{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:55:50Z","timestamp":1760144150702,"version":"build-2065373602"},"reference-count":48,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T00:00:00Z","timestamp":1710201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Geriatrics"],"abstract":"<jats:p>Background: Depression and cardiovascular diseases are two main health conditions contributing to the global disease burden. Several studies indicate a reciprocal association between them. It is still unclear how changes in overall muscle strength may impact this association. This study aimed to analyse how muscular strength moderates the relationship between cardiovascular events and depressive symptoms among middle-aged and older adults. Methods: Wave 8 of the population-based Survey of Health, Ageing, and Retirement in Europe (2019\/2020) cross-sectional data, which included 41,666 participants (17,986 men) with a mean age of 70.65 (9.1) years old, was examined. Grip strength was measured twice on each hand using a dynamometer. The 12-item EURO-D scale was employed to gauge depressive symptoms. Results: Grip strength negatively moderates the link between cardiovascular events and depressive symptoms (male: B = \u22120.03, 95% CI = \u22120.04, \u22120.03; female: B = \u22120.06, 95% CI = \u22120.06, \u22120.05). Additionally, the grip strength moderation values in the significant zone for males and females were less than 63.2 kg and 48.3 kg, respectively. Conclusions: Muscular strength modifies depressive symptoms and lessens their correlation with cardiovascular diseases. Muscle-strengthening activities could be incorporated into primary and secondary preventive strategies to reduce the burden of depression in people with CVD.<\/jats:p>","DOI":"10.3390\/geriatrics9020036","type":"journal-article","created":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T03:55:34Z","timestamp":1710215734000},"page":"36","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Moderating Effect of Muscular Strength in the Association between Cardiovascular Events and Depressive Symptoms in Middle-Aged and Older Adults\u2014A Cross Sectional Study"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9638-8702","authenticated-orcid":false,"given":"Diogo","family":"Veiga","sequence":"first","affiliation":[{"name":"Centro Interdisciplinar de Performance Humana, (CIPER) Faculdade de Motricidade Humana, Universidade de Lisboa, 1499-002 Cruz-Quebrada, Portugal"}]},{"given":"Miguel","family":"Peralta","sequence":"additional","affiliation":[{"name":"Centro Interdisciplinar de Performance Humana, (CIPER) Faculdade de Motricidade Humana, Universidade de Lisboa, 1499-002 Cruz-Quebrada, Portugal"},{"name":"Instituto de Sa\u00fade Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-026 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0927-692X","authenticated-orcid":false,"given":"\u00c9lvio R.","family":"Gouveia","sequence":"additional","affiliation":[{"name":"Department of Physical Education and Sport, University of Madeira, 9020-105 Funchal, Portugal"},{"name":"Laboratory for Robotics and Engineering Systems (LARSYS), Interactive Technologies Institute, 9020-105 Funchal, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3577-3439","authenticated-orcid":false,"given":"Marcelo de Maio","family":"Nascimento","sequence":"additional","affiliation":[{"name":"Department of Physical Education, Federal University of Vale do S\u00e3o Francisco, Petrolina 56.304-205, Brazil"}]},{"given":"Laura","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Centro Interdisciplinar de Performance Humana, (CIPER) Faculdade de Motricidade Humana, Universidade de Lisboa, 1499-002 Cruz-Quebrada, Portugal"}]},{"given":"Jorge","family":"Encantado","sequence":"additional","affiliation":[{"name":"Centro Interdisciplinar de Performance Humana, (CIPER) Faculdade de Motricidade Humana, Universidade de Lisboa, 1499-002 Cruz-Quebrada, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9850-7771","authenticated-orcid":false,"given":"Adilson","family":"Marques","sequence":"additional","affiliation":[{"name":"Centro Interdisciplinar de Performance Humana, (CIPER) Faculdade de Motricidade Humana, Universidade de Lisboa, 1499-002 Cruz-Quebrada, Portugal"},{"name":"Instituto de Sa\u00fade Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-026 Lisboa, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1093\/eurpub\/ckac066","article-title":"Burden of cardiovascular diseases and depression attributable to psychosocial work exposures in 28 European countries","volume":"32","author":"Villeneuve","year":"2022","journal-title":"Eur. J. Public Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1111\/jebm.12310","article-title":"Effects of depression on heart rate variability in elderly patients with stable coronary artery disease","volume":"11","author":"Luo","year":"2018","journal-title":"J. Evid. Based Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"450","DOI":"10.3389\/fpsyt.2018.00450","article-title":"DSM-5 Criteria and Depression Severity: Implications for Clinical Practice","volume":"9","author":"Tolentino","year":"2018","journal-title":"Front. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1002\/wps.20580","article-title":"Prevention of depression will only succeed when it is structurally embedded and targets big determinants","volume":"18","author":"Ormel","year":"2019","journal-title":"World Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Bromet, E., Andrade, L.H., Hwang, I., A Sampson, N., Alonso, J., de Girolamo, G., de Graaf, R., Demyttenaere, K., Hu, C., and Iwata, N. (2011). Cross-national epidemiology of DSM-IV major depressive episode. BMC Med., 9.","DOI":"10.1186\/1741-7015-9-90"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1001\/archpsyc.62.10.1097","article-title":"Epidemiology of Major Depressive Disorder: Results From the National Epidemiologic Survey on Alcoholism and Related Conditions","volume":"62","author":"Hasin","year":"2005","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e071940","DOI":"10.1136\/bmjopen-2023-071940","article-title":"Clinical practice guidelines for cardiovascular disease: How is depression addressed? Protocol for a systematic review","volume":"13","author":"Buhayer","year":"2023","journal-title":"BMJ Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1136\/spcare-2022-003884","article-title":"Depression prevalence in cardiovascular disease: Global systematic review and meta-analysis","volume":"13","author":"Rafiei","year":"2023","journal-title":"BMJ Support. Palliat. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1093\/eurheartj\/ehad173","article-title":"Successful psychological treatment of depression and subsequent reduction in CVD events","volume":"44","author":"Hare","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.jjcc.2022.11.010","article-title":"Depression and cardiovascular diseases","volume":"81","author":"Shiga","year":"2023","journal-title":"J. Cardiol."},{"key":"ref_11","first-page":"e26296","article-title":"Association of Depression With Cardiovascular Diseases","volume":"14","author":"Warriach","year":"2022","journal-title":"Cureus"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.2147\/NDT.S200360","article-title":"Cardiac dysautonomia in depression\u2014Heart rate variability biofeedback as a potential add-on therapy","volume":"15","author":"Pinter","year":"2019","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Dziurkowska, E., and Wesolowski, M. (2021). Cortisol as a Biomarker of Mental Disorder Severity. J. Clin. Med., 10.","DOI":"10.3390\/jcm10215204"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1007\/s11883-022-01048-0","article-title":"A Narrative Review of the Association Between Depression and Heart Disease Among Women: Prevalence, Mechanisms of Action, and Treatment","volume":"24","author":"Rome","year":"2022","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"695925","DOI":"10.1155\/2013\/695925","article-title":"Depression and cardiac disease: Epidemiology, mechanisms, and diagnosis","volume":"2013","author":"Huffman","year":"2013","journal-title":"Cardiovasc. Psychiatry Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1753944719851950","DOI":"10.1177\/1753944719851950","article-title":"Inflammation, depression and cardiovascular disease in women: The role of the immune system across critical reproductive events","volume":"13","author":"Mattina","year":"2019","journal-title":"Ther. Adv. Cardiovasc. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/7854_2016_28","article-title":"Inflammation-Associated Co-morbidity Between Depression and Cardiovascular Disease","volume":"Volume 31","author":"Halaris","year":"2017","journal-title":"Inflammation-Associated Depression: Evidence, Mechanisms and Implications. Current Topics in Behavioral Neurosciences"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2396","DOI":"10.1001\/jama.2020.23068","article-title":"Association Between Depressive Symptoms and Incident Cardiovascular Diseases","volume":"324","author":"Harshfield","year":"2020","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1001\/jamapsychiatry.2020.1351","article-title":"Association of Symptoms of Depression With Cardiovascular Disease and Mortality in Low-, Middle-, and High-Income Countries","volume":"77","author":"Rajan","year":"2020","journal-title":"JAMA Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Belvederi Murri, M., Folesani, F., Zerbinati, L., Nanni, M.G., Ounalli, H., Caruso, R., and Grassi, L. (2020). Physical Activity Promotes Health and Reduces Cardiovascular Mortality in Depressed Populations: A Literature Overview. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17155545"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.pcad.2018.11.005","article-title":"An Update on the Role of Cardiorespiratory Fitness, Structured Exercise and Lifestyle Physical Activity in Preventing Cardiovascular Disease and Health Risk","volume":"61","author":"Ozemek","year":"2018","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2796","DOI":"10.1080\/02640414.2021.1964721","article-title":"Muscle Strength Explains the Protective Effect of Physical Activity against COVID-19 Hospitalization among Adults aged 50 Years and Older","volume":"39","author":"Maltagliati","year":"2021","journal-title":"J. Sports Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4347","DOI":"10.3390\/jcm12134347","article-title":"The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women&rsquo;s Lifespan: An Updated Review","volume":"12","author":"Bucciarelli","year":"2023","journal-title":"J. Clin. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.exger.2018.04.001","article-title":"Depressive symptoms and muscle weakness: A two-way relation?","volume":"108","author":"Bertoni","year":"2018","journal-title":"Exp. Gerontol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"36","DOI":"10.11606\/s1518-8787.2022056004025","article-title":"Gender and education inequalities in dynapenia-free life expectancy: ELSI-Brazil","volume":"56","author":"Borges","year":"2022","journal-title":"Rev. Saude Publica"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Gracia, K.C., Llanas-Cornejo, D., and Husi, H. (2017). CVD and Oxidative Stress. J. Clin. Med., 6.","DOI":"10.3390\/jcm6020022"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1089\/met.2022.0003","article-title":"Mediation of Grip Strength on the Association Between Self-Rated Health and Estimated Cardiovascular Disease Risk","volume":"20","author":"Lee","year":"2022","journal-title":"Metab. Syndr. Relat. Disord."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Bae, E.-J., Park, N.-J., Sohn, H.-S., and Kim, Y.-H. (2019). Handgrip Strength and All-Cause Mortality in Middle-Aged and Older Koreans. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16050740"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1093\/ije\/dyt088","article-title":"Data Resource Profile: The Survey of Health, Ageing and Retirement in Europe (SHARE)","volume":"42","author":"Brandt","year":"2013","journal-title":"Int. J. Epidemiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.jad.2012.10.037","article-title":"What predicts persistent depression in older adults across Europe? Utility of clinical and neuropsychological predictors from the SHARE study","volume":"147","author":"Gallagher","year":"2013","journal-title":"J. Affect. Disord."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1192\/bjp.174.4.330","article-title":"Development of the EURO-D scale\u2014A European, Union initiative to compare symptoms of depression in 14 European centres","volume":"174","author":"Prince","year":"1999","journal-title":"Br. J. Psychiatry J. Ment. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/ageing\/afr051","article-title":"A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach","volume":"40","author":"Roberts","year":"2011","journal-title":"Age Ageing"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1037\/0022-3514.51.6.1173","article-title":"The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations","volume":"51","author":"Baron","year":"1986","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1052702","DOI":"10.3389\/fpsyg.2022.1052702","article-title":"Causes of the male-female ratio of depression based on the psychosocial factors","volume":"13","author":"Tang","year":"2022","journal-title":"Front. Psychol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.jad.2022.12.006","article-title":"Reduced grip strength potentially indicates depression: Investigating multicontinental databases","volume":"323","author":"Oh","year":"2023","journal-title":"J. Affect. Disord."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"937087","DOI":"10.3389\/fnagi.2022.937087","article-title":"The Association Between Grip Strength and Depression Among Adults Aged 60 Years and Older: A Large-Scaled Population-Based Study From the Longitudinal Aging Study in India","volume":"14","author":"Wang","year":"2022","journal-title":"Front. Aging Neurosci."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Marconcin, P., Peralta, M., Ferrari, G., de Matos, M.G., Espanha, M., Murawska-Cia\u0142owicz, E., and Marques, A. (2020). The Association of Grip Strength with Depressive Symptoms among Middle-Aged and Older Adults with Different Chronic Diseases. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17196942"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.jad.2022.12.055","article-title":"Global prevalence of depression, anxiety, and stress in cardiac patients: A systematic review and meta-analysis","volume":"324","author":"Karami","year":"2023","journal-title":"J. Affect. Disord."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s11936-019-0724-5","article-title":"Psychosocial Stress and Cardiovascular Disease","volume":"21","author":"Dar","year":"2019","journal-title":"Curr. Treat. Options Cardiovasc. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"33","DOI":"10.3389\/fpsyt.2016.00033","article-title":"Depression and the Link with Cardiovascular Disease","volume":"7","author":"Dhar","year":"2016","journal-title":"Front. Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1159\/000481403","article-title":"Personalized Management of Cardiovascular Disorders","volume":"26","author":"Jain","year":"2017","journal-title":"Med. Princ. Pract."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1007\/s11606-019-05325-8","article-title":"Association of depression risk with patient experience, healthcare expenditure, and health resource utilization among adults with atherosclerotic cardiovascular disease","volume":"34","author":"Okunrintemi","year":"2019","journal-title":"J. Gen. Intern. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3389\/fcvm.2019.00069","article-title":"Effects of Exercise to Improve Cardiovascular Health","volume":"6","author":"Pinckard","year":"2019","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Herti\u0161 Petek, T., Petek, T., Mo\u010dnik, M., and Mar\u010dun Varda, N. (2022). Systemic Inflammation, Oxidative Stress and Cardiovascular Health in Children and Adolescents: A Systematic Review. Antioxidants, 11.","DOI":"10.3390\/antiox11050894"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"17","DOI":"10.3233\/BPL-180069","article-title":"The Neuroprotective Effects of Exercise: Maintaining a Healthy Brain Throughout Aging","volume":"4","author":"Vecchio","year":"2018","journal-title":"Brain Plast."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"112802","DOI":"10.1016\/j.psychres.2020.112802","article-title":"Depression and cardiovascular disease: Shared molecular mechanisms and clinical implications","volume":"285","author":"Shao","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/j.jsams.2019.03.006","article-title":"A source of systematic bias in self-reported physical activity: The cutpoint bias hypothesis","volume":"22","author":"Olds","year":"2019","journal-title":"J. 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