,
controlling for baseline physical limitations to account for participants’ initial functional limitations
or limitation change to account for potential improvements did not change the above findings (β
= .073, p = .545; β = .051, p = .621, respectively). Of note, change in steps also did not predict
changes in depression (main effect of age: β = .158, p = .087; main effect of step change: β
= .002, p = .979; interaction (age x step change): β = -1.123, p = .268).
Aim 4: Regression models with change in body function satisfaction predicting final
depressive symptoms across age
To determine whether change in body function satisfaction contributed to change in
depressive symptoms and whether this link is age-dependent, linear hierarchical regressions
were computed. For all ages, changes in depressive symptoms were not predicted by the
overall improvements in body function satisfaction (main effect of age: β = -.179, p = .061; main
effect of BFS change: β = .046, p = .635; interaction (age x BFS): β = .109, p = .251).
Additionally, neither baseline physical limitations nor percent increases in steps to account for
intervention success or limitation change did account for the lack of the above association (main
effect of physical limitations: β = -.099, p = .349; main effect of steps: β = -.044, p = .636; main
effect of limitation change: β = .011, p = .903).
Discussion
Over the course of the 12-week walking intervention, we observed improvements in
physical activity as well as body function satisfaction, and decreases in depressive symptoms.
Furthermore, the magnitude of body function satisfaction and daily step counts increases was
comparable across all ages. In contrast, depressive symptom decreases were more
11
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
12
pronounced for older participants. Body function satisfaction did not significantly contribute to
the observed depressive symptom reduction, nor was it dependent upon the intervention
success (steps increase). These findings did not change when accounting for physical activity
increases or physical limitations amongst participants.
Do mental and physical health indicators differ across age?
Examination of whether mental and physical health indicators differed across age
revealed that depressive symptoms, body function satisfaction, and physical limitations did not
vary by age, at neither baseline nor post-intervention time points. These findings are in contrast
to the few previous reports on this topic.
Previous research has emphasized that with increasing age, women tend to put a
greater emphasis on body function satisfaction (de Souto Barreto et al., 2011; Umstattd, 2011).
However, the specific studies highlighting this association did not focus on sedentary women,
thus allowing for more variability in function satisfaction. Furthermore, women on average were
older with a wider age range (e.g., 70.33 ± 7.9 years, 60-93 years) compared to the present
study (59 ± 6.5 years, max-min: 50 – 73 yrs.). Hence, the current sample’s age characteristics
may have limited our ability to find an association between age and function satisfaction. The
same rationale may explain the lack of age-dependent differences in depressive symptoms.
Alternatively, previous studies have described non-linear associations between
depressive symptoms and age, such that depressive symptom scores beginning to rise sharply
after the age of 60 (Kessler, Foster, Webster & House, 1992). These results suggest that the
current study population may not have crossed the threshold beyond which age effects on
depressive symptoms emerge. Findings regarding age-related changes in physical fitness
support a threshold model for function limitations as well. For example, older women were found
to show a decrease in physical fitness particularly after age 60 (Milanović et al., 2013). Thus,
12
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
13
women in the present study may not yet have necessarily encountered age-related physical
limitations or may have been less aware of them due to being sedentary.
Are physical health indicators related to depressive symptoms?
Importantly, however, both physical limitations and body function satisfaction were linked to
depressive symptom severity in the expected directions. That is, our findings are in line with
previous reports of individuals with higher depressive symptoms to be also less satisfied with
their body function and to experience greater physical limitations (Umstattd, 2011; Gayman et
al., 2008; Hybels et al., 2009). Alternatively, given the correlational nature of the findings, a
depression-related reporter bias has to be considered, such that more severe depressive
symptoms may drive reports of lower body function satisfaction and more physical limitations.
What effects did the walking intervention have on mental and physical health indicators?
Overall, the walking intervention was successful in increasing individuals’ daily step count
and furthermore, was associated with beneficial changes in both mental and physical health
indicators. With regard to changes in daily steps, participants increased their steps on average
by 71% over their individual baseline (5316 steps to 7500 steps). In line with the study’s
inclusion criteria, the initial step value was close to the sedentary cut off of 5000 steps (TudorLocke & Bassett, 2004), and the majority of participants fell into the “low activity” group.
Importantly, the participants’ step counts varied extensively, from the lower end of being
sedentary to several participants being in the “higher activity” range. Furthermore, the overall
goal of the intervention aimed to result in a roughly doubling of steps based upon each
individual’s baseline step count. While not all participants met the overall 100% increase in
steps, participants still reported mental and physical health improvements, suggesting a benefit
of participation in a tailored intervention based upon individualized step goals.
In more detail and with regard to mental health, over the course of the 12-week walking
program, individuals experienced a decrease in depressive symptoms. Previous findings
13
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
14
suggest that this mental health improvement can be attributed to the increases in physical
activity (Blake et al., 2009; de Labra, Guimaraes-Pinheiro, Maseda, Lorenzo, & Millán-Calenti,
2015; J. Rimer, K. Dwan, & Lawlor, 2012; Lawlor & Hopker, 2001). Interestingly, depressive
symptom decreases were more pronounced with increasing age, indicating that the intervention
provided even greater mental health benefits for the older women. Perhaps, with increasing
age, women are more likely to decouple mental health from overall physical ability, which could
be considered a beneficial strategy to compensate for present physical limitations (Netz, Wu,
Becker, & Tenenbaum, 2005). However, the previous studies required high-intensity or groupbased physical activity interventions to achieve the same benefits, while the present study
achieved the benefits through a low-impact walking intervention over a shorter period of time
(Blake et al., 2009).
Additionally, participants showed significant improvements in how satisfied they were with
how their body is functioning. Since physical ability did not change over the course of the
intervention, this finding emphasizes the importance of differentiating subjective feelings of
one’s physical functions from actual physical ability. Furthermore, it suggests function
satisfaction as a promising intervention target that is particularly relevant for older adults who
are dealing with the onset of physical limitations.
Similar to depressive symptoms, previous studies suggest that function satisfaction
improvements may be due to physical activity increases (Rejeski & Mihalko, 2001; Umstattd,
2011). The lack of an association in the current study does not support this interpretation. It
should be pointed out, however, that the majority of earlier studies implemented interventions
that more directly targeted body functions, such as programs aimed at increasing muscular
strength and balance (Rejeski & Mihalko, 2001; Umstattd, 2011).Thus, the purpose and
outcome are more clearly linked. In contrast, the current intervention’s effect were multi-faceted
and interrelated in terms of affecting physical and psychological processes, making it more
difficult to link one specific indicator to changes in walking behavior.
14
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
15
Taken together, function satisfaction and mental health benefits provide a positive outcome
of the intervention across all ages, regardless of physical ability and functional limitation
improvements.
Were improvements in body function satisfaction crucial for improving mental health?
When considering whether improvements in body function satisfaction were crucial for
improving mental health, it was found that function satisfaction did not contribute to the
observed depressive symptom reduction. While function satisfaction pre-intervention was
related to depressive symptoms, it is important to consider that a multitude of factors may
contribute to the changes observed over the course of the 12-week walking intervention.
Previous studies have found relations between physical fitness and self-efficacy and body
function satisfaction in older adults (McAuley, 2000). Specifically, self-efficacy perception was
directly enhanced through physical activity leading to increased satisfaction of specific
outcomes, such as function satisfaction (Morris, McAuley, & Motl, 2008; Rejeski & Mihalko,
2001). Furthermore, self-efficacy was found to be a cognitive precursor and component of
depressive symptoms (Comunian, 1989).Therefore, it is possible that both function satisfaction
and depressive symptom improvements are related to overall increased self-efficacy due to
successful engagement in physical activity. Indeed, the present intervention provided
informational support and manageable, individualized goals, which allowed the participants to
gain the necessary tools and skills and take ownership of their own success.
How much did the increase in physical activity contribute to improving body function
satisfaction?
Lastly, increases in physical activity did not significantly contribute to improvements in
body function satisfaction. Previous studies have identified step counts as a predictor of body
function satisfaction amongst middle-aged individuals (Arbour & Martin Ginis, 2008). However,
the results of Arbour focused on a younger age group compared to the present study, which
15
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
16
may indicate a shift in relevance of step goal accomplishment for driving function satisfaction.
Similar to above, these results suggest a more multifaceted effect of participating in a
individualized walking intervention.
Limitations and Future Studies
Limitations of the present study include the relatively narrow age range as discussed in
previous sections and the focus on sedentary women. To address the latter generalizability
issue, future studies may explore how a walking intervention affects physical function
satisfaction and depressive symptoms in older men. Lastly, in regards to function satisfaction,
improvements in function satisfaction have been found to be closely tied to overall
improvements in satisfaction with body appearance (de Souto Barreto et al., 2011). Therefore, it
would be important to expand this line of work to assess the potential differential roles of various
body image facets.
Outlook and Implications
The results of this study highlight the mental and physical health benefits of a
manageable and low-impact walking intervention that emphasizes tailored goals for each
participant. The next step will have to be to determine whether and for how long these benefits
extend beyond conclusion of the intervention. Additionally, further investigation into processes
underlying the improvements in body function satisfaction and depressive symptom is
recommended, with increasing self-efficacy as a first promising target mechanism.
16
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
17
Tables
Table 1. Correlation analysis for age, depressive symptoms, body function
satisfaction, and physical limitation measures.
Age
CESD
BES
MOS
Age
-
-.263
.273
.010
CESD
-.136
-
-.280
-.487**
BES
.163
-.415**
-
.417**
MOS
-.011
-.509**
.452**
-
Note. Shaded values indicate values from initial visit. CESD = depressive symptoms;
BES = body functioning satisfaction, MOS = physical limitations. Significance found following
two-tailed test. *p<.05, **p<.01.
17
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
18
Figures
Figure 1. Differences in baseline and final visit scores for study variables.
Differences in baseline and final visit scores for step increases, body function satisfaction, and
depressive symptom improvements. Note. BFS = body function satisfaction, DEP = depressive
symptoms.
18
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
Figure 2. Step improvements across all ages.
Step improvements across all ages showing an overall increase in steps for all
participants.
19
19
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
20
Figure 3. Depressive symptom changes across ages.
Depressive symptom (CESD-R) changes across all ages were observed with a trend for
older participants to show greater decreases in symptoms.
20
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
21
Figure 4. Body function satisfaction changes across ages.
Figure 4. Body function satisfaction improvements were observed for all participants.
21
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
22
References
Arbour, K. P., & Martin Ginis, K. A. (2008). Improving body image one step at a time: Greater
pedometer step counts produce greater body image improvements. Body Image, 5(4),
331-336. doi:http://doi.org/10.1016/j.bodyim.2008.05.003
Blake, H., Mo, P., Malik S., & Thomas, S. (2009). How effective are physical activity
interventions for alleviating depressive symptoms in older people? A systematic review.
Clinical Rehabilitation, 23, 873-887. doi:10.1177/0269215509337449
Brach, J. S., Simonsick, E. M., Kritchevsky, S., Yaffe, K., Newman, A. B., for the Health, A., &
Body Composition Study Research, G. (2004). The association between physical
function and lifestyle activity and exercise in the health, aging and body composition
study. Journal Of The American Geriatrics Society, 52(4), 502-509. doi:10.1111/j.15325415.2004.52154.x
Chui, H., Gerstorf, D., Hoppmann, C. A., & Luszcz, M. A. (2015). Trajectories of depressive
symptoms in old age: Integrating age-, pathology-, and mortality-related changes.
Psychology and Aging, 30(4), 940-951. doi:10.1037/pag0000054
10.1037/pag0000054.supp (Supplemental)
Comunian, A. L. (1989). Some characteristics of relations among depression, anxiety, and selfefficacy. Perceptual and Motor Skills(0031-5125 (Print)).
de Labra, C., Guimaraes-Pinheiro, C., Maseda, A., Lorenzo, T., & Millán-Calenti, J. C. (2015).
Effects of physical exercise interventions in frail older adults: a systematic review of
randomized controlled trials. BMC Geriatrics, 15(1), 154. doi:10.1186/s12877-015-01554
de Souto Barreto, P., Ferrandez, A.-M., & Guihard-Costa, A.-M. (2011). Predictors of body
satisfaction: Differences between older men and women’s perceptions of their body
functioning and appearance. Journal of Aging and Health, 23(3), 505-528.
Fisher, K. J., & Li, F. (2004). Community-based walking trial to improve neighborhood quality of
life in older adults: A multilevel analysis. Annals Of Behavioral Medicine, 28(3), 186-194.
doi:10.1207/s15324796abm2803_7
Franzoi, S. L., & Shields, S. A. (1984). The body esteem scale: Multidimensional structure and
sex differences in a college population. Journal of personality assessment, 48(2), 173178.
Gayman, M. D., Turner, R. J., & Cui, M. (2008). Physical limitations and depressive symptoms:
Exploring the nature of the association. The Journals of Gerontology: Series B, 63(4),
S219-S228. doi:10.1093/geronb/63.4.S219
Hillsdon, M. M., Brunner, E. J., Guralnik, J. M., & Marmot, M. G. Prospective study of physical
activity and physical function in early old age. American Journal of Preventive Medicine,
28(3), 245-250. doi:10.1016/j.amepre.2004.12.008
Hybels, C. F., Pieper, C. F., & Blazer, D. G. (2009). The Complex relationship between
depressive symptoms and functional limitations in community dwelling older adults: The
impact of subthreshold depression. Psychological medicine, 39(10), 1677-1688.
doi:10.1017/S0033291709005650
J. Rimer, K. Dwan, & Lawlor, D. A. (2012). Exercise for depression. Cochrane Database
System. Revised., 7.
Kaplan, M. S., Newsom, J. T., McFarland, B. H., & Lu, L. Demographic and psychosocial
correlates of physical activity in late life. American Journal of Preventive Medicine, 21(4),
306-312. doi:10.1016/S0749-3797(01)00364-6
Kessler, R. C., Foster C Fau - Webster, P. S., Webster Ps Fau - House, J. S., & House, J. S.
The relationship between age and depressive symptoms in two national surveys. (08827974 (Print)).
22
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
23
King, A. C., Taylor, C. B., & Haskell, W. L. (1993). Effects of differing intensities and formats of
12 months of exercise training on psychological outcomes in older adults. Health
Psychology, 12(4), 292-300. doi:10.1037/0278-6133.12.4.292
Lawlor, D. A., & Hopker, S. W. (2001). The effectiveness Of exercise as an intervention in the
management of depression: Systematic review And meta-regression analysis Of
randomised controlled trials. BMJ: British Medical Journal, 322(7289), 763-767.
Lindwall, M., Larsman, P., & Hagger, M. S. (2011). The reciprocal relationship between physical
activity and depression in older European adults: A prospective cross-lagged panel
design using SHARE data. Health Psychology, 30(4), 453-462. doi:10.1037/a0023268
Martinsen, E. W. (2008). Physical activity in the prevention and treatment of anxiety and
depression. Nordic Journal of Psychiatry, 62(Suppl 47), 25-29.
doi:10.1080/08039480802315640
McAuley, E., Blissmer, B, Katula, J., Duncan, TE., & Mihalko, SL. (2000). Physical activity, selfesteem, and self-efficacy relationships in older adults: a randomized controlled trial.
Annals Of Behavioral Medicine, 22(2), 131-139.
Milanović, Z., Pantelić, S., Trajković, N., Sporiš, G., Kostić, R., & James, N. (2013). Age-related
decrease in physical activity and functional fitness among elderly men and women.
Clinical Interventions in Aging, 8, 549-556. doi:10.2147/CIA.S44112
Morris, K. S., McAuley, E., & Motl, R. W. (2008). Neighborhood satisfaction, functional
limitations, and self-efficacy influences on physical activity in older women. The
International Journal of Behavioral Nutrition and Physical Activity, 5, 13-13.
doi:10.1186/1479-5868-5-13
Netz, Y., Wu, M.-J., Becker, B. J., & Tenenbaum, G. (2005). Physical activity and psychological
well-being in advanced age: A meta-analysis of intervention studies. Psychology and
Aging, 20(2), 272-284. doi:10.1037/0882-7974.20.2.272
Paterson, D. H., & Warburton, D. E. R. (2010). Physical activity and functional limitations in
older adults: a systematic review related to Canada's Physical Activity Guidelines. The
International Journal of Behavioral Nutrition and Physical Activity, 7, 38.
Penninx, B. H., Leveille, S., Ferrucci, L., van Eijk, J. M., & Guralnik, J. M. (1999). Exploring the
effect of depression on physical disability: Longitudinal evidence from the established
populations for epidemiologic studies of the elderly. American Journal Of Public Health,
89(9), 1346-1352. doi:10.2105/AJPH.89.9.1346
Rejeski, W. J., King, A. C., Katula, J. A., Kritchevsky, S., Miller, M. E., Walkup, M. P., . . .
Investigators, f. t. L. (2008). Physical activity in prefrail older adults: confidence and
satisfaction related to physical function. The Journals of Gerontology Series B:
Psychological Sciences and Social Sciences, 63(1), P19-P26.
Rejeski, W. J., & Mihalko, S. L. (2001). Physical activity and quality of Life in older adults. The
Journals of Gerontology: Series A, 56(suppl_2), 23-35.
doi:10.1093/gerona/56.suppl_2.23
Rethorst C.D., W., B. M., and Landers, D. M. (2009). The antidepressive effects of exercise: a
meta-analysis of randomized trials. Sports Medicine, 39(6), 491-511.
Roberston, R., Roberston, A., Jepson, R., Maxwell, M. (2012). Walking for depression or
depressive symptoms: A systematic review and meta-analysis. Mental Health and
Physical Activity, 5(1), 66-75.
Singh A, M. N. (2009). Loneliness, depression and sociability in old age. Industrial Psychiatry
Journal., 18(1), 51-55. doi:10.4103/0972-6748.57861.
Thielke, S. M., Diehr, P., & Unützer, J. . (2010). Prevalence, incidence, and persistence of major
depressive symptoms in the cardiovascular health study. Aging & Mental Health, 14(2),
168-176. doi:http://doi.org/10.1080/13607860903046537
Tudor-Locke, C., & Bassett, D. R., Jr. (2004). How many steps/day are enough? Preliminary
pedometer indices for public health. (0112-1642 (Print)).
23
BODY FUNCTION SATISFACTION AND DEPRESSION IN WOMEN
24
Umstattd, M. R., Wilcox, S., & Dowda, M. (2011). Predictors of change in satisfaction with body
appearance and body function in mid-life and older adults: Active for Life®. Annals Of
Behavioral Medicine, 41(3), 342-352. doi:10.1007/s12160-010-9247-8
Vallance J, E. D., Gardiner P, Taylor L, Johnson S. (2016). Associations of daily pedometer
steps and self-reported physical activity with health-related quality of life: Results from
the alberta older adult health survey. Journal of Aging Health, 28, 661-674.
doi:10.1177/0898264315609905
Wolinsky, F. D., Stump, T. E., & Clark, D. O. (1995). Antecedents and consequences of physical
activity and exercise among older adults. The Gerontologist, 35(4), 451-462.
doi:10.1093/geront/35.4.451
24