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. 2022 Aug;13(4):1983-1994.
doi: 10.1002/jcsm.12963. Epub 2022 Jun 8.

Muscle strength and incidence of depression and anxiety: findings from the UK Biobank prospective cohort study

Verónica Cabanas-Sánchez  1   2 , Irene Esteban-Cornejo  3 , Solange Parra-Soto  2   4 , Fanny Petermann-Rocha  2   4   5 , Stuart R Gray  2 , Fernando Rodríguez-Artalejo  1   6   7 , Frederick K Ho  4 , Jill P Pell  4 , David Martínez-Gómez  1   6 , Carlos Celis-Morales  2   8
Affiliations

Muscle strength and incidence of depression and anxiety: findings from the UK Biobank prospective cohort study

Verónica Cabanas-Sánchez et al. J Cachexia Sarcopenia Muscle. 2022 Aug.

Abstract

Background: Depression and anxiety are the leading mental health problems worldwide; depression is ranked as the leading cause of global disability with anxiety disorders ranked sixth. Preventive strategies based on the identification of modifiable factors merit exploration. The aim of the present study was to investigate the associations of handgrip strength (HGS) with incident depression and anxiety and to explore how these associations differ by socio-demographic, lifestyle, and health-related factors.

Methods: The analytic sample comprised 162 167 participants (55% women), aged 38-70 years, from the UK Biobank prospective cohort study. HGS was assessed at baseline using dynamometry. Depression and anxiety were extracted from primary care and hospital admission records. Cox proportional models were applied, with a 2 year landmark analysis, to investigate the associations between HGS and incident depression and anxiety.

Results: Of the 162 167 participants included, 5462 (3.4%) developed depression and 6614 (4.1%) anxiety, over a median follow-up period of 10.0 years (inter-quartile range: 9.3-10.8) for depression and 9.9 (inter-quartile range: 9.0-10.8) for anxiety. In the fully adjusted model, a 5 kg lower HGS was associated with a 7% (HR: 1.07 [95% CI: 1.05, 1.10]; P < 0.001) and 8% (HR: 1.08 [95% CI: 1.06, 1.10]; P < 0.001) higher risk of depression and anxiety, respectively. Compared with participants in the sex and age-specific highest tertiles of HGS, those in the medium and lowest tertiles had an 11% (HR: 1.11 [95% CI: 1.04, 1.19]; P = 0.002) and 24% (HR: 1.24 [95% CI: 1.16, 1.33]; P < 0.001) higher risk of depression and 13% (HR: 1.13 [95% CI: 1.06, 1.20]; P < 0.001) and 27% (HR: 1.27 [95% CI: 1.19, 1.35]; P < 0.001) higher risk of anxiety, respectively. The association of HGS with depression was stronger among participants with average or brisk walking pace (vs. slow walking pace; Pinteraction < 0.001). The association with anxiety was stronger in those participants aged ≥58 years (vs. ≤58 years; Pinteraction = 0.002) and those living in more affluent areas (vs. deprived; Pinteraction = 0.001).

Conclusions: Handgrip strength was inversely associated with incident depression and anxiety. Because HGS is a simple, non-invasive, and inexpensive measure, it could be easily used in clinical practice to stratify patients and identify those at elevated risk of mental health problems. However, future research should assess if resistance training aimed at increasing HGS can prevent the occurrence of mental health conditions.

Keywords: Anxiety; Depression; Grip strength; Mental disorders; Mental health; Muscular fitness.

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Conflict of interest statement

All the authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare the following: UK Biobank was established by the Wellcome Trust medical charity, Medical Research Council, Department of Health, Scottish government, and Northwest Regional Development Agency; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Penalized cubic spline analyses for the association of handgrip strength with (A–C) depression and (D–F) anxiety incidence. Data are presented as hazard ratio (HR) (thick blue line) and their 95% confidence interval (shaded areas). Participants with depression, anxiety, or mental health conditions at baseline were excluded from the analyses. A 2 year landmark analysis was applied. Analyses were adjusted for Model 1 (top plots) by socio‐demographic variables, including age, sex, deprivation index, and ethnicity; Model 2 (middle plots) was additionally adjusted by lifestyle factors, including smoking status, alcohol intake, walking pace, TV viewing, sleep time, and dietary intake (fruits and vegetables, read meat, processed meat, and oily fish intake); and Model 3 (bottom plots) was additionally adjusted by health markers, including body mass index and multimorbidity.
Figure 2
Figure 2
Depression incidence per 5 kg lower handgrip strength stratified by socio‐demographic, lifestyle, and health‐related factors. Analyses were adjusted for age, sex, deprivation index, ethnicity, smoking status, alcohol intake, walking pace, TV viewing, sleep time, dietary intake (fruits and vegetables, red meat, processed meat, and oily fish intake), body mass index, and multimorbidity, eliminating as co‐variable the grouping variable in each case. CI, confidence interval; HR, hazard ratio.
Figure 3
Figure 3
Anxiety incidence per 5 kg lower handgrip strength stratified by socio‐demographic, lifestyle, and health‐related factors. Analyses were adjusted for age, sex, deprivation index, ethnicity, smoking status, alcohol intake, walking pace, TV viewing, sleep time, dietary intake (fruits and vegetables, red meat, processed meat, and oily fish intake), body mass index, and multimorbidity, eliminating as co‐variable the grouping variable in each case. CI, confidence interval; HR, hazard ratio.
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