PURPOSE The present study aimed to analyse the effects of 12 months of participation in a public physical activity program linked to primary care on depression level and fitness, and to determine which fitness components were responsible for the improvement in depression using mediation analysis. METHODS Participants of this program were 2768 middle-aged and older adults from 67 municipalities throughout the Spanish region of Extremadura. In the analysis only participants with depression and without any missing values for fitness variables were included. This sample was 303 for exercise group and 74 for control group. Socio-demographic data, Geriatric Depression Scale and some fitness tests were applied at baseline and 1 year later. Exercise group performed the program 3 days/week for 50-60 min per session involving brisk walking with intermittent flexibility, strength and balance activities/exercises. Socializing within the group was encouraged in all sessions. Data analysis included analysis of covariance, chi-squared and effect size statistics. Additionally, a parallel model of mediation analysis was performed to determine the indirect effect of the participation in the exercise program on depression through improvements in fitness. RESULTS A considerable reduction from mild, moderate or severe depression to non-depression were obtained for exercise group (68%) P-value < .05. The parallel mediation analysis showed that flexibility (sit-and-reach [β - 0.04 (- 0.07 to - 0.01)], back scratch [β - 0.06 (- 0.12 to - 0.02)]) and cardiorespiratory fitness (6-min walk [β - 0.09 (- 0.15 to - 0.04)]) were mediators of the reduction in depression. CONCLUSION This exercise program was effective in improving depression in older adults. Integrating aerobic and flexibility exercises in a group-based program of physical activity programs could improve the severity of depression in this population.

中文翻译：

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与初级保健相关的运动计划对老年人抑郁症的影响：健身是改善的中介。

目的本研究旨在分析与初级保健相关的参与公共体育活动计划的12个月对抑郁水平和适应性的影响，并使用调解分析确定哪些适应性成分导致抑郁症的改善。方法该方案的参与者是来自西班牙埃斯特雷马杜拉地区67个城市的2768名中老年人。在分析中，仅包括患有抑郁症且健身变量没有任何缺失值的参与者。运动组为303，对照组为74。在基线和一年后应用社会人口统计学数据，老年抑郁量表和一些适应性测试。练习组每周3天每天进行一次该程序，每次训练50-60分钟，包括快步走，间歇性的灵活性，力量和平衡活动/锻炼。在所有会议中都鼓励在小组内进行社交。数据分析包括协方差分析，卡方分析和效应量统计。此外，还进行了并行的中介分析模型，以确定参加锻炼计划对通过改善健康状况对抑郁症的间接影响。结果运动组从轻度，中度或重度抑郁降至非抑郁程度显着降低（68％）P值<.05。平行中介分析显示，柔韧性（即坐即伸[β-0.04（-0.07至-0.01）]，后刮擦[β-0.06（-0.12至-0.02）]）和心肺适应性（步行6分钟[ β-0。09（-0.15至-0.04）]）是抑郁症减轻的介体。结论该运动计划可有效改善老年人的抑郁症。将有氧运动和柔韧性运动整合到基于小组的体育锻炼计划中可以改善该人群的抑郁症严重程度。