Physical fitness, menopausal symptom management help ward off depression in Singaporeans

In Singaporean women, improved physical performance appears to reduce the risk of depression during midlife, whereas worsening menopausal symptoms and pelvic floor dysfunction contribute to a risk increase, according to a local study.

Analysis of data from the Integrated Women’s Health Program (IWHP)* showed that over 6.8 years of follow-up, participants with incident depression saw their Menopause Rating Scale (MRS) scores rise by a mean of 0.20 points, while those who remained free of clinically significant depression experienced a mean decrease of 0.06 points (p=0.019). [Sci Rep 2025;15:18069]

Furthermore, participants with incident depression had declines in both one-leg stand duration (mean, –0.19 points) and overall physical performance battery scores (mean, –0.16 points). On the other hand, those who remained free of clinically significant depression had slight improvements in both metrics (mean, 0.05 and 0.03 points, respectively; p=0.020 for one-leg stand duration score; p=0.036 for physical performance battery score).

For the Pelvic Floor Distress Inventory Short Form 20 (PFDI-20) score, participants with incident depression experienced a mean increase of 0.21 points, while those without clinically significant depression saw no change (mean, 0.00 point; p=0.052).

In multivariable modified Poisson regression models, a 1-standard deviation (SD) increase in MRS scores (SD, 5.36) was associated with a 91-percent increased risk of incident depression (adjusted relative risk [aRR], 1.91, 95 percent confidence interval [CI], 1.64–2.23). Additionally, a 1-SD increase in PFDI-20 scores (SD, 32.57) correlated with a 53-percent risk increase (aRR, 1.53, 95 percent CI, 1.36–1.72).

Conversely, improvements in one-leg stand duration and physical performance battery scores were associated with roughly a 20-percent reduction in the risk of incident depression (aRR, 0.79, 95 percent CI, 0.67–0.94 and aRR, 0.80, 95 percent CI, 0.69–0.93, respectively).

Preventing depression in midlife

“These findings highlight physical performance, menopausal symptoms, and pelvic floor dysfunction as modifiable targets for future interventions aimed at reducing the burden of depression in midlife Asian women,” the investigators said.

“Managing depressive symptoms through exercise interventions has demonstrated effectiveness among postmenopausal women, with mind-body exercises emerging as particularly beneficial, through underlying mechanisms of enhanced neuroplasticity, reduced inflammation, improved self-esteem, and increased social support,” they added. [BMC Public Health 2024;24:1816]

Meanwhile, worsening pelvic floor symptom dysfunction, which includes urinary incontinence, pelvic organ prolapse, and faecal incontinence, may cause psychosocial distress, according to the investigators. For example, “women with incontinence often worry about the worsening of symptoms in the future and have embarrassment concerns from odour and stains, resulting in social withdrawal and poor mental well-being.” [J Clin Med 2024;13:1896]

The investigators emphasized the importance of identifying poor physical performance and menopausal symptoms, given that their progression over time has detrimental effects on emotional well-being. Risk factor screening may be performed by using novel indicators such as pelvic floor dysfunction and poor physical performance, they added.  

A total of 825 IWHP participants were included in the analysis. Of these, 131 participants received a diagnosis of depression and 694 showed no clinically significant depressive symptoms during the 6.8-year follow-up period. The mean age at baseline of the total population was 56.5 years, and most participants were Chinese (86.8 percent), employed (69.1 percent), married (81.6 percent), and postmenopausal (71.9 percent).

At baseline, the mean BMI was 23.5 kg/m², the median MRS score was 6.0, the median PFDI-20 score was 18.8, the mean one-leg stand duration was 26.7 s, and the physical performance battery score was 2.6 points. The longitudinal changes in the outcome metrics were measured in terms of 1-SD increases.

*IWHP is a prospective observational cohort study examining the health of midlife Singaporean women.