Association between physical activity and comorbid anxiety/depression in 46 low- and middle-income countries

Background: Evidence on the association of low physical activity (PA) with depression or anxiety is well estab-lished. Yet, evidence on the association between PA and comorbid anxiety/depression remains scarce, especially in low-and middle-income countries (LMICs). Thus, this study explored this relationship among adults aged >= 18 years from 46 LMICs.Methods: Cross-sectional, community-based data were analyzed from the World Health Survey (WHS). Multi -variable multinomial logistic regression analysis was conducted to examine the association between low PA and comorbid anxiety/depression with no anxiety or depression as the base category.Results: 237,023 participants [mean (SD) age = 38.4 (16.0) years; 50.8 % female] were included in the analysis. Low PA was significantly associated with depression alone (OR = 1.33; 95%CI = 1.12-1.57) and anxiety alone (OR = 1.37; 95%CI = 1.23-1.53), while the OR was highest among those with comorbid anxiety/depression (OR = 1.75; 95%CI = 1.52-2.01).Conclusion: Low PA is associated with particularly increased odds for comorbid anxiety/depression. Increasing PA may have a beneficial effect on the prevention of comorbid anxiety/depression. However, future longitudinal research establishing the direction of this relationship is warranted.