The associations of chronic pain and 24-h movement behaviors with incident mental disorders: evidence from a large-scale cohort study.

BACKGROUND: Chronic pain was associated with a higher risk of mental disorders (e.g., depression and anxiety). However, the role of 24-h movement behaviors in the association remains unclear. METHODS: A total of 72,800 participants with accelerometer data and free of mental disorders from the UK Biobank were analyzed. The compositional mediation model and isotemporal substitution model were used to explore the associations between chronic pain, 24-h movement behaviors, and the incidence of overall mental disorders, depression, and anxiety. RESULTS: With a median follow-up of 13.36 years, participants with chronic pain had a higher rate of incident overall mental disorders (hazard ratio (HR): 1.281, 95% confidence interval (CI): 1.219 to 1.344), anxiety (HR: 1.391, 95% CI: 1.280 to 1.536), and depression (HR: 1.703, 95% CI: 1.551 to 1.871). Increased sedentary behavior (SB) and reduced moderate-to-vigorous physical activity (MVPA) caused by chronic pain both increased the risk of mental disorders. Twenty-four-hour movement behaviors explained the relationship between chronic pain and overall mental disorders, depression, and anxiety by 10.77%, 5.70%, and 6.86%, respectively. Interaction effects were found between MVPA and chronic pain when predicting the incidence of depression and between MVPA, sleep (SLP), and chronic pain when predicting the incidence of mental disorders. People with chronic pain would recommend at least 0.5 h per day of MVPA and 7 h per day of SLP and restricting SB below 11.5 h per day. CONCLUSIONS: Twenty-four-hour movement behaviors played a significant mediating role in the association between chronic pain and mental disorders. Individuals with chronic pain should engage in more MVPA, less sedentary behavior, and have 7-h sleep per day.

Trajectories network analysis of chronic diseases among middle-aged and older adults: evidence from the China Health and Retirement Longitudinal Study (CHARLS).

BACKGROUND: Given the increased risk of chronic diseases and comorbidity among middle-aged and older adults in China, it is pivotal to identify the disease trajectory of developing chronic multimorbidity and address the temporal correlation among chronic diseases. METHOD: The data of 15895 participants from the China Health and Retirement Longitudinal Study (CHARLS 2011 - 2018) were analyzed in the current study. Binomial tests and the conditional logistic regression model were conducted to estimate the associations among 14 chronic diseases, and the disease trajectory network analysis was adopted to visualize the relationships. RESULTS: The analysis showed that hypertension is the most prevalent disease among the 14 chronic conditions, with the highest cumulative incidence among all chronic diseases. In the disease trajectory network, arthritis was found to be the starting point, and digestive diseases, hypertension, heart diseases, and dyslipidemia were at the center, while memory-related disease (MRD), stroke, and diabetes were at the periphery of the network. CONCLUSIONS: With the chronic disease trajectory network analysis, we found that arthritis was prone to the occurrence and development of various other diseases. In addition, patients of heart diseases/hypertension/digestive disease/dyslipidemia were under higher risk of developing other chronic conditions. For patients with multimorbidity, early prevention can preclude them from developing into poorer conditions, such as stroke, MRD, and diabetes. By identifying the trajectory network of chronic disease, the results provided critical insights for developing early prevention and individualized support services to reduce disease burden and improve patients' quality of life.

Relationship between physical activity and mental health in a national representative cross-section study: Its variations according to obesity and comorbidity.

BACKGROUND: Physical activity is positively associated with mental health in obese people with chronic comorbidities. However, how physical activity types (PATs), physical activity frequency (PAF), and physical activity duration (PAD) are associated with mental health need to be further clarified. The current study investigated and compared the effectiveness of PATs, physical activity frequency PAF and PAD for mental health in obese people with various chronic comorbid conditions. METHODS: This cross-sectional study included 871,919 adults who participated in the Behavioral Risk Factor Surveillance System (BRFSS). They were divided into four groups: healthy people, obese people with 0, 1, and 2+ chronic comorbid conditions. The zero-inflated negative binomial (ZINB) regression model and the generalized additive model were used to explore the association between physical activity and mental health burden in the four groups, respectively. RESULTS: Jogging (30.00%), hiking (28.36%) and bicycling (28.32%) have greater improvement in mental health of healthy people; jogging (19.25%), golf (19.95%) and bicycling machine exercise (19.13%) showed a greater improvement in mental health of obese people with no chronic comorbid condition; and aerobic exercise videos or class showed a greater improvement in mental health of obese people with one chronic comorbid condition (22.14%) and obese people with two or more chronic comorbid conditions (19.60%). Non-linear relationships were observed between PAF, PAD, and energy expenditure and mental health. The healthy participants who exercised about 10-15 times a month and 40-50 min per session or about 400-600 METs-min per week had greater benefits for mental health. However, the lowest point of the smooth curve moved to the left with an increasing number of chronic comorbid conditions in obese people. CONCLUSIONS: Almost all PATs were associated with better mental health, but their benefits decreased with increasing number of chronic comorbid conditions in obese people. There were U-shaped relationships between mental health and weekly physical activity frequency, duration, and METs-min.