The Relationship Between Physical Activity, Pain-Induced Disability and Body Perception with Depressive Symptoms in Older Adults: The Mediating Role of Quality of Life

Nowadays, depression is one of the most common psychological disorders, posing a significant challenge in the lives of individuals in later stages of life. It can affect their quality of life (QOL) and various physical and mental aspects. Therefore, the aim of this study was to predict depressive symptoms based on physical activity, pain-related disability (PRD), and body perception, with QOL as a mediating variable. This was a descriptive study, using structural equation modeling (SEM). The statistical population consisted of all individuals over the age of 60, from whom a sample of 300 was selected through convenience sampling at the Bagh-e Tajrobeh (The Experience Garden) in Isfahan, Iran in 2024. The data collection tools included Yesavage et al.’s Geriatric Depression Scale, Washburn et al.’s Physical Activity Scale, Melzack’s Pain Disability Index, Cash et al.’s Body Perception Questionnaire, and Diego et al.’s QOL Scale. Data analysis was conducted using SEM in AMOS-23 and SPSS-23 software. The results indicated that the causal model showed a good fit in the study sample (p<.05). Findings also revealed that physical activity, PRD, and body perception had an indirect relationship with depressive symptoms through QOL (p<0.05). Based on these findings, individuals who have more active and dynamic lifestyle tend to experience better body perception, lower PRD, and improved QOL and reduced depressive symptoms. Therefore, health policymakers are advised to develop programs and provide facilities to promote physical activity among older adults. Additionally, light exercise and regular physical activity should be considered as cost-effective and healthy methods for preventing age-related issues, as they contribute to the improvement of various aspects of QOL.
EXTENDED ABSTRACT
 Introduction
Depression is one of the most prevalent psychological disorders in later life, influenced by a combination of genetic, biological, and environmental factors. Various psychological studies have explored different predictors of depressive symptoms in older adults, with physical activity being one of the most significant. Engaging in physical activity has been shown to enhance psychological well-being, including a reduction in depressive symptoms. Additionally, pain-related disability (PRD) is a common experience and a significant challenge in older age. Body perception in older adults also plays a crucial role in predicting depressive symptoms, as it reflects an individual’s internalized perception of their physical appearance, encompassing physical, perceptual, and attitudinal dimensions. While previous studies have examined the relationships between physical activity, PRD, and body perception in relation to depression, little research has investigated the mechanisms through which these factors are related to depressive symptoms in older adults. Moreover, the role of quality of life (QOL) as a mediating variable has not been extensively studied, either among older adults or in other age groups. Given these gaps in the literature, the present study aims to explore the relationship between physical activity, PRD, and body perception with depressive symptoms in older adults, considering the mediating role of QOL.
Method
The present study employed a correlational research design using structural equation modeling (SEM). The statistical population consisted of all individuals aged 65 years and older in Isfahan Province, Iran, from whom 300 participants were selected through convenience sampling in the Bagh-e Tajrobeh (The Experience Garden). The inclusion criteria were: (1) a minimum age of 65 years, (2) literacy in reading and writing, and (3) willingness and ability to complete the questionnaire. Exclusion criteria included: (1) use of psychotropic medications and (2) physical or cognitive disabilities such as Alzheimer's disease. Participants completed Yesavage et al.’s Geriatric Depression Scale, Washburn et al.’s Physical Activity Scale, Melzack’s Pain Disability Index, Cash et al.’s Body Perception Questionnaire, and Diego et al.’s QOL Scale. After obtaining informed consent, the questionnaires were individually distributed, with necessary instructions provided for completion. Additionally, for individuals facing difficulties, such as forgetting their glasses or experiencing functional limitations, the questions were read aloud, and their responses were recorded. Finally, the data obtained from the questionnaires were analyzed using Pearson’s correlation coefficient method in SPSS-23 and SEM in Amos-23.
Results
Before conducting data analysis, the score distributions for all variables were found to be normal. The results also indicated that there was no collinearity among the variables. To test the research hypotheses, model fit was examined using SEM to evaluate the proposed model. Findings from Pearson’s correlation test revealed a significant negative correlation between depressive symptoms and physical activity, QOL, and body perception, while a significant positive correlation was found between depressive symptoms and PRD. In addition, QOL, physical activity, and body perception
were positively and significantly correlated with each other, whereas QOL and PRD exhibited a significant negative correlation. Furthermore, there was a significant positive correlation between body perception and physical activity, and significant negative correlations were observed between body perception and PRD as well as between PRD and physical activity.
The fit indices for the obtained model (figure 1) were as follows: χ²/df = 3.707, NFI = .92, GFI = .90, IFI = .92, AGFI = .91, CFI = .90, and RMSEA = .077. These indices indicate that the model demonstrates an acceptable level of fit. Furthermore, the bootstrap test results confirmed that quality of life significantly mediated the relationship between physical activity and depressive symptoms (P=.012), between PRD and depressive symptoms (P=.009), and between body perception and depressive symptoms (P=.017).
Conclusion
Older adults represent valuable sources of intellectual and spiritual capital, and enhancing their quality of life is a critical concern for society. Appropriate physical activity helps these individuals regulate their nervous systems, build self-confidence, and make sound decisions when facing age-related challenges. A high quality of life combined with regular physical activity contributes to a reduction in age-related illnesses and lessens pain-induced disability. Moreover, engaging in physical activity and maintaining a high quality of life are key determinants of energy expenditure, energy balance, weight control, and fostering a positive body image. A more positive body perception is linked with increased psychological self-confidence, a brighter outlook on life, and diminished depressive symptoms. Being well-regarded and perceived as attractive by others can foster a more affirmative self-concept. This, in turn, reduces concerns about body image, enhances overall quality of life, and alleviates symptoms of depression. Consequently, it is imperative for professionals to support healthy lifestyle modifications among older adults. By promoting increased physical activity, they can help counteract negative body perceptions and reduce the disability associated with chronic pain, ultimately contributing to lower levels of depression.
Ethical Consideration
Ethical Code: This article is derived from a Master's thesis in Psychology.
Financial Support
This research did not receive any financial support.
Authors’ Contributions
M.Kh: Conceptualization, Methodology, Data curation, Writing - Original draft; P.S: Writing-Review & editing, Project administration, Visualization; M.K: Software, Validation, Formal analyses.
Conflict of Interest
The authors had no conflicts of interest.
Acknowledgments
The authors would like to express their gratitude to the management of Bagh-e Tajrobeh, all older adults, and everyone who assisted with the distribution of the research questionnaire and other aspects of the study’s implementation.
References
Alboa, J.M., Núñezb, J.L, Evelia, D., Leónb, J., Tomásc, J.M. (2012). Relationships between intrinsic motivation, physical self-concept and satisfaction with life: A Longitudinal study. Journal of Sports Sciences. 30(4), 337-347. https://doi.org/10.1080/02640414.2011.649776
Arab, B., Ramezanzadeh, H. (2019). The relationship between body image concerns, body perception and exercise intention in women in the stages of changing exercise behavior. Quarterly Journal of Sports Psychology Studies, 8, 28, 113-132. [Persian]
Abbaspour, K., Fathi Rezaei, Z., Zamani, H., Keshavarz, M., Qiami, A. (2018). The relationship between body image perception, body mass index and physical activity in elderly women. Sociology of Lifestyle, 4(12), 1-29. [Persian]
Andrena, D., & Kurdi, F. (2023). Application of relaxation therapy on chronic pain in the elderly with hypertension at upt pstw jember: A Case study. Jurnal Kesehatan Komunitas Indonesia, 3(1), 59-80. https://doi.org/10.58545/jkki.v3i1.58
Brasileiro, L. E. E., Dantas, A. A. G., Linhares, D. B., Vale, H. A., Terradas-Monllor, M., Ochandorena-Acha, M., Paiva, A. L. M., de Medeiros, M. Y. D., Jerez-Roig, J., & de Souza, D. L. B. (2024). Incidence of depression among community-dwelling older adults: A Systematic review. Psychogeriatrics, 24(2), 496-512. https://doi.org/ 10.1136/bmjopen-2021-052147
Cai, H., Jin, Y., Liu, R., Zhang, Q., Su, Z., Ungvari, G. S., Tang, Y. L., Ng, C. H., Li, X. H., & Xiang, Y. T. (2023). Global prevalence of depression in older adults: A Systematic review and meta-analysis of epidemiological surveys. Asian Journal Psychiatr, 80, Article103417. https://doi.org/ 10.1016/j.ajp.2022.103417
Cairncross L, Magee H, Ask ham J. A hidden problem: Pain in older people. A Qualitative study [on line].‌‌‌
Cash, T. F., Mikulka, P. J., & Brown, T. A. (1990). Attitudinal body –image assessment: Factor analysis of the body – Self Relations Questionnaire. Journal of‌‌‌ Personality Assessment, 55, 135-144. https://doi.org/ 10.1080/00223891.1990.9674053
Cheraghi, P., Cheraghi, Z., Doosti-Irani, A., Nedjat, S., & Nedjat, S. (2017). Quality of life in elderly Iranian population using leiden-padua questionnaire: A Systematic review and meta-analysis. International Journal of Preventive Medicine, 8, 55. https://doi.org/ 10.4103/ijpvm.IJPVM_265_16
Choobforoshzadeh, A., Mohammadpanah Ardakan, A., Behjati Ardakan, F., & Ahmadi Ardakan, Z. (2018). The Effectiveness of life review on depression and life satisfaction in the elderly. Psychology of Aging, 4(2), 155-164. [Persian]
Dagnino, A. P. A., & Campos, M. M. (2022). Chronic pain in the elderly: mechanisms and perspectives. Front Hum Neurosci, 16, 736688. https://doi.org/10.3389/fnhum.2022.736688
De Carvalho-Costa, T. M., do Carmo Neto, J. R., Teodoro, A.G.F., Soares, F.Z., Rochael, L. P., de Assunção, T.F.S., de Souza, B.C., .... & da Silva, M. V. (2022). Immunophenotypic analysis of t lymphocytes and cytokine production in elderly practicing physical activities and its relationship with quality of life and depression. Oxid Med Cell Longev, 20(11), 7985596. https://doi.org/ 10.1155/2022/7985596
De Leo, D., Diekstra, R. F., Lonnqvist, J., Trabucchi, M., Cleiren, M.H., Frisoni, G.B, & et al. (1998). LEIPAD, An Internationally applicable instrument to assess quality of life in the elderly. Journal of Behavioral Medicine, 24, 17‑27.
Fishman, S. M., Ballantyne, J. C., & Rathmell, J. P. (2010). Bonica’s management of pain. New York: Wolters Kluwer press. 17.
Gianni, W., Madaio, R. A., Di Cioccio, L., D'Amico, F., Policicchio, D., Postacchini, D., et al. (2010). Prevalence of pain in elderly hospitalized patients. Arch Gerontol Geriatr. 51(3): 273-276.‌‌‌
Ginnerup-Nielsen, E., Harreby, M., Christensen, R., Bliddal, H., & Henriksen, M. (2022). The Correlation between illness perception, pain intensity and quality of life in elderly with low back pain in Denmark: a cross-sectional study. Peer Journal, 10, e14129. https://doi.org/ 10.7717/peerj.14129
Gruszka, W., Owczarek, A.J., Glinianowicz, M. & et al. (2022). Perception of body size and body dissatisfaction in adults. Scientific Reports, 12, 1159. https://doi.org/ 10.1038/s41598-021-04706-6
Hatami, O., Aghabagheri, M., Kahdouei, S., & Nasiriani, K. (2021). Psychometric properties of the persian version of the physical activity scale for the elderly (PASE). BMC geriatrics, 21(1), 383. https://doi.org/ 10.1186/s12877-021-02337-0
Hu, T., Zhao, X., Wu, M., Li, Z., Luo, L., Yang, C., & Yang, F. (2022). Prevalence of depression in older adults: A systematic review and meta-analysis. Psychiatry Research, 311, 114511. https://doi.org/ 10.1016/j.psychres.2022.114511
Iliaz R, Ozturk GB, Akpinar TS, Tufan A, Sarihan I, Erten N, et al. (2013) Approach to pain in the elderly. Journal of‌‌‌ Gerontol Geriat Research; 2(3): 1-10. https://doi.org/10.4172/2167-7182.1000125
Jin, X., Liu, H., & Niyomsilp, E. (2023). The Impact of physical activity on depressive symptoms among urban and rural older adults: Empirical study based on the 2018 CHARLS database. Behavioral Sciences (Basel), 13(10), 864.‌ https://doi.org/ 10.3390/bs13100864
Joyce, C., Keysor, J., Stevans, J., Ready, K., Roseen, E. J., & Saper, R. B. (2023). Beyond the pain: A Qualitative study exploring the physical therapy experience in patients with chronic low back pain. Physiotherapy Theory and Practice, 39(4), 803-813. https://doi.org/ 10.1080/09593985.2022.2029650
Kang, D., Kim, I. R., Choi, H. J., Jung, C. W., Yoon, S. S., Kim, J. S., Lee, C. H., Jang, J. H., & Cho J. (2021). Association between body image dissatisfaction and poor quality of life and depression among patients with hematopoietic stem cell transplantation. Support Care Cancer, 29(7), 3815-3822. https://doi.org/10.1007/s00520-020-05884-1
Kashani Movahed, B., Nikfarjad, H., Shahbazpour, H. R., Davudzadeh, S. K., Mollaei, P., and Molhammoudi, M. (2018). The Relationship between regular physical activity with spiritual intelligence and psychological well-being in the elderly in Tehran. Research in Religion and Health, 4(2), 81-93. [Persian]
Kaye, A. D., Baluch, A., Scott, J.T. (2010). Pain management in the elderly population: A Review. Ochsner Journal; 10(3):179–187. PMCID: PMC3096211
Kaye, A, D., Baluch, A.R., Kaye, R.J., Niaz, R.S., Kaye, R.J., Liu, H., et al. (2014). Geriatric pain management, pharmacological and non-pharmacological considerations. Psychology & Neuroscience 7(1):15–26. https://doi.org/10.3922/j.psns.2014.1.04
Kazemi, N., Sajjadi, H. and Bahrami, G. (2019). Quality of life of Iranian elderly: A Review study. Salamand: Iranian Journal of Aging. 13 (5)518-533. [Persian]
Kermani, Sh., Ebrahimi, Bagherian Sararudi, A., Feyzi, R., and Mottaghi, P. (2014). The Mediating role of pain catastrophizing, depression, and anxiety in the relationship between psychological flexibility and pain self-efficacy in patients with musculoskeletal pain. Journal of Isfahan Medical School, 40, 690, 789-799. [Persian]
Khajoui, D., Khanmohammadi, R. (2015). Predicting depressive symptoms in the elderly based on physical activity level and demographic characteristics: A Study of the role of age and gender. Development and Learning in Motor-Sports, 7, 1, 87-103. [Persian]
Khanizadeh, S., Ehsani, M., Yun, Y. J., Norouzi, R., & Ghaedrahmati, P. (2017). Compensating for the gaps caused by aging: An analysis of the main themes of physical activity in the neighborhood environment from the perspective of the elderly (a phenomenological approach). Journal of Gerontology, 8(1), 99-88. [Persian]
Khodaparast, S., Bakhshalipour, V., Kalashi, M., & Babaei Begham Lahiji, M. (2017). Correlation between sports participation and quality of life of athletic and non-athletic elderly. Journal of Gerontology, 6(3), 19-27. [Persian]
Kocyigit, E. (2023). Body image in aging. Anti-Aging Eastern Europe, 2(1), 23-28. https://doi.org/10.56543/aaeeu.2023.2.1.04
Langley P, Muller-Schwefe G, Nicolaou A, Liedgens H, Pergolizzi J, Varrassi G. (2010). The Impact of pain onlabor force participation, absenteeism and presenteeism in the European Union. Journal of Medical Economics; 13(4): 662–72. DOI: 10.3111/13696998.2010.529379
Lerche, S., Gutfreund, A., Brockmann, K., Hobert, M. A., Wurster, I., Sünkel, U., & Berg, D. (2018). Effect of physical activity on cognitive flexibility, depression and RBD in healthy elderly. Clinical neurology and neurosurgery, 165:88-93. https://doi.org/10.1016/j.clineuro.2018.01.008.
Malkouti, S. K., Fatholahi, P., Mirabzadeh, A., Salavati, M., and Kahani, S. A. (2006). Normalization of the geriatric depression scale (GDS); 15-question form in Iran. Research in Medicine, 30(4), 368 - 361. [Persian]
Mazloum, S. R., Abbasi Teshnizi, M., Kianinejad, A., & Gandomkar, F. (2012). Effect of applying Ice bag on pain intensity associated with chest tube removal after cardiac surgery. Journal of HMS, 18(3), 109-14. URL: http://imtj.gmu.ac.ir/article-1-1270-en.html
McDonald, D. D. (2011). Acute pain reduction strategies used by well older adults. International Journal of Nursing Studies. 35(5):265-70, https://doi.org/10.1016/s0020-7489(98)00039-x
McKenzie, G., Shields, N., & Willis, C. (2023). Finding what works for me’–A Qualitative study of factors influencing community gym participation for young adults with cerebral palsy. Disability and Rehabilitation, 45(12), 1984-1991. https://doi.org/10.1080/09638288.2022.2083243
Mellor, D., Russo, S., McCabe, M. P., Davison, T. E., & George, K. (2008). Depression training program for caregivers of elderly care re-cipients: Implementation and qualitative evaluation. Journal of Gerontological Nursing, 34(9),8-15. https://doi.org/10.3928/00989134- 20080901-09
Melzack, R. (1995). The McGill pain questionnaire: major properties and scoring methods. Pain, 1(3), 277-299. https://doi.org/ 10.1016/0304-3959(75)90044-5
Mohammadzadeh, M., Rashedi, V., Hashemi, M., and Borhaninejad, V.R. (2010). Studying the relationship between daily living activities and depression in the elderly of Mane and Samalqan counties. Salamand Journal: Iranian Journal of Aging, 15, 2, 200-211. [Persian]
Momeni, K., Amani, R., Janjani, P., Majzoobi, M. R., Forstmeier, S., & Nosrati, P. (2022). Attachment styles and happiness in the elderly: The Mediating role of reminiscence styles. BMC Geriatrics, 22, Article 349. https://doi.org/10.1186/s12877-022-03053-z
Momeni, K., Amani, R., Janjani, P., Majzoubi, M. R., and Hadian Hamedani, K., (1400). The Relationship between attachment styles and positive and negative emotions in the elderly: The Mediating role of memory styles. Psychology of Aging, 7(4), 422-407. [Persian]
Momeni, Kh., Amani, R., Janjani, P., Majzoobi, M. R., & Hadian Hamedani, K. (2021). The Relationship between attachment styles with positive and negative affect in the elderly: The Mediating role of reminiscence styles. Aging Psychology, 7(4), 407-422.
Nafei, A., Rashedi, V., Ghafouri, R., Khalvati, M., Eslamian, A., Sharifi, D., et al. (1403). Death anxiety and its related factors in the elderly in Iran: A National study. Salamand: Iranian Journal of Aging, 19(1), 144-157. [Persian]
National academies of sciences, engineering, and medicine. (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. https://doi.org/10.17226/13172.
Niazi, M., Malekian Fini, A., and Shefaei Moghadam, A. (1401). Physical activity and quality of life in the elderly. Culture and Health Promotion, 6(3), 463-457. [Persian]
Peterlin, J., Dimovski, V., Colnar, S., Blažica, B., & Kejžar, A. (2024). Older adults' perceptions of online physical exercise management. Front Public Health, 12, 1303113. https://doi.org/ 10.3389/fpubh.2024.1303113
Petrini, L., & Arendt-Nielsen, L. (2024). Pain catastrophizing in the elderly: An Experimental pain study" Scandinavian Journal of Pain, 24(1), 20230035.‌ https://doi.org/10.1515/sjpain-2023-0035
Pizzo, P. A., Clark, N.M., Carter-Pokras, O., Christopher, M., Farrar, J.T., Follett, K.A., et al. IOM (Institute of Medicine). (Relieving pain in america: A Blueprint for transforming prevention, care, Education, and Research. Washington, DC: The National academies press. (2011). International Standard Book Number, 10: 0-309-25627-5 (paperback)
Rasouli, A., and Afraz, A. (2019). Comparison of quality of life, life satisfaction and death anxiety among introverted and extroverted elderly living in homes and nursing homes in Kermanshah. Journal of Psychology Development, Volume 8, Issue 10, pp. 19-26. [Persian]
Rezaian, M., Alinejad, H., Hajali Akbari, Z., Taherifard, A. R., Alinejad, M., and Sabbaghi, P. (2014). Studying the relationship between sleep quality and quality of life of elderly people with cardiovascular diseases with the role of physical activity in Rafsanjan city in 2020. Scientific Research Journal of Shahid Sadoughi University of Medical Sciences, Yazd, 30 (8), 5141-5151. [Persian]
Saeedi Mehr, S., Garavandi, S., Izad Mehr, A., & Mohammadi, M.J. (2016). The Relationship between Quality of Life and depressive symptoms in the elderly. Salamand: Iranian Journal of Aging, 11, 1, 90-98. [Persian]
Sahoo, S. S., Kaur, V., Panda, U. K., Nath, B., Parija, P. P., & Sahu, D. P. (2022). Depression and quality of life among elderly: Comparative cross-sectional study between elderly in community and old age homes in Eastern India. Journal of Education and Health Promotion, 11, 301.‌‌ https://doi.org/ 10.4103/jehp.jehp_1665_21
Schlechter, P., Ford, T.J. & Neufeld, S.A.S. (2023). The Development of depressive symptoms in older adults from a network perspective in the English Longitudinal Study of Ageing. Transl Psychiatry, 13, 363.‌‌ https://doi.org/ 10.1038/s41398-023-02659-0
Schuch, F. B., Vancampfort, D., Richards, J., Rosenbaum, S., Ward, P. B., & Stubbs, B. (2016). Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. Journal of psychiatric research, 77, 42-51. https://doi.org/ 10.1016/j.jpsychires.2016.02.023
Shamshadi, H., Shams, A., Sahaf, R., Shamsipour Dehkordi, P., Zareian, H., & Muslim, A. R. (2010). Psychometric properties of the persian version of the multidimensional body sense questionnaire (MBSRQ) in Iranian elderly. Salamand: Iranian Journal of Aging. 15 (3), 298-311. [Persian]
Shafiei Alavijeh, N. (2017). The relationship between physical activity level and depression and quality of life of the elderly in Alavijeh, Isfahan. Quarterly Journal of Geriatric Nursing, 3(4):34-45. [Persian]
Shirazi, M., Manouchehri, H., Zaghari Tafreshi, M., Zairi, F. & Alipour, V. (2016). Investigating the relationship between pain acceptance, life pattern and limitations caused by chronic pain in the elderly. Ibn Sina Journal of Nursing and Midwifery Care, 24, 3, 148-158. [Persian]
Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6th ed.). Boston, MA: Pearson.
Tse, M.M., Vong, S. K., Ho, S. S. (2013). Pain management for older persons living in nursing homes: A pilot study. Pain management nursing; 14(2): 10-21. DOI: 10.1016/j.pmn.2011.01.004
jsi, M. M., Vong, S. K., Ho, S. S. (2012). The Effectiveness of an integrated pain management program for olderpersons and staff in nursing homes. Archives of Gerontology and Geriatrics, 54(2): e203–e212. https://doi.org/ 10.1016/j.archger.2011.04.015
Vance, D.E., Wadley, V.G., Ball, K.K., Roenker, D.L., & Rizzo, M. (2005). The Effects of physical activity and sedentary behavior on cognitive health in older adults. Journal of Aging and Physical Activity, 13(3), PP:294-313. https://doi.org/10.1123/japa.13.3.294
Van Malderen,‌‌ L., Mets, T., Gorus, E. (2013). Interventions to enhance the Quality of Life of older people in residential long -term care: a systematic review. Ageing research reviews. 12(1):141 -50,‌‌ https://doi.org/ 10.1016/j.arr.2012.03.007
Walaszek, A. (2024). Optimizing the treatment of late-life depression. American Journal of Psychiatry, 181(1), 7-10. https://doi.org/ 10.1176/appi.ajp.20230919
Washburn, R. A., Smith, K. W., Jette, A. M., & Janney, C. A. (1993). The Physical activity scale for the elderly (PASE): development and evaluation. Journal of clinical epidemiology, 46(2), 153-162. https://doi.org/ 10.1016/0895-4356(93)90053-4
Wickramarachchi, B., Torabi, M. R., & Perera, B. (2023). Effects of physical activity on physical fitness and functional ability in older adults. Journal of Gerontology & Geriatric Medicine, 9, 23337214231158476. https://doi.org/ 10.1177/23337214231158476
Xu, L., Gu, H., Cai, X., Zhang, Y., Hou, X., Yu, J., Sun, T. (2023). The Effects of exercise for cognitive function in older adults: a systematic review and meta-analysis of randomized controlled trials. International Journal of Environmental Research and Public Health, 20(2), 1088. https://doi.org/ 10.3390/ijerph20021088
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, 0., Huang, V., Adey, M., Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17(1), 37-49. https://doi.org/ 10.1016/0022-3956(82)90033-4