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

Abstract 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.