Research Article| Volume 64, ISSUE 4, P235-240, December 20, 2009

Download started.


Depressed mood but not fatigue mediate the relationship between physical activity and perceived stress in middle-aged women

Published:September 18, 2009DOI:



      To determine whether depressed mood and fatigue mediate the relationships between physical activity, body mass index, menopausal hot flashes, and perceived stress.


      This study is a secondary analysis of data obtained from a sub-sample of peri- and postmenopausal women (N = 212) from the TREMIN Research Program on Women's Health.


      The hypothesized mediational model was tested using path analysis within a structural equation modeling framework in Mplus Version 5.1. In unadjusted analysis, the relationships between physical activity, menopausal hot flashes, and perceived stress were mediated by depressed mood; fatigue mediated the relationships between hot flashes, body mass index, and perceived stress. When adjusting for age, insomnia, menopausal and hormone use status, the mediational effects of depressed mood on stress remained significant only for physical activity, and fatigue mediated the relationship between hot flashes and stress. The adjusted model explained 70% of variance in perceived stress, 82% of variance in depressed mood, and 81% of variance in fatigue.


      Depressed mood may partially explain the relationship between physical activity and perceived stress in middle-aged women, however further studies are needed to corroborate causality.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dennerstein L.
        • Lehert P.
        • Guthrie J.R.
        • Burger H.G.
        Modeling women's health during the menopausal transition: a longitudinal analysis.
        Menopause. 2007; 14: 53-62
        • Alexander J.L.
        • Dennerstein L.
        • Woods N.F.
        • et al.
        Role of stressful life events and menopausal stage in wellbeing and health.
        Expert Rev Neurotherapeutics. 2007; 7: S93-113
        • Avis N.E.
        • Brambilla D.
        • McKinlay S.M.
        • Vass K.
        A longitudinal analysis of the association between menopause and depression. Results from the Massachusetts Women's Health Study.
        Ann Epidemiol. 1994; 4: 214-220
        • Yasui T.
        • Maegawa M.
        • Tomita J.
        • et al.
        Changes in serum cytokine concentrations during the menopausal transition.
        Maturitas. 2007; 56: 396-403
        • Yasui T.
        • Maegawa M.
        • Tomita J.
        • et al.
        Association of serum cytokine concentrations with psychological symptoms in midlife women.
        J Reprod Immunol. 2007; 75: 56-62
        • Wang H.X.
        • Leineweber C.
        • Kirkeeide R.
        • et al.
        Psychosocial stress and atherosclerosis: family and work stress accelerate progression of coronary disease in women. The Stockholm Female Coronary Angiography Study.
        J Intern Med. 2007; 261: 245-254
        • Thurston R.C.
        • Bromberger J.
        • Chang Y.
        • et al.
        Childhood abuse or neglect is associated with increased vasomotor symptom reporting among midlife women.
        Menopause. 2008; 15: 16-22
        • North American Menopause Society [NAMS]
        Treatment of menopause-associated vasomotor symptoms: Position statement.
        Menopause. 2004; 2: 11-33
        • Lovejoy J.C.
        • Champagne C.M.
        • de Jonge L.
        • Xie H.
        • Smith S.R.
        Increased visceral fat and decreased energy expenditure during the menopausal transition.
        Int J Obes (Lond). 2008; 32: 949-958
        • Owens J.F.
        • Matthews K.A.
        • Räikkönen K.
        • Kuller L.H.
        It is never too late: change in physical activity fosters change in cardiovascular risk factors in middle-aged women.
        Prev Cardiol. 2003; 6: 22-28
        • Pettee K.K.
        • Kriska A.M.
        • Conroy M.B.
        • et al.
        Discontinuing hormone replacement therapy: attenuating the effect on CVD risk with lifestyle changes.
        Am J Prev Med. 2007; 32: 483-489
        • Sternfeld B.
        • Wang H.
        • Quesenberry Jr., C.P.
        • et al.
        Physical activity and changes in weight and waist circumference in midlife women: Findings from the Study of Women's Health Across the Nation.
        Am J Epidemiol. 2004; 160: 912-922
        • Sarbadhikari S.N.
        • Saha A.K.
        Moderate exercise and chronic stress produce counteractive effects on different areas of the brain by acting through various neurotransmitter receptor subtypes: a hypothesis.
        Theor Biol Med Model. 2006; 3: 33
        • Tsatsoulis A.
        • Fountoulakis S.
        The protective role of exercise on stress system dysregulation and comorbidities.
        Ann N Y Acad Sci. 2006; 1083: 196-213)
        • Nelson D.B.
        • Sammel M.D.
        • Freeman E.W.
        • Lin H.
        • Gracia C.R.
        • Schmitz K.H.
        Effect of physical activity on menopausal symptoms among urban women.
        Med Sci Sports Exerc. 2008; 40: 50-58
        • Salmon P.
        Effects of physical exercise on anxiety, depressing, and sensitivity to stress: A unifying theory.
        Clin Psychol Rev. 2000; 21: 33-61
        • Campisi J.
        • Leem T.H.
        • Greenwood B.N.
        • et al.
        Habitual physical activity facilitates stress-induced HSP72 induction in brain, peripheral, and immune tissues.
        Am J Physiol Regul Integr Comp Physiol. 2003; 284: R520-530
        • Moraska A.
        • Fleshner M.
        Voluntary physical activity prevents stress-induced behavioral depression and anti-KLH antibody suppression.
        Am J Physiol Regul Integr Comp Physiol. 2001; 281: R484-489
        • Valkeinen H.
        • Alén M.
        • Häkkinen A.
        • Hannonen P.
        • Kukkonen-Harjula K.
        • Häkkinen K.
        Effects of concurrent strength and endurance training on physical fitness and symptoms in postmenopausal women with fibromyalgia: a randomized controlled trial.
        Arch Phys Med Rehabil. 2008; 89: 1660-1666
        • Puetz T.W.
        • O’Connor P.J.
        • Dishman R.K.
        Effects of chronic exercise on feelings of energy and fatigue: a quantitative synthesis.
        Psychol Bull. 2006; 132: 866-876
        • Mutrie N.
        The relationship between physical activity and clinically defined depression.
        in: Biddle S.J.H. Fox K.R. Boutcher S.H. Physical Activity And Psychological Well-Being. Routledge, New York2000: 46-62
      1. Nelson HD, Haney E, Humphrey L, et al. Management of Menopause-Related Symptoms. Evidence Report/Technology Assessment No. 120. (Prepared by the Oregon Evidence-based Practice Center, under Contract No. 290-02-0024.) AHRQ Publication No. 05-E016-2. Rockville, MD: Agency for Healthcare Research and Quality. March 2005.

        • Alexander J.L.
        • Neylan T.
        • Kotz K.
        • Dennerstein L.
        • Richardson G.
        • Rosenbaum R.
        Assessment and treatment for insomnia and fatigue in the symptomatic menopausal woman with psychiatric comorbidity.
        Expert Rev Neurother. 2007; 7: S139-155
        • Waidyasekera H.
        • Wijewardena K.
        • Lindmark G.
        • Naessen T.
        Menopausal symptoms and quality of life during the menopausal transition in Sri Lankan women.
        Menopause. 2009; 16: 164-170
        • Wilbur J.
        • Shaver J.
        • Kogan J.
        • Buntin M.
        • Wang E.
        Menopausal transition symptoms in midlife women living with fibromyalgia and chronic fatigue.
        Health Care Women Int. 2006; 27: 600-614
      2. Ma J, Xiao L. Obesity and Depression in US Women: Results From the 2005–2006 National Health and Nutritional Examination Survey. Obesity (2009), doi:10.1038/oby.2009.213.

        • Daley A.J.
        • Stokes-Lampard H.J.
        • Macarthur C.
        Exercise to reduce vasomotor and other menopausal symptoms: a review.
        Maturitas. 2009; 63: 176-180
        • Mansfield P.K.
        • Bracken S.
        The Tremin Program: Sixty-eight years of research on menstruation and women's health.
        Women's Stud Q. 2003; 31: 25-41
        • Mansfield P.K.
        • Voda A.M.
        Hormone use among middle-aged women: results of a three-year study.
        Menopause. 1994; 1: 99-108
        • Cohen S.
        • Kamarck T.
        • Mermelstein R.
        A global measure of perceived stress.
        J Health Soc Behav. 1983; 24: 385-396
      3. Mplus [computer program]. Version 5.1. Los Angeles: Muthen and Muthen; 1998–2007.

        • Kessler R.C.
        • Greenberg D.F.
        Linear Panel Analysis. Models of Quantitative Change.
        Academic Press, New York, USA1981
        • Bollen K.A.
        Structural Equations With Latent Variables.
        John Wiley & Sons, New York1989
        • Hu L.
        • Bentler P.M.
        Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives.
        Struct Equation Modell. 1999; 6: 1-55
        • Bentler P.M.
        Comparative fix indexes in structural models.
        Psychol Bull. 1990; 107: 238-246
        • Baron R.M.
        • Kenny D.A.
        The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.
        J Pers Soc Psychol. 1986; 51: 1173-1182
        • MacKinnon D.P.
        • Fairchild A.J.
        • Fritz M.S.
        Mediation analysis.
        Annu Rev Psychol. 2007; 58: 593-614
        • McEwen B.S.
        Allostasis and allostatic load: implications for neuropsychopharmacology.
        Neuropsychopharmacology. 2000; 22: 108-124
        • Bromberger J.T.
        • Kravitz H.M.
        • Matthews K.
        • Youk A.
        • Brown C.
        • Feng W.
        Predictors of first lifetime episodes of major depression in midlife women.
        Psychol Med. 2009; 39: 55-64
        • Chida Y.
        • Hamer M.
        Chronic psychosocial factors and acute physiological responses to laboratory-induced stress in healthy populations: a quantitative review of 30 years of investigations.
        Psychol Bull. 2008; 134: 829-885
        • Woods N.F.
        • Mitchell E.S.
        • Percival D.B.
        • Smith-DiJulio K.
        Is the menopausal transition stressful? Observations of perceived stress from the Seattle Midlife Women's Health Study.
        Menopause. 2009; 16: 90-97
        • Netz Y.
        • Zach S.
        • Taffe J.R.
        • Guthrie J.
        • Dennerstein L.
        Habitual physical activity is a meaningful predictor of well-being in mid life women: a longitudinal analysis.
        Climacteric. 2008; 11: 337-344
        • Daley A.
        • Macarthur C.
        • Mutrie N.
        • Stokes-Lampard H.
        Exercise for vasomotor menopausal symptoms.
        Cochrane Database Syst Rev. 2007; 4 (October 17): CD006108
        • van Poppel M.N.
        • Brown W.J.
        “It's my hormones, doctor”--does physical activity help with menopausal symptoms?.
        Menopause. 2008; 15: 78-85
        • Thurston R.C.
        • Sowers M.R.
        • Sutton-Tyrrell K.
        • et al.
        Abdominal adiposity and hot flashes among midlife women.
        Menopause. 2008; 15: 429-434
        • Elavsky S.
        • McAuley E.
        Physical activity and mental health outcomes during menopause: A randomized controlled trial.
        Ann Behav Med. 2007; 33: 132-142
        • McTiernan A.
        • Stanford J.L.
        • Daling J.R.
        • Voigt L.F.
        Prevalence and correlates of recreational physical activity in women aged 50-64 years.
        Menopause. 1998; 5: 95-101
        • Zervas I.M.
        • Lambrinoudaki I.
        • Spyropoulou A.C.
        • et al.
        Additive effect of depressed mood and vasomotor symptoms on postmenopausal insomnia.
        Menopause. 2009; 16: 837-842
        • McAdams M.A.
        • Van Dam R.M.
        • Hu F.B.
        Comparison of self-reported and measured BMI as correlates of disease markers in US adults.
        Obesity. 2007; 15: 188-196