Systemic immune-inflammatory index mediates the association between regular walking and depression in the elderly with coronary heart disease

Systemic immune-inflammatory index mediates the association between regular walking and depression in the elderly with coronary heart disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Systemic immune-inflammatory index mediates the association between regular walking and depression in the elderly with coronary heart disease Yanmin Ju, Xuncan Liu, Liang Zhao, Xixi Xie, Haoyue Jin, Jinying Chi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5885365/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Jun, 2025 Read the published version in BMC Geriatrics → Version 1 posted 8 You are reading this latest preprint version Abstract Background Depressive disorders and coronary heart disease (CHD) are significant and pervasive global public health challenges, influenced by various factors such as diet, physical activity, social circumstances, and lifestyle habits. This study aim to investigate the relationship among regular walking, the systemic immune-inflammation index (SII), and depression in CHD patients. Additionally, it seeks to explore the mediating role of SII in the effect of regular walking on depression among these patients. Methods This cross-sectional study involved 464 patients aged ≥ 65 years with CHD, admitted to the cadre ward of the First Hospital of Jilin University from September 2021 to December 2022. A comprehensive geriatric assessment (CGA) inventory was prepared by compiling and screening regular walking, calculated SII, and the Geriatric Depression Scale (GDS). Binary logistic regression was employed to examine the relationship among walking, ln(SII) and depression. After adjusting for confounding factors, linear regression analysis was used to assess the correlation among exercise-related factors, ln(SII) and depression. Sensitivity analyses were performed through stratified analysis, investigating the relationship between walking and depression within the strata of each variable, as well as the P -interaction among stratified variables. Additionally, the Process package in SPSS was used to explore the mediating role of ln(SII) in the association between regular walking and depression. The proportion of the mediating effect was calculated using the formula:(mediated effect / total effect) × 100%. Results Model 2: Elderly individuals who walk regularly are 72.2% less likely to experience depression compared to those who do not engage in regular walking (odds ratio (OR) = 0.278, 95% CI = 0.178–0.433, P < 0.001). However, one-unit increases in ln(SII) corresponds to an approximately sixfold in the likelihood of depression among elderly individuals (OR = 5.899, 95% CI = 4.183–8.318, P < 0.001). Model 3: Participants who walk regularly are 69.4% less likely to suffer from depression compared to those who do not walk regularly (OR = 0.306, 95% CI = 0.190–0.491, P < 0.001). Similarly, a one-unit increase in ln(SII) is associated with an approximately sixfold increase in the probability of depression elderly individuals (OR = 5.976, 95% CI = 4.126–8.656, P < 0.001). The stratified analysis examining the effect of regular walking on depression in patients with CHD confirms the robustness of these associations. Additionally, SII was found to mediate the relationship between regular walking and depression in CHD patients, accounting for 43.19% of the total effect. Conclusions An interaction exists among SII, regular walking and depression in elderly patients with coronary heart disease. Furthermore, SII partially mediates the relationship between regular walking and depression. Systemic immune-inflammation index regular walking depression elderly coronary heart disease Figures Figure 1 1. Introduction The main symptoms of depression in the elderly include impaired cognitive function, reduced executive capabilities, diminished language fluency, delayed thinking, difficulty concentrating, decreased memory, and weakened problem-solving abilities [ 1 ] . Additionally, elderly depression heightens the risk of cerebrovascular disease (CVD), ischemic heart disease, cancer and suicide [ 2 ] . Diagnosing depression in older adults is notably complex due to its significant clinical polymorphism, which includes challenges in recognizing depressive symptoms, frequent reporting of physical ailments, and a heightened risk of associated disabilities-factors that can severely impact quality of life [ 3 ] . In China, the prevalence of depression among older adults stands at 22.7% [ 4 ] . ‌Similarly, an estimated 20.04% of adults aged 65 and over in the United States experience depression, with severe cases showing an upward trend [ 5 ] . It is noteworthy that the prevalence of depression is markedly higher among patients with CHD, approximately three times that of the general population [ 6 ] . Previous research suggests that SII may be a potential risk factor for depression [ 7 ] , while regular walking has been shown to alleviate negative emotions in patients with depression [ 8 ] . Recent evidence suggests that immune-inflammatory mediators play a pivotal role in regulating various immune and inflammatory processes, thereby increasing the risk of depression [ 9 , 10 ] . SII is a novel composite indicator derived from the ratio of neutrophils to lymphocytes and platelet count. Consequently, SII is hypothesized to outperform the neutrophil-to-lymphocyte ratio as a biomarker of inflammation in certain diseases [ 11 ] . A study utilizing data from the National Health and Nutrition Examination Survey (NHANES) revealed that elevated SII levels significantly heighten the risk of depression, highlighting its potential as a biomarker for anti-inflammatory treatments targeting depression [ 7 ] . Another investigation based on the same database demonstrated that, even after adjusting for confounding variables, high SII level remained an independent risk factor for depression in patients with diabetes [ 12 ] . Nevertheless, limited research has explored the relationship between SII and depression in elderly patients with CHD. Currently, suboptimal treatment outcomes, poor compliance and low uptake of prescribed therapies underscore the growing need for alternative and supplementary treatment options [ 13 , 14 ] . Systematic reviews and meta-analyses have shown that exercise not only enhances the effectiveness of medication in alleviating and treating depression but also reduces metabolic risk factors associated with cardiovascular disease, improves brain function, and mitigates medication side effects [ 15 ] . Furthermore, exercise exhibits direct antidepressant effects and offers promising protective benefits [ 16 – 18 ] . Previous research has established a connection between walking [ 19 ] and SII [ 20 ] with depression. However, the interplay among walking, SII and depression remains unclear. In this study, we hypothesize that SII mediates the relationship between walking and depression in elderly patients with CHD. To investigate this, we will analyze the correlation using date from the comprehensive geriatric assessment (CGA) database. 2. Materials and Methods 2.1 Sample This cross-sectional study(excluding the establishment of causation), consecutively 480 patients aged 65 years or older with CHD. The patients were admitted to the Cadre Ward Department of the First Hospital of Jilin University from September 2021 to December 2022. All participants underwent coronary angiography prior to enrollment, confirming the diagnosis of CHD, and all were in the stable phase of the disease. Only elderly patients who voluntarily agreed to participate in the study were included. Patients were excluded if they were unable to walk due to neuromusculoskeletal disorders, such as severe cerebrovascular disease, Parkinson’s disease, knee or hip osteoarthritis, or lumbar spinal stenosis. Those with severe cognitive impairment, infections, autoimmune diseases, severe liver and kidney dysfunction, or malignant tumors, were also excluded. Additionally, 16 participants were excluded due to incomplete data following a CGA. Ultimately, 464 patients were included in the study. The research adhered to the Helsinki Declaration and was approved by the Ethics Committee of the First Hospital of Jilin University (21K103-002). 2.2 Data Measurement 2.2.1 Depression assessment The Geriatric Depression Scale (GDS) is a screening questionnaire specifically designed for older adults. It consists of 30 items, intentionally omitting physical symptoms to prevent confusion between common physical ailments and underlying physical illnesses [ 21 ] . Among these items, 10 questions with a "no" response indicate depressive symptoms, while 20 questions with a "yes" response are also associated with depressive symptoms. A GDS score exceeding 10 is indication of depression. Previous studies have shown that this threshold demonstrates 100% sensitivity and 84% specificity when compared to other depression assessment scale criteria [ 22 ] . 2.2.2 Regular Walking Regular walking is defined as patients engaging in walking [ 8 ] for over one hour per day, at least five days per week (Patients document the number of days they walk each week alongside the total duration of their walking). Systemic immune inflammatory (SII) Blood samples were collected by a qualified nurse after an overnight fast, the morning following hospital admission. These samples were then analyzed by clinical laboratory technicians in a certified hospital laboratory. SII was calculated using the formula: SII = P × N/L, where P, N and L represent the respective counts of peripheral platelets, neutrophils, and lymphocytes [ 11 ] . 2.2.3 Covariate Assessment General information General information was gathered about the patients, including their age, gender, high-fat diet (HFD) (high-fat diet defined as the habitual consumption of foods rich in fatty acids, but low in fiber, vitamins and minerals [ 23 ] .), smoking history, drinking history (referring to regular smoking and drinking habits, regardless of quantity and sustained for over a year.), and the presence of chronic disease such as hypertension, diabetes or CVD. Activities of Daily Living and Instrumental Activities of Daily Living (ADLs and IADLs) Composite scores for ADLs and IADLs are calculated based on various activities. ADLs encompass essential self-care tasks such an walking, eating, dressing, washing hair, brushing teeth, and using the toilet routinely. Meanwhile, IADLs include more complex activities necessary for independent living, such as driving or using a vehicle, preparing meals, performing household chores, doing laundry, shopping, managing medications, making phone calls, and organizing personal belongings [ 24 ] . Anthropometric measurements and blood biochemical indicators The body composition of all patients was assessed using Bioelectrical Impedance Analysis (BIA) with the Inbody S10 device (Biospace, Seoul, South Korea) [ 25 ] . BIA employs electrical impedance measurements at varying frequencies to evaluate parameters such as upper arm circumference (UAC), calf circumference (CC), body fat rate (BFR), visceral fat area (VFA), and muscle mass (MM) [ 26 ] . In addition, blood biochemical indicators including triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) were analyzed. 3. Statistical Analysis The statistical analysis in this study was conducted using SPSS/WIN 23.0 software (IBM Corp., Armonk, NY, United States) and GraphPad Prism 8 (GraphPad Prism Software Inc., San Diego, CA, United States). The Kolmogorov-Smirnov test (K-S test) was used to test the normality of continuous variables. Continuous variables conforming to the normal distribution were expressed as mean ± standard deviation (SD), whereas those that did not adhere to the normal distribution were described using median and inter-quartile range (IQR). To detect differences between non-depression group and depression group, the independent sample t-test or the Mann-Whitney U test was utilized. Categorical variables were presented as absolute values and percentages, with chi-square tests applied to compare between the two groups. The SII was transformed using a natural logarithm to normalize the data, yielding the variable ln(SII). Binary logistic regression was performed to explore relationships among walking, ln(SII) and depression. After adjusting for confounding factors, linear regression analyses were further used to evaluate links among exercise-related factors, ln(SII) and depression. (Model 1 did not adjust for confounding factors, while Model 2 adjusted for age, HFD, Hypertension, Diabetes, CVD, ADLs and IADLs. In addition, besides adjusting the factors of Model 2, Model 3 also adjusted UAC, CC, ,BFR, MM, TG, LDL-c.) Sensitivity analysis was performed using stratified analysis to assess the correlation between walking and depression cross various stratified variables, along with P -interaction values among these factors. Furthermore, the mediating role of ln(SII) between walking and depression was analyzed using Process package of SPSS. The proportion of the mediating effect was calculated with the formula: (mediated effect / total effect)× 100%. 4. Result Characteristics of participants non-depression and depression. This study included a total of 464 participants, comprising 313 participants without depression and 151 participants with depression. The prevalence of depression among elderly individuals with CHD was calculated to be 32.54%. Compared to non-depressed patients, depressed individuals demonstrated higher ln(SII) levels( P < 0.05). Additionally, the proportion of depressed patients who engaged in walking was lower, while the prevalence of HFD and exercise-related conditions such as hypertension, diabetes and CVD was notably higher ( P < 0.05); Furthermore, depressed patients, exhibited higher motor-related indicators, including ADLs and IADLs, BFR, VFA, TG and LDL-c, whereas other indicators such as UAC, CC and MM were comparatively lower ( P < 0.05);Notably, depressed patients were also relatively older in comparison to their non-depressed counterparts ( P < 0.05) (Table 1). Table 1. Characteristics of participants non-depression and depression. Variates Non-depression(N=313) Depression(151) P Age, years 80.24 ± 8.76 82.11 ± 8.98 0.033 Gender, % Male 203(64.86) 92(60.93) 0.410 Female 110(35.14) 59(39.07) Walking, % Yes 189(60.38) 44(29.14) <0.001 No 124(39.62) 107(70.86) HFD, % Yes 84(26.84) 69(45.70) <0.001 No 229(73.16) 82(54.30) Smoking, % Yes 104(33.23) 46(30.46) 0.551 No 209(66.77) 105(69.54) Drinking, % Yes 74(23.64) 41(27.15) 0.412 No 239(76.36) 110(72.85) Hypertension, % Yes 149(47.60) 88(58.28) 0.031 No 164(52.40) 63(41.72) Diabetes, % Yes 106(33.87) 81(53.64) <0.001 No 207(66.13) 70(46.36) CVD,% Yes 105(33.55) 67(44.37) 0.024 No 208(66.45) 84(55.63) ADLs and IADLs 17.00(14.00, 23.00) 20.00(17.00, 29.00) <0.001 Ln(SII) 6.38 ± 0.79 7.70 ± 0.83 <0.001 UAC, cm 27.76 ± 3.35 26.74 ± 3.29 0.002 CC, cm 33.27 ± 3.27 31.65 ± 4.24 <0.001 BFR, % 28.87 ± 6.39 31.05 ± 4.95 <0.001 VFA, cm² 85.10(64.05, 107.20) 90.30(71.10, 121.40) 0.038 MM, kg 45.71 ± 8.02 42.30 ± 7.63 <0.001 TG, mmol/L 1.17(0.88, 1.58) 1.62(1.07, 1.90) <0.001 LDL-C, mmol/L 2.54(1.80, 3.10) 2.91(2.04, 3.47) 0.002 Abbreviation: high-fat diet, HFD; cerebrovascular disease, CVD; Activities of Daily Living and Instrumental Activities of Daily Living, ADLs and IADLs; systemic immune inflammatory, SII; upper arm circumference, UAC; calf circumference, CC; body fat rate, BFR; visceral fat area, VFA; muscle mass, MM; triglycerides, TG; low-density lipoprotein cholesterol, LDL-C. P < 0.05 indicates that the difference is statistically significant. Logistic regression model of the impact of walking and ln(SII) on depression. Model 1: The results of the unadjusted multivariable logistic regression model revealed significant correlation between walking (OR = 0.270, 95% CI = 0.178–0.410, P < 0.001) and Ln(SII) (OR = 6.375, 95% CI = 4.578–8.877, P < 0.001) and depression; Model 2: After adjusting for age, HFD, hypertension, diabetes, CVD, ADLs and IADLs, it was observed that participants who engage in regular walking are 72.2% less likely to experience depression compared to their counterparts who do not walk regularly (OR = 0.278, 95% CI = 0.178–0.433, P < 0.001). Conversely, for every unit increase in ln(SII), the likelihood of depression among elderly individuals rises approximately sixfold (OR = 5.899, 95% CI = 4.183–8.318, P < 0.001). Model 3: Beyond the adjustments made in Model 2, additional factors including UAC, CC, BFR, MM, TG, and LDL-c were taken into account. In this adjusted model, participants who engage in regular walking are 69.4% less likely to suffer from depression compared to those who do not walk regularly (OR = 0.306, 95% CI = 0.190–0.491, P < 0.001). Similarly, for every unit increase in ln(SII), the likelihood of depression in elderly individuals rises approximately sixfold (OR = 5.976, 95% CI = 4.126–8.656, P < 0.001) (Table 2 ). Table 2 Logistic regression model of the impact of walking and Ln(SII) on depression Model 1 a Model 2 b Model 3 c OR 95%(CI) P OR 95%(CI) P OR 95%(CI) P Walking 0.270(0.178, 0.410) < 0.001 0.278(0.178, 0.433) < 0.001 0.306(0.190, 0.491) < 0.001 Ln(SII) 6.375(4.578, 8.877) < 0.001 5.899(4.183, 8.318) < 0.001 5.976(4.126, 8.656) < 0.001 Abbreviation: Systemic immune inflammatory, SII a unadjusted b adjusted for age, HFD, Hypertension, Diabetes, CVD, ADLs and IADLs c adjusted for b + UAC, CC, ,BFR, MM, TG, LDL-c P < 0.05 indicates that the difference is statistically significant. Linear regression analysis of factors related to exercise with GDS score and ln (SII). The linear regression analysis of GDS score and ln (SII) with factors related to exercise shows that: Compared to elderly CHD patients who do not engage in regular walking, those who maintain a consistent walking routine exhibit significantly lower GDS scores ( β = -1.488, P < 0.001). Their UAC (β = -0.153, P = 0.019) and MM ( β = -0.074, P = 0.002) are negatively correlated with GDS scores, and HFD ( β = 2.641, P < 0.001), TG ( β = 0.782, P = 0.001), LDL-C ( β = 0.598, P = 0.001), and ADLs and IADLs ( β = 0.071, P = 0.003) were positively correlated with GDS scores. Compared with elderly CHD patients who walk regularly, those who do not engage in regular walking exhibit higher ln(SII) value ( β = -0.351, P < 0.001). Their CC levels (β = -0.039, P = 0.007) show a negative correlation with ln(SII) values, while HFD ( β = 0.522, P < 0.001), ADLs and IADLs ( β = 0.016, P = 0.005) display positive correlation. Furthermore, elderly patients CHD with a history of diabetes, demonstrate significantly higher ln(SII) values compared to those without such a history ( β = 0.318, P = 0.001)(Table 3 ). Table 3 Linear regression analysis of factors related to exercise with GDS score and Ln (SII). Variates GDS score Ln(SII) β P β P Walking -1.488 < 0.001 -0.351 < 0.001 HFD 2.641 < 0.001 0.522 < 0.001 UAC -0.153 0.019 0.011 0.490 CC -0.088 0.153 -0.039 0.007 BFR 0.056 0.071 0.007 0.362 MM -0.074 0.002 -0.010 0.077 TG 0.782 0.001 0.021 0.695 LDL-C 0.598 0.001 0.058 0.197 ADLs and IADLs 0.071 0.003 0.016 0.005 Hypertension 0.524 0.159 0.072 0.415 Diabetes 0.683 0.080 0.318 0.001 CVD 0.658 0.087 0.072 0.435 Abbreviation: Geriatric Depression Scale, GDS; systemic immune inflammatory, SII; high-fat diet, HFD; upper arm circumference, UAC; calf circumference, CC; body fat rate, BFR, visceral fat area, VFA, muscle mass, MM; triglycerides, TG; low-density lipoprotein cholesterol, LDL-C; Activities of Daily Living and Instrumental Activities of Daily Living, ADLs and IADLs; ,cerebrovascular disease, CVD. P < 0.05 indicates that the difference is statistically significant. Hierarchical regression analysis of the effect of regular walking on depression in elderly patients with CHD. In Table 4 , we analyzed the interaction between covariates and regular walking, finding no significant interaction ( P -interaction > 0.05). The result indicates that the association remains consistent across various subgroups. Additionally, the table presents the outcomes of hierarchical regression analysis. When combined with the findings from Tables 2 and 3 , the data demonstrate a significant relationship between depression and regular walking in CHD patients, along with the mediating role of SII (Table 4 ). The mediating role of Ln(SII) in the association between regular walking and GDS scores. As shown in Fig. 1 , the result reveal the following: Total Effect = -3.2372( P < 0.001), Indirect Effects = -1.8365( P < 0.001) and Mediated Effect = -1.3961( P < 0.001). These relationships are governed by the equation: Total Effect = Direct Effect + Indirect Effect, which in this case is expressed as: -3.2327 = -1.8365 + -1.3961. The proportion of the intermediate effects is calculated as Mediated Effect / Total Effects (%) = -1.3961/-1.8365 = 43.19%. This demonstrates that the Mediated Effect contributes 43.19% to the Total Effect, a result that is both statistically significant and visually supported by Fig. 1 . 5. Discussion This study utilizes the CGA database to examine the relationship among regular walking habits, SII, and depression in elderly patients with CHD. The prevalence of depression in this population is 32.54%. Notably, SII serves as a mediator in the association between regular walking and depression, with the mediated effect accounting for 43.19% of the total effect. To the best of knowledge, this is the first study to investigate the interplay among regular walking, SII, and depression in elderly individuals with CHD. Additionally, linear regression analysis revealed several exercise-related factors associated with SII and depressive disorders in CHD patients. Regular walking, UAC and MM were identified as protective factors against depression. In contrast, HFD, TG, LDL-C, as well as limitations in ADLs and IADLs, emerged as risk factors for depression. An interventional randomized controlled study revealed that exercise intervention can reduce SII in children with cancer [27] . Similarly, findings from an analysis based on the NHANES database examining the correlation between lifestyle characteristics in the general population and SII, indicated that physical activity is negatively correlated with SII. These results suggest that reducing inflammation through lifestyle improvements may offer greater benefits for disease prevention [28] . Additionally, a cross-sectional study involving blood samples from 195 healthy national Olympic team athletes, collected before and after exercise, identified a negative correlation between aerobic exercise and SII upon analysis [29] . In parallel, a review focusing on SII as an immune marker in clinical practice, explore its link with exercise physiology, emphasizing that chronic physical activity may aid in improving SII [30] . Furthermore, researchers studying populations characterized by short sleep durations observed that engaging in up to 2400 minutes of physical exercise per week was associated with lower SII levels, though increased exercise beyond this threshold did not yield added benefits [31] . These studies consistently highlight the association between exercise and SII, supporting the conclusions drawn from our research findings. Extensive prior research has consistently demonstrated a significant correlation between exercise and depression. For instance, a randomized controlled study involving 48 patients with severe depression revealed that walking could alleviate negative emotions in these patients; however, the effects were not sustained beyond 48 hours [8] . Another randomized clinical trial, conducted in a primary healthcare setting, examined 347 patients aged 65 years and older with mild to moderate depressive disorders. Results indicated that patients receiving both antidepressant medication and physical activity interventions experienced a reduction in depressive symptoms, with the physical activity group showing superior outcomes in the medium term [32] . Additionally, a cross-sectional survey conducted in northern China, assessed the relationship between physical exercise frequency and depression among 1604 urban residents aged 50 and older. The research found that the prevalence of depression in urban communities in Jinan was 16.52%, with exercising three times per week being associated with a lower prevalence of depression [33] . Surprisingly, some prior studies have corroborated the notion that exercise may be as effective as medication in reducing depressive symptoms in patients with depression [34, 35] . Exercise appears to alleviate depression through various mechanisms one of which is its neurobiological impact. Aerobic exercise acutely regulates key physiological factors such as 5-HT/NE, BDNF, TNF-α, IL-6, and IL-10 [15] . Physical activity has been shown to alleviate symptoms of depression in patients to varying degrees. While studies indicate that the antidepressant effect of exercise may not be long-lasting, the advantages of regular moderate, and appropriately tailored exercise for individuals with depression are well-established, particularly for those whose physical condition permits such activity. Both the decline in physiological function and the presence of emotional disorders are significant predictors of poor outcomes in patients with CHD. As such, integrating physical and psychological assessments and treatments has become increasingly critical in managing CHD patients. Effective cardiac rehabilitation exercises not only enhance exercise tolerance, heart function, and overall quality of life, but also lower the risks of major cardiovascular events, while mitigating psychological issues such as anxiety and depression [36] . Research has demonstrated that exercise based cardiac rehabilitation programs significantly improve the physical capacity of CHD patients [37] . Furthermore, a meta-analysis highlights the benefits of incorporation Tai Chi into rehabilitation programs, revealing that this form of holistic exercise can promote both physical and mental health in CHD patients. These findings suggest that Tai Chi may serve as a viable approach to cardiovascular rehabilitation [38] . Among various types of exercise recommended in clinical guidelines, brisk walking stands out for several reasons. It is a widely accessible and practical form of physical activity particularly living with CHD [39] . Research utilizing NHANES data indicates that the SII index is associated with an increased risk of depressive disorder, including depressive disorder coexisting with diabetes and post-stroke depressive disorder [7, 12, 40] . Additionally, a cross-sectional study identified SII as an independent risk factor for the development of CHD, highlighting its notable connection to the prediction and severity of the condition [41] . Among the general US population, a U-shaped correlation has been observed between the SII index and both all-cause mortality and cardiovascular disease-related mortality. Moreover, similar patterns have been identified in patients with CHD, angina pectoris, and myocardial infarction, where the association between SII and all-cause mortality in CHD patients also exhibits a U-shaped trend. However, in individuals with congestive heart failure, higher SII levels correspond to an increased rate of cardiovascular disease-relate mortality. These findings suggest that SII could serve as a clinical predictor of all-cause mortality in patients with cardiovascular conditions [42] . In summary, the SII demonstrates a substantial negative impact on both depression and CHD. Nevertheless, our study has not established a definitive causal relationship among these factors, and the mechanisms underlying their interactions remain unclear. Further investigation into these relationships could provide meaningful insights for disease prevention and the improvement of prognostic strategies. This study offers several key advantages. It investigates the mediating role of SII in the relationship between regular walking and depression by observing the daily habits of elderly patients with CHD, providing valuable insights into this population. Importantly, the elderly sample we collected demonstrates a certain degree of representativeness strengthening the study’s broader applicability. Additionally, this research offers theoretical support for preventing depression in elderly patients with CHD who are able to engage in walking. Walking, an inexpensive, convenient, and accessible form of exercise, is particularly suitable for the elderly, and has been shown to be an effective method for alleviating depression. It helps elderly CHD patients mitigate depressive symptoms, prevent psychological disorders, reduce hospitalization time, and conserve medical resources. However, this study also has several limitations. First, its cross-sectional design prevents the establishment of causation. Future longitudinal research would be invaluable in exploring the causal relationships among walking, SII, and depression. Second, some variables, such as walking habits were self-reported, and the lack of specific measurements, may have introduced recall bias, potentially leading to an overestimation or underestimation of the association between SII and depressive disorder in CHD patients. Third, there was no precise measurement of walking pace or quantification of walking duration, which limits the study’s findings. Additionally, the relatively small sample size underscores the need for future muti-center studies with large sample to enhance the robustness of the conclusions. Finally, incorporating additional factors, such as patients' medication use and economic status into future studies, would be meaningful as these variables could influence the results. Moreover, exploring age, gender and medical history on the relationship between walking and SII is critically important for more comprehensive understanding of this association. 6. Conclusion An interaction exists among SII, regular walking and depression in elderly patients with coronary heart disease. Furthermore, SII partially mediates the relationship between regular walking and depression. Declarations Funding support: Jilin Provincial Department of Science and Technology (20240305049YY) Acknowledgements Not applicable. Author contributions YMJ, ZLL and XCL drafted the manuscript. YMJ and LZ revised the manuscript. XXX, HYJ, and TYC made tables. YMJ, XCL and LZ were responsible for the data acquisition. JYC, SBM and XXX performed the data analysis. YMJ and ZLL performed the statistical analyses. YMJ, ZLL and XCL conceived of and designed the study. All authors have read and approved the final manuscript. Competing interests The authors declare no competing interests. Data availability statement If the request is reasonable, the first author will provide the original data that supports the conclusions of this article without reservation. 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Association between physical exercise and mental health in 1.2 million individuals in the USA between 2011 and 2015: a cross-sectional study [J]. Lancet Psychiatry. 2018;5(9):739–46. PEARCE M, GARCIA L, ABBAS A, et al. Association Between Physical Activity and Risk of Depression: A Systematic Review and Meta-analysis [J]. JAMA Psychiatry. 2022;79(6):550–9. DISHMAN R K, MCDOWELL C P, HERRING MP. Customary physical activity and odds of depression: a systematic review and meta-analysis of 111 prospective cohort studies [J]. Br J Sports Med. 2021;55(16):926–34. YU D J, YU A P, LEUNG C K, et al. Comparison of moderate and vigorous walking exercise on reducing depression in middle-aged and older adults: A pilot randomized controlled trial [J]. Eur J Sport Sci. 2023;23(6):1018–27. WANG M, PENG C, JIANG T, et al. Association between systemic immune-inflammation index and post-stroke depression: a cross-sectional study of the national health and nutrition examination survey 2005–2020 [J]. Front Neurol. 2024;15:1330338. YESAVAGE JA, BRINK T L, ROSE T L, et al. Development and validation of a geriatric depression screening scale: a preliminary report [J]. J Psychiatr Res. 1982;17(1):37–49. LYNESS JM, NOEL T K, COX C, et al. Screening for depression in elderly primary care patients. A comparison of the Center for Epidemiologic Studies-Depression Scale and the Geriatric Depression Scale [J]. Arch Intern Med. 1997;157(4):449–54. IMAMURA F, MICHA R, KHATIBZADEH S, et al. Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment [J]. Lancet Glob Health. 2015;3(3):e132–42. NUNES D P, BRITO T R P, GIACOMIN K C et al. Performance pattern of activities of daily living for older adults in the city of Sao Paulo in 2000, 2006, and 2010 [J]. Rev Bras Epidemiol, 2019, 21Suppl 02(Suppl 02): e180019. MORRIS JS, FRITH C D, PERRETT D I, et al. A differential neural response in the human amygdala to fearful and happy facial expressions [J]. Nature. 1996;383(6603):812–5. ZHANG K, JU Y, YANG D, et al. Correlation analysis between body composition, serological indices and the risk of falls, and the receiver operating characteristic curve of different indexes for the risk of falls in older individuals [J]. Front Med (Lausanne). 2023;10:1228821. WINKER M, STOSSEL S, NEU M A, et al. Exercise reduces systemic immune inflammation index (SII) in childhood cancer patients [J]. Support Care Cancer. 2022;30(4):2905–8. GUO L, HUANG Y, HE J, et al. Associations of lifestyle characteristics with circulating immune markers in the general population based on NHANES 1999 to 2014 [J]. Sci Rep. 2024;14(1):13444. ZACHER J, WESEMANN F, JOISTEN N, et al. Cellular Integrative Immune Markers in Elite Athletes [J]. Int J Sports Med. 2023;44(4):298–308. WALZIK D, JOISTEN N, ZACHER J, et al. Transferring clinically established immune inflammation markers into exercise physiology: focus on neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index [J]. Eur J Appl Physiol. 2021;121(7):1803–14. YOU Y, ABLITIP A, CHEN Y et al. Saturation effects of the relationship between physical exercise and systemic immune inflammation index in the short-sleep population: a cross-sectional study [J]. BMC Public Health, 2024, 24(1): 1920. HIDALGO JL, SOTOS J R, GROUP D-E. Effectiveness of Physical Exercise in Older Adults With Mild to Moderate Depression [J]. Ann Fam Med. 2021;19(4):302–9. WANG S, MA W, WANG SM et al. A Cross Sectional Examination of the Relation Between Depression and Frequency of Leisure Time Physical Exercise among the Elderly in Jinan, China [J]. Int J Environ Res Public Health, 2018, 15(9). KVAM S, KLEPPE C L, NORDHUS I H, et al. Exercise as a treatment for depression: A meta-analysis [J]. J Affect Disord. 2016;202:67–86. COONEY G M, DWAN K, GREIG C A, et al. Exercise for depression [J]. Cochrane Database Syst Rev. 2013;2013(9):CD004366. GOEL K, LENNON R J, TILBURY R T, et al. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community [J]. Circulation. 2011;123(21):2344–52. UDDIN J, ZWISLER A D, LEWINTER C, et al. Predictors of exercise capacity following exercise-based rehabilitation in patients with coronary heart disease and heart failure: A meta-regression analysis [J]. Eur J Prev Cardiol. 2016;23(7):683–93. FAN C, YAN H, LEI K, et al. Effect of Tai Chi-Based Psychosomatic Rehabilitation Exercise on Physiological Function and Mental Health of Patients with Coronary Heart Disease: A Meta-Analysis [J]. Rev Cardiovasc Med. 2024;25(6):227. WANG J, LIU H, CHEN C, et al. Physical Activity and Factors Affecting Its Maintenance Among Patients With Coronary Heart Disease Not Undergoing Cardiac Rehabilitation in China [J]. J Cardiovasc Nurs. 2020;35(6):558–67. HU J, WANG L, FAN K, et al. The Association Between Systemic Inflammatory Markers and Post-Stroke Depression: A Prospective Stroke Cohort [J]. Clin Interv Aging. 2021;16:1231–9. DONG W, GONG Y, ZHAO J, et al. A combined analysis of TyG index, SII index, and SIRI index: positive association with CHD risk and coronary atherosclerosis severity in patients with NAFLD [J]. Front Endocrinol (Lausanne). 2023;14:1281839. WANG XIAOS, ZUO Z. Association of Systemic Immune Inflammation Index with All-Cause, Cardiovascular Disease, and Cancer-Related Mortality in Patients with Cardiovascular Disease: A Cross-Sectional Study [J]. J Inflamm Res. 2023;16:941–61. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 06 Jun, 2025 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Revision requested 19 May, 2025 Reviews received at journal 13 May, 2025 Reviewers agreed at journal 19 Apr, 2025 Reviews received at journal 19 Apr, 2025 Reviewers agreed at journal 19 Apr, 2025 Reviewers invited by journal 17 Apr, 2025 Submission checks completed at journal 15 Apr, 2025 First submitted to journal 01 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5885365","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":444560876,"identity":"45e920e9-3184-49c7-98de-f7b7cafa1610","order_by":0,"name":"Yanmin Ju","email":"","orcid":"","institution":"the First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Yanmin","middleName":"","lastName":"Ju","suffix":""},{"id":444560878,"identity":"78ac6eaf-3a9b-4ed3-a852-3a4d3b8722b5","order_by":1,"name":"Xuncan Liu","email":"","orcid":"","institution":"the First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Xuncan","middleName":"","lastName":"Liu","suffix":""},{"id":444560880,"identity":"f6ab2ed0-5990-45f5-b195-f5bb1cb244c5","order_by":2,"name":"Liang Zhao","email":"","orcid":"","institution":"the First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Liang","middleName":"","lastName":"Zhao","suffix":""},{"id":444560881,"identity":"87d50002-e477-4d9b-9bb9-6d9a39b8d93e","order_by":3,"name":"Xixi Xie","email":"","orcid":"","institution":"the First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Xixi","middleName":"","lastName":"Xie","suffix":""},{"id":444560882,"identity":"77227856-3858-428f-9763-f0282ac4d0c9","order_by":4,"name":"Haoyue Jin","email":"","orcid":"","institution":"the First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Haoyue","middleName":"","lastName":"Jin","suffix":""},{"id":444560883,"identity":"a127aa8e-3215-4908-9b80-8e51159d1062","order_by":5,"name":"Jinying Chi","email":"","orcid":"","institution":"the First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Jinying","middleName":"","lastName":"Chi","suffix":""},{"id":444560884,"identity":"2d1f4932-93b1-4269-bc92-a04c65528e29","order_by":6,"name":"Songbai Miao","email":"","orcid":"","institution":"the First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Songbai","middleName":"","lastName":"Miao","suffix":""},{"id":444560885,"identity":"6c549098-c3ca-4304-b34f-cbe6fa1fd76c","order_by":7,"name":"Zhenlan Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIie3OMQuCQBTA8XcINxmtb9KvoAQufZmTIBejJqcG5UCXaBbsS/QNjANH5wYHJ2cnaSlSh0a9tqD7wxsO3o93ACrVL4b91AAGSYYXlSUMYEX4t8QNNVliZryo2bHyONctaAMByyycJuRSeBYrml3UE5KWArDKp4mGvoOMipFoi1iAhWyaUNx3yF7CIwN5yhAdfYpuLNhIiAxB3DronoUdcXq4nUpPx/sMMdNNg20nTDvh1/oRrI1lOkM+2SFAPvxUcn84J7+qUqlU/9YbZQY+htVal/UAAAAASUVORK5CYII=","orcid":"","institution":"the First Hospital of Jilin University","correspondingAuthor":true,"prefix":"","firstName":"Zhenlan","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2025-01-23 05:53:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5885365/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5885365/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-025-06085-3","type":"published","date":"2025-06-06T15:57:51+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81002071,"identity":"13406127-d236-414b-bbbc-2383d317d732","added_by":"auto","created_at":"2025-04-21 06:31:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":23603,"visible":true,"origin":"","legend":"\u003cp\u003eThe mediating role of Ln(SII) in the association between regular walking and GDS scores.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5885365/v1/6ca6cfb5d7be8044b6335382.png"},{"id":84242642,"identity":"82a9fb18-04bd-4597-bf8c-3ff6e6cf7f47","added_by":"auto","created_at":"2025-06-09 16:10:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":970638,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5885365/v1/f80d1cc2-64a5-46d3-a364-9e0bf798651a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Systemic immune-inflammatory index mediates the association between regular walking and depression in the elderly with coronary heart disease","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe main symptoms of depression in the elderly include impaired cognitive function, reduced executive capabilities, diminished language fluency, delayed thinking, difficulty concentrating, decreased memory, and weakened problem-solving abilities\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Additionally, elderly depression heightens the risk of cerebrovascular disease (CVD), ischemic heart disease, cancer and suicide\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Diagnosing depression in older adults is notably complex due to its significant clinical polymorphism, which includes challenges in recognizing depressive symptoms, frequent reporting of physical ailments, and a heightened risk of associated disabilities-factors that can severely impact quality of life\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. In China, the prevalence of depression among older adults stands at 22.7%\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. \u0026zwnj;Similarly, an estimated 20.04% of adults aged 65 and over in the United States experience depression, with severe cases showing an upward trend\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. It is noteworthy that the prevalence of depression is markedly higher among patients with CHD, approximately three times that of the general population\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Previous research suggests that SII may be a potential risk factor for depression\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, while regular walking has been shown to alleviate negative emotions in patients with depression\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRecent evidence suggests that immune-inflammatory mediators play a pivotal role in regulating various immune and inflammatory processes, thereby increasing the risk of depression\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. SII is a novel composite indicator derived from the ratio of neutrophils to lymphocytes and platelet count. Consequently, SII is hypothesized to outperform the neutrophil-to-lymphocyte ratio as a biomarker of inflammation in certain diseases\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. A study utilizing data from the National Health and Nutrition Examination Survey (NHANES) revealed that elevated SII levels significantly heighten the risk of depression, highlighting its potential as a biomarker for anti-inflammatory treatments targeting depression\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Another investigation based on the same database demonstrated that, even after adjusting for confounding variables, high SII level remained an independent risk factor for depression in patients with diabetes\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Nevertheless, limited research has explored the relationship between SII and depression in elderly patients with CHD.\u003c/p\u003e \u003cp\u003eCurrently, suboptimal treatment outcomes, poor compliance and low uptake of prescribed therapies underscore the growing need for alternative and supplementary treatment options\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Systematic reviews and meta-analyses have shown that exercise not only enhances the effectiveness of medication in alleviating and treating depression but also reduces metabolic risk factors associated with cardiovascular disease, improves brain function, and mitigates medication side effects\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Furthermore, exercise exhibits direct antidepressant effects and offers promising protective benefits\u003csup\u003e[\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePrevious research has established a connection between walking\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e and SII\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e with depression. However, the interplay among walking, SII and depression remains unclear. In this study, we hypothesize that SII mediates the relationship between walking and depression in elderly patients with CHD. To investigate this, we will analyze the correlation using date from the comprehensive geriatric assessment (CGA) database.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Sample\u003c/h2\u003e \u003cp\u003eThis cross-sectional study(excluding the establishment of causation), consecutively 480 patients aged 65 years or older with CHD. The patients were admitted to the Cadre Ward Department of the First Hospital of Jilin University from September 2021 to December 2022. All participants underwent coronary angiography prior to enrollment, confirming the diagnosis of CHD, and all were in the stable phase of the disease. Only elderly patients who voluntarily agreed to participate in the study were included. Patients were excluded if they were unable to walk due to neuromusculoskeletal disorders, such as severe cerebrovascular disease, Parkinson\u0026rsquo;s disease, knee or hip osteoarthritis, or lumbar spinal stenosis. Those with severe cognitive impairment, infections, autoimmune diseases, severe liver and kidney dysfunction, or malignant tumors, were also excluded. Additionally, 16 participants were excluded due to incomplete data following a CGA. Ultimately, 464 patients were included in the study. The research adhered to the Helsinki Declaration and was approved by the Ethics Committee of the First Hospital of Jilin University (21K103-002).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data Measurement\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Depression assessment\u003c/h2\u003e \u003cp\u003eThe Geriatric Depression Scale (GDS) is a screening questionnaire specifically designed for older adults. It consists of 30 items, intentionally omitting physical symptoms to prevent confusion between common physical ailments and underlying physical illnesses\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Among these items, 10 questions with a \"no\" response indicate depressive symptoms, while 20 questions with a \"yes\" response are also associated with depressive symptoms. A GDS score exceeding 10 is indication of depression. Previous studies have shown that this threshold demonstrates 100% sensitivity and 84% specificity when compared to other depression assessment scale criteria\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Regular Walking\u003c/h2\u003e \u003cp\u003eRegular walking is defined as patients engaging in walking\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e for over one hour per day, at least five days per week (Patients document the number of days they walk each week alongside the total duration of their walking).\u003c/p\u003e \u003cp\u003e \u003cb\u003eSystemic immune inflammatory (SII)\u003c/b\u003e \u003c/p\u003e \u003cp\u003eBlood samples were collected by a qualified nurse after an overnight fast, the morning following hospital admission. These samples were then analyzed by clinical laboratory technicians in a certified hospital laboratory. SII was calculated using the formula: SII\u0026thinsp;=\u0026thinsp;P \u0026times; N/L, where P, N and L represent the respective counts of peripheral platelets, neutrophils, and lymphocytes\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 Covariate Assessment\u003c/h2\u003e \u003cp\u003e \u003cem\u003eGeneral information\u003c/em\u003e \u003c/p\u003e \u003cp\u003eGeneral information was gathered about the patients, including their age, gender, high-fat diet (HFD) (high-fat diet defined as the habitual consumption of foods rich in fatty acids, but low in fiber, vitamins and minerals\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e.), smoking history, drinking history (referring to regular smoking and drinking habits, regardless of quantity and sustained for over a year.), and the presence of chronic disease such as hypertension, diabetes or CVD.\u003c/p\u003e \u003cp\u003e \u003cem\u003eActivities of Daily Living and Instrumental Activities of Daily Living (ADLs and IADLs)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eComposite scores for ADLs and IADLs are calculated based on various activities. ADLs encompass essential self-care tasks such an walking, eating, dressing, washing hair, brushing teeth, and using the toilet routinely. Meanwhile, IADLs include more complex activities necessary for independent living, such as driving or using a vehicle, preparing meals, performing household chores, doing laundry, shopping, managing medications, making phone calls, and organizing personal belongings\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cem\u003eAnthropometric measurements and blood biochemical indicators\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe body composition of all patients was assessed using Bioelectrical Impedance Analysis (BIA) with the Inbody S10 device (Biospace, Seoul, South Korea)\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. BIA employs electrical impedance measurements at varying frequencies to evaluate parameters such as upper arm circumference (UAC), calf circumference (CC), body fat rate (BFR), visceral fat area (VFA), and muscle mass (MM)\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. In addition, blood biochemical indicators including triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) were analyzed.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"3. Statistical Analysis","content":"\u003cp\u003eThe statistical analysis in this study was conducted using SPSS/WIN 23.0 software (IBM Corp., Armonk, NY, United States) and GraphPad Prism 8 (GraphPad Prism Software Inc., San Diego, CA, United States). The Kolmogorov-Smirnov test (K-S test) was used to test the normality of continuous variables. Continuous variables conforming to the normal distribution were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), whereas those that did not adhere to the normal distribution were described using median and inter-quartile range (IQR). To detect differences between non-depression group and depression group, the independent sample t-test or the Mann-Whitney U test was utilized. Categorical variables were presented as absolute values and percentages, with chi-square tests applied to compare between the two groups. The SII was transformed using a natural logarithm to normalize the data, yielding the variable ln(SII). Binary logistic regression was performed to explore relationships among walking, ln(SII) and depression. After adjusting for confounding factors, linear regression analyses were further used to evaluate links among exercise-related factors, ln(SII) and depression. (Model 1 did not adjust for confounding factors, while Model 2 adjusted for age, HFD, Hypertension, Diabetes, CVD, ADLs and IADLs. In addition, besides adjusting the factors of Model 2, Model 3 also adjusted UAC, CC, ,BFR, MM, TG, LDL-c.) Sensitivity analysis was performed using stratified analysis to assess the correlation between walking and depression cross various stratified variables, along with \u003cem\u003eP\u003c/em\u003e-interaction values among these factors. Furthermore, the mediating role of ln(SII) between walking and depression was analyzed using Process package of SPSS. The proportion of the mediating effect was calculated with the formula: (mediated effect / total effect)\u0026times; 100%.\u003c/p\u003e"},{"header":"4. Result","content":"\u003cp\u003e \u003cb\u003eCharacteristics of participants non-depression and depression.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study included a total of 464 participants, comprising 313 participants without depression and 151 participants with depression. The prevalence of depression among elderly individuals with CHD was calculated to be 32.54%. Compared to non-depressed patients, depressed individuals demonstrated higher ln(SII) levels(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, the proportion of depressed patients who engaged in walking was lower, while the prevalence of HFD and exercise-related conditions such as hypertension, diabetes and CVD was notably higher (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05); Furthermore, depressed patients, exhibited higher motor-related indicators, including ADLs and IADLs, BFR, VFA, TG and LDL-c, whereas other indicators such as UAC, CC and MM were comparatively lower (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05);Notably, depressed patients were also relatively older in comparison to their non-depressed counterparts (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eTable 1. Characteristics of participants non-depression and depression.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"603\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 211px;\"\u003e\n \u003cp\u003eVariates\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eNon-depression(N=313)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eDepression(151)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 211px;\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e80.24 \u0026plusmn; 8.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e82.11 \u0026plusmn; 8.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 139px;\"\u003e\n \u003cp\u003eGender, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e203(64.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e92(60.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.410\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e110(35.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e59(39.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 139px;\"\u003e\n \u003cp\u003eWalking, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e189(60.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e44(29.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e124(39.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e107(70.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 139px;\"\u003e\n \u003cp\u003eHFD, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e84(26.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e69(45.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e229(73.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e82(54.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 139px;\"\u003e\n \u003cp\u003eSmoking, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e104(33.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e46(30.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.551\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e209(66.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e105(69.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 139px;\"\u003e\n \u003cp\u003eDrinking, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e74(23.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e41(27.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.412\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e239(76.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e110(72.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 139px;\"\u003e\n \u003cp\u003eHypertension, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e149(47.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e88(58.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e164(52.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e63(41.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 139px;\"\u003e\n \u003cp\u003eDiabetes, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e106(33.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e81(53.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e207(66.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e70(46.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 139px;\"\u003e\n \u003cp\u003eCVD,%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e105(33.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e67(44.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e208(66.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e84(55.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003eADLs and IADLs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e17.00(14.00, 23.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e20.00(17.00, 29.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eLn(SII)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e6.38 \u0026plusmn; 0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e7.70 \u0026plusmn; 0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eUAC, cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e27.76 \u0026plusmn; 3.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e26.74 \u0026plusmn; 3.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eCC, cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e33.27 \u0026plusmn; 3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e31.65 \u0026plusmn; 4.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eBFR, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e28.87 \u0026plusmn; 6.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e31.05 \u0026plusmn; 4.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eVFA, cm\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e85.10(64.05, 107.20)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e90.30(71.10, 121.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eMM, kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e45.71 \u0026plusmn; 8.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e42.30 \u0026plusmn; 7.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eTG, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e1.17(0.88, 1.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1.62(1.07, 1.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eLDL-C, mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e2.54(1.80, 3.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e2.91(2.04, 3.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviation: high-fat diet, HFD; cerebrovascular disease, CVD; Activities of Daily Living and Instrumental Activities of Daily Living, ADLs and IADLs; systemic immune inflammatory, SII; upper arm circumference, UAC; calf circumference, CC; body fat rate, BFR; visceral fat area, VFA; muscle mass, MM; triglycerides, TG; low-density lipoprotein cholesterol, LDL-C.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05 indicates that the difference is statistically significant.\u003c/p\u003e\u003cp\u003e \u003cb\u003eLogistic regression model of the impact of walking and ln(SII) on depression.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eModel 1: The results of the unadjusted multivariable logistic regression model revealed significant correlation between walking (OR\u0026thinsp;=\u0026thinsp;0.270, 95% CI\u0026thinsp;=\u0026thinsp;0.178\u0026ndash;0.410, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and Ln(SII) (OR\u0026thinsp;=\u0026thinsp;6.375, 95% CI\u0026thinsp;=\u0026thinsp;4.578\u0026ndash;8.877, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and depression;\u003c/p\u003e \u003cp\u003eModel 2: After adjusting for age, HFD, hypertension, diabetes, CVD, ADLs and IADLs, it was observed that participants who engage in regular walking are 72.2% less likely to experience depression compared to their counterparts who do not walk regularly (OR\u0026thinsp;=\u0026thinsp;0.278, 95% CI\u0026thinsp;=\u0026thinsp;0.178\u0026ndash;0.433, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Conversely, for every unit increase in ln(SII), the likelihood of depression among elderly individuals rises approximately sixfold (OR\u0026thinsp;=\u0026thinsp;5.899, 95% CI\u0026thinsp;=\u0026thinsp;4.183\u0026ndash;8.318, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eModel 3: Beyond the adjustments made in Model 2, additional factors including UAC, CC, BFR, MM, TG, and LDL-c were taken into account. In this adjusted model, participants who engage in regular walking are 69.4% less likely to suffer from depression compared to those who do not walk regularly (OR\u0026thinsp;=\u0026thinsp;0.306, 95% CI\u0026thinsp;=\u0026thinsp;0.190\u0026ndash;0.491, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, for every unit increase in ln(SII), the likelihood of depression in elderly individuals rises approximately sixfold (OR\u0026thinsp;=\u0026thinsp;5.976, 95% CI\u0026thinsp;=\u0026thinsp;4.126\u0026ndash;8.656, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression model of the impact of walking and Ln(SII) on depression\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eModel 1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eModel 2\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eModel 3\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR 95%(CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR 95%(CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOR 95%(CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWalking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.270(0.178, 0.410)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.278(0.178, 0.433)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.306(0.190, 0.491)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLn(SII)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.375(4.578, 8.877)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.899(4.183, 8.318)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5.976(4.126, 8.656)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eAbbreviation: Systemic immune inflammatory, SII\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ea\u003c/sup\u003e unadjusted\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003eb\u003c/sup\u003e adjusted for age, HFD, Hypertension, Diabetes, CVD, ADLs and IADLs\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ec\u003c/sup\u003e adjusted for b\u0026thinsp;+\u0026thinsp;UAC, CC, ,BFR, MM, TG, LDL-c\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicates that the difference is statistically significant.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eLinear regression analysis of factors related to exercise with GDS score and ln (SII).\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe linear regression analysis of GDS score and ln (SII) with factors related to exercise shows that:\u003c/p\u003e \u003cp\u003eCompared to elderly CHD patients who do not engage in regular walking, those who maintain a consistent walking routine exhibit significantly lower GDS scores (\u003cem\u003eβ\u003c/em\u003e = -1.488, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Their UAC \u003cem\u003e(β\u003c/em\u003e = -0.153, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.019) and MM (\u003cem\u003eβ\u003c/em\u003e = -0.074, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) are negatively correlated with GDS scores, and HFD (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.641, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), TG (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.782, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), LDL-C (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.598, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), and ADLs and IADLs (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.071, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) were positively correlated with GDS scores.\u003c/p\u003e \u003cp\u003eCompared with elderly CHD patients who walk regularly, those who do not engage in regular walking exhibit higher ln(SII) value (\u003cem\u003eβ\u003c/em\u003e = -0.351, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Their CC levels \u003cem\u003e(β\u003c/em\u003e = -0.039, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007) show a negative correlation with ln(SII) values, while HFD (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.522, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ADLs and IADLs (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005) display positive correlation. Furthermore, elderly patients CHD with a history of diabetes, demonstrate significantly higher ln(SII) values compared to those without such a history ( \u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.318, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001)(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLinear regression analysis of factors related to exercise with GDS score and Ln (SII).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariates\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGDS score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eLn(SII)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWalking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.488\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHFD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.490\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBFR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.362\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.695\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL-C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADLs and IADLs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.415\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCVD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviation: Geriatric Depression Scale, GDS; systemic immune inflammatory, SII; high-fat diet, HFD; upper arm circumference, UAC; calf circumference, CC; body fat rate, BFR, visceral fat area, VFA, muscle mass, MM; triglycerides, TG; low-density lipoprotein cholesterol, LDL-C; Activities of Daily Living and Instrumental Activities of Daily Living, ADLs and IADLs; ,cerebrovascular disease, CVD.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicates that the difference is statistically significant.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eHierarchical regression analysis of the effect of regular walking on depression in elderly patients with CHD.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e, we analyzed the interaction between covariates and regular walking, finding no significant interaction (\u003cem\u003eP\u003c/em\u003e-interaction\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The result indicates that the association remains consistent across various subgroups. Additionally, the table presents the outcomes of hierarchical regression analysis. When combined with the findings from Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the data demonstrate a significant relationship between depression and regular walking in CHD patients, along with the mediating role of SII (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e\u003cimg 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\" height=\"582\" width=\"506\"\u003e\u003c/p\u003e\u003cp\u003e \u003cb\u003eThe mediating role of Ln(SII) in the association between regular walking and GDS scores.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the result reveal the following: Total Effect = -3.2372(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Indirect Effects = -1.8365(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and Mediated Effect = -1.3961(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These relationships are governed by the equation: Total Effect\u0026thinsp;=\u0026thinsp;Direct Effect\u0026thinsp;+\u0026thinsp;Indirect Effect, which in this case is expressed as: -3.2327 = -1.8365 + -1.3961. The proportion of the intermediate effects is calculated as Mediated Effect / Total Effects (%) = -1.3961/-1.8365\u0026thinsp;=\u0026thinsp;43.19%. This demonstrates that the Mediated Effect contributes 43.19% to the Total Effect, a result that is both statistically significant and visually supported by Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e "},{"header":"5. Discussion","content":"\u003cp\u003eThis study utilizes the\u0026nbsp;CGA\u0026nbsp;database to examine the relationship among regular walking habits, SII, and depression in elderly patients with CHD. The prevalence of depression in this population is 32.54%. Notably, SII serves as a mediator in the association between regular walking and depression, with the mediated effect accounting for 43.19% of the total effect. To the best of knowledge, this is the first study to investigate the interplay among regular walking, SII, and depression in elderly individuals with CHD. Additionally, linear regression analysis revealed several exercise-related factors associated with SII and depressive disorders in CHD patients. Regular walking, UAC and MM were identified as protective factors against depression. In contrast, HFD, TG, LDL-C, as well as limitations in ADLs and IADLs, emerged as risk factors for depression.\u003c/p\u003e\n\u003cp\u003eAn interventional randomized controlled study revealed that exercise intervention can reduce SII in children with cancer\u003csup\u003e[27]\u003c/sup\u003e. Similarly, findings from an analysis based on the NHANES database examining the correlation between lifestyle characteristics in the general population and SII, indicated that physical activity is negatively correlated with SII. These results suggest that reducing inflammation through lifestyle improvements may offer greater benefits for disease prevention\u003csup\u003e[28]\u003c/sup\u003e. Additionally, a cross-sectional study involving blood samples from 195 healthy national Olympic team athletes, collected before and after exercise, identified a negative correlation between aerobic exercise and SII upon analysis\u003csup\u003e[29]\u003c/sup\u003e. In parallel, a review focusing on SII as an immune marker in clinical practice, explore its link with exercise physiology, emphasizing that chronic physical activity may aid in improving SII\u003csup\u003e[30]\u003c/sup\u003e. Furthermore, researchers studying populations characterized by short sleep durations observed that engaging in up to 2400 minutes of physical exercise per week was associated with lower SII levels, though increased exercise beyond this threshold did not yield added benefits \u003csup\u003e[31]\u003c/sup\u003e. These studies consistently highlight the association between exercise and SII, supporting the conclusions drawn from our research findings.\u003c/p\u003e\n\u003cp\u003eExtensive prior research has consistently demonstrated a significant correlation between exercise and depression. For instance, a randomized controlled study involving \u0026nbsp;48 patients with severe depression revealed that walking could alleviate negative emotions in these patients; however, the effects were not sustained beyond 48 hours\u003csup\u003e[8]\u003c/sup\u003e. Another randomized clinical trial, conducted in a primary healthcare setting, examined 347 patients aged 65 years and older with mild to moderate depressive disorders. Results indicated that patients receiving both antidepressant medication and physical activity interventions experienced a reduction in depressive symptoms, with the physical activity group showing superior outcomes in the medium term\u003csup\u003e[32]\u003c/sup\u003e. Additionally, a cross-sectional survey conducted in northern China, assessed the relationship between physical exercise frequency and depression among 1604 urban residents aged 50 and older. The research found that the prevalence of depression in urban communities in Jinan was 16.52%, with exercising three times per week being associated with a lower prevalence of depression\u003csup\u003e[33]\u003c/sup\u003e. Surprisingly, some prior studies have corroborated the notion that exercise may be as effective as medication in reducing depressive symptoms in patients with depression\u003csup\u003e[34, 35]\u003c/sup\u003e. Exercise appears to alleviate depression through various mechanisms one of which is its neurobiological impact. Aerobic exercise acutely regulates key physiological factors such as 5-HT/NE, BDNF, TNF-\u0026alpha;, IL-6, and IL-10\u003csup\u003e[15]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003ePhysical activity has been shown to alleviate symptoms of depression in patients to varying degrees. While studies indicate that the antidepressant effect of exercise may not be long-lasting, the advantages of regular moderate, and appropriately tailored \u0026nbsp;exercise for individuals with depression are well-established, particularly for those whose physical condition permits such activity. Both the decline in physiological function and the presence of emotional disorders are significant predictors of poor outcomes in patients with CHD. As such, integrating physical and psychological assessments and treatments has become increasingly critical in managing CHD patients. Effective cardiac rehabilitation exercises not only enhance exercise tolerance, heart function, and overall quality of life, but also lower the risks of major cardiovascular events, while mitigating psychological issues such as anxiety and depression\u003csup\u003e[36]\u003c/sup\u003e. Research has demonstrated that exercise based cardiac rehabilitation programs significantly improve the physical capacity of CHD patients\u003csup\u003e[37]\u003c/sup\u003e. Furthermore, a meta-analysis highlights the benefits of incorporation Tai Chi into rehabilitation programs, revealing that this form of holistic exercise can promote both physical and mental health in CHD patients. These findings suggest that Tai Chi may serve as a viable approach to cardiovascular rehabilitation\u003csup\u003e[38]\u003c/sup\u003e. Among various types of exercise recommended in clinical guidelines, brisk walking stands out for several reasons. It is a widely accessible and practical form of physical activity particularly living with CHD\u003csup\u003e[39]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eResearch utilizing NHANES data indicates that the SII index is associated with an increased risk of depressive disorder, including depressive disorder coexisting with diabetes and post-stroke depressive disorder\u003csup\u003e[7, 12, 40]\u003c/sup\u003e. Additionally, a cross-sectional study identified SII as an independent risk factor for the development of CHD, highlighting its notable connection to the prediction and severity of the condition\u003csup\u003e[41]\u003c/sup\u003e. Among the general US population, a U-shaped correlation has been observed \u0026nbsp;between the SII index and both all-cause mortality and cardiovascular disease-related mortality. Moreover, similar patterns have been identified in patients with CHD, angina pectoris, and myocardial infarction, where the association between SII and all-cause mortality in CHD patients also exhibits a U-shaped trend. However, in individuals with congestive heart failure, higher SII levels correspond to an increased rate of cardiovascular disease-relate mortality. These findings suggest that SII could serve as a clinical predictor of all-cause mortality in patients with cardiovascular conditions\u003csup\u003e[42]\u003c/sup\u003e. In summary, the SII demonstrates a substantial negative impact on both depression and CHD. Nevertheless, our study has not established a definitive causal relationship among these factors, and the mechanisms underlying their interactions remain unclear. Further investigation into these relationships could provide meaningful insights for disease prevention and the improvement of prognostic strategies.\u003c/p\u003e\n\u003cp\u003eThis study offers several key advantages. It investigates the mediating role of SII in the relationship between regular walking and depression by observing the daily habits of elderly patients with CHD, providing valuable insights into this population. Importantly, the elderly sample we collected demonstrates a certain degree of representativeness strengthening the study\u0026rsquo;s broader applicability. Additionally, this research offers theoretical support for preventing depression in elderly patients with CHD who are able to engage in walking. Walking, an inexpensive, convenient, and accessible form of exercise, is particularly suitable for the elderly, and has been shown to be an effective method for alleviating depression. It helps elderly CHD patients mitigate depressive symptoms, prevent psychological disorders, reduce hospitalization time, and conserve medical resources. However, this study also has several limitations. First, its cross-sectional design prevents the establishment of causation. Future longitudinal research would be invaluable in exploring the causal relationships among walking, SII, and depression. Second, some variables, such as walking habits were self-reported, and the lack of specific measurements, may have introduced recall bias, potentially leading to an overestimation or underestimation of the association between SII and depressive disorder in CHD patients. Third, there was no precise measurement of walking pace or quantification of walking duration, which limits the study\u0026rsquo;s findings. Additionally, the relatively small sample size underscores the need for future muti-center studies with large sample to enhance the robustness of the conclusions. Finally, incorporating additional factors, such as patients\u0026apos; medication use and economic status into future studies, would be meaningful as these variables could influence the results. Moreover, exploring age, gender and medical history on the relationship between walking and SII is critically important for more comprehensive understanding of this association.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eAn interaction exists among SII, regular walking and depression in elderly patients with coronary heart disease. Furthermore, SII partially mediates the relationship between regular walking and depression.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding support:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJilin Provincial Department of Science and Technology (20240305049YY)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYMJ, ZLL and XCL drafted the manuscript. YMJ and LZ revised the manuscript. XXX, HYJ, and TYC made tables. YMJ, XCL and LZ were responsible for the data acquisition. JYC, SBM and XXX performed the data analysis. YMJ and ZLL performed the statistical analyses. YMJ, ZLL and XCL conceived of and designed the study. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIf the request is reasonable, the first author will provide the original data that supports the conclusions of this article without reservation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe studies involving human participants were reviewed and approved by the Ethics Committee of The First Hospital of Jilin University. The patients/participants provided their written informed consent to participate in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMANNING K J, STEFFENS DC. State of the Science of Neural Systems in Late-Life Depression: Impact on Clinical Presentation and Treatment Outcome [J]. J Am Geriatr Soc. 2018;66(Suppl 1):S17\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMOODLEY S. MAISTO A. Late-life depression and the family physician [J]. S Afr Fam Pract (2004), 2022, 64(1): e1-e4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKOK R M, REYNOLDS C F. 3RD. Management of Depression in Older Adults: A Review [J]. JAMA. 2017;317(20):2114\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZHANG L, XU Y, NIE H, et al. 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Circulation. 2011;123(21):2344\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUDDIN J, ZWISLER A D, LEWINTER C, et al. Predictors of exercise capacity following exercise-based rehabilitation in patients with coronary heart disease and heart failure: A meta-regression analysis [J]. Eur J Prev Cardiol. 2016;23(7):683\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFAN C, YAN H, LEI K, et al. Effect of Tai Chi-Based Psychosomatic Rehabilitation Exercise on Physiological Function and Mental Health of Patients with Coronary Heart Disease: A Meta-Analysis [J]. Rev Cardiovasc Med. 2024;25(6):227.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWANG J, LIU H, CHEN C, et al. Physical Activity and Factors Affecting Its Maintenance Among Patients With Coronary Heart Disease Not Undergoing Cardiac Rehabilitation in China [J]. 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J Inflamm Res. 2023;16:941\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Systemic immune-inflammation index, regular walking, depression, elderly, coronary heart disease","lastPublishedDoi":"10.21203/rs.3.rs-5885365/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5885365/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDepressive disorders and coronary heart disease (CHD) are significant and pervasive global public health challenges, influenced by various factors such as diet, physical activity, social circumstances, and lifestyle habits. This study aim to investigate the relationship among regular walking, the systemic immune-inflammation index (SII), and depression in CHD patients. Additionally, it seeks to explore the mediating role of SII in the effect of regular walking on depression among these patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study involved 464 patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years with CHD, admitted to the cadre ward of the First Hospital of Jilin University from September 2021 to December 2022. A comprehensive geriatric assessment (CGA) inventory was prepared by compiling and screening regular walking, calculated SII, and the Geriatric Depression Scale (GDS). Binary logistic regression was employed to examine the relationship among walking, ln(SII) and depression. After adjusting for confounding factors, linear regression analysis was used to assess the correlation among exercise-related factors, ln(SII) and depression. Sensitivity analyses were performed through stratified analysis, investigating the relationship between walking and depression within the strata of each variable, as well as the \u003cem\u003eP\u003c/em\u003e-interaction among stratified variables. Additionally, the Process package in SPSS was used to explore the mediating role of ln(SII) in the association between regular walking and depression. The proportion of the mediating effect was calculated using the formula:(mediated effect / total effect) \u0026times; 100%.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eModel 2: Elderly individuals who walk regularly are 72.2% less likely to experience depression compared to those who do not engage in regular walking (odds ratio (OR)\u0026thinsp;=\u0026thinsp;0.278, 95% CI\u0026thinsp;=\u0026thinsp;0.178\u0026ndash;0.433, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, one-unit increases in ln(SII) corresponds to an approximately sixfold in the likelihood of depression among elderly individuals (OR\u0026thinsp;=\u0026thinsp;5.899, 95% CI\u0026thinsp;=\u0026thinsp;4.183\u0026ndash;8.318, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Model 3: Participants who walk regularly are 69.4% less likely to suffer from depression compared to those who do not walk regularly (OR\u0026thinsp;=\u0026thinsp;0.306, 95% CI\u0026thinsp;=\u0026thinsp;0.190\u0026ndash;0.491, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, a one-unit increase in ln(SII) is associated with an approximately sixfold increase in the probability of depression elderly individuals (OR\u0026thinsp;=\u0026thinsp;5.976, 95% CI\u0026thinsp;=\u0026thinsp;4.126\u0026ndash;8.656, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The stratified analysis examining the effect of regular walking on depression in patients with CHD confirms the robustness of these associations. Additionally, SII was found to mediate the relationship between regular walking and depression in CHD patients, accounting for 43.19% of the total effect.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAn interaction exists among SII, regular walking and depression in elderly patients with coronary heart disease. Furthermore, SII partially mediates the relationship between regular walking and depression.\u003c/p\u003e","manuscriptTitle":"Systemic immune-inflammatory index mediates the association between regular walking and depression in the elderly with coronary heart disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-21 06:31:40","doi":"10.21203/rs.3.rs-5885365/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-19T10:11:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-13T14:03:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"261965113400850856276473154568215849270","date":"2025-04-19T12:45:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-19T12:43:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"17357585633906877169686357626791748035","date":"2025-04-19T12:40:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-17T06:45:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-15T14:35:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-04-02T02:39:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a3dfe709-de6d-415f-8c82-ce22ec4ef430","owner":[],"postedDate":"April 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-09T16:04:24+00:00","versionOfRecord":{"articleIdentity":"rs-5885365","link":"https://doi.org/10.1186/s12877-025-06085-3","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2025-06-06 15:57:51","publishedOnDateReadable":"June 6th, 2025"},"versionCreatedAt":"2025-04-21 06:31:40","video":"","vorDoi":"10.1186/s12877-025-06085-3","vorDoiUrl":"https://doi.org/10.1186/s12877-025-06085-3","workflowStages":[]},"version":"v1","identity":"rs-5885365","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5885365","identity":"rs-5885365","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}