Associations of 24-h movement behaviors with depressive symptoms among cancer survivors: findings from the NHANES 2011–2014

BACKGROUND: Cancer survivors have a high prevalence of depressive symptoms. Moderate-to-vigorous physical activity (MVPA), sedentary time, and sleep are key modifiable behaviors associated with depressive symptoms. This study examines the associations between accelerometer-measured 24-h movement behaviors and self-reported depressive symptoms in cancer survivors. METHODS: This is a cross-sectional analysis using data from the NHANES 2011-2012 and 2013-2014 cycles. The 24-h movement behaviors were measured by wrist accelerometers, including MVPA, sedentary time, and nightly sleep time. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Robust Poisson regression was used to estimate the prevalence ratio (PR) with their respective 95% confidence intervals (CI) for the categorical depression outcomes, considering independent and combined analyses of the exposures. RESULTS: Data from 683 adults (aged 65.0 ± 13.1 years, females 55.5%) were analyzed. In mutually adjusted analyses, compared with inactive cancer survivors (< 150 min/week), those who were active (≥ 150 min/week of MVPA) had lower depressive symptoms (PR = 0.70; p = 0.026). Sedentary and sleep time were not independently associated with depressive symptoms. Meeting the combined recommendations for both MVPA and sedentary time (PR = 0.77; p = 0.044) and for MVPA and sleep time (PR = 0.76; p = 0.041) was associated with fewer depressive symptoms. Similarly, meeting the combined recommendations for sedentary and sleep time (PR = 0.64; p = 0.009), as well as all three behaviorrecommendations simultaneously (PR = 0.64; p = 0.009), were associated with lower symptoms. CONCLUSION: MVPA was consistently associated with fewer depressive symptoms among cancer survivors, whereas sedentary and sleep time alone showed no independently association. Combined movement behaviors patterrns, particularly were also associated with a lower prevalence of depressive symptoms, reinforcing the potential relevance of an integrated 24-hour movement behavior approach for mental health in this population. IMPLICATIONS FOR CANCER SURVIVORS: Strategies that promote physically active lifestyles and other healthy (non)movement behaviors, including reduced sedentary time and adequate sleep time, may help support mental health among cancer survivors.