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Differential association of step count with depressive and anxiety symptoms in older adults at risk of dementia
Lau Y, Phannarus H, Cooper C, Walker Z, Demnitz-King H, Marchant NL.. medRxiv, 2026-07-13
Topic: Health services, long-term care and technology
Background Depressive and anxiety symptoms are prevalent among older adults and associated with increased dementia risk. In healthy older adults, higher step counts are associated with fewer depressive and anxiety symptoms; whether this holds in individuals with cognitive concerns (subjective cognitive decline [SCD] or mild cognitive impairment [MCI]) is unknown. Objective To test whether step count was associated with depressive and anxiety symptoms (cross-sectionally and over 24 months), and whether APPLE-Tree increased step count in participants with clinical anxiety or depression. At baseline, higher step counts were associated with fewer depressive symptoms (β = −0.11, 95% CI −0.17 to −0.05, p < 0.001) but, counter to our hypothesis, more anxiety symptoms (β = 0.12, 95% CI 0.06 to 0.19, p = 0.003). Over two years, change in step count was not associated with change in depressive or anxiety symptoms (all p ≥ 0.12). Conclusions This provides the first evidence in older adults with cognitive concerns that higher step counts are associated with fewer depressive but more anxiety symptoms. Existing research has shown that physical activity (e.g., walking) is associated with lower depressive and anxiety symptoms in healthy adults, and physical activity interventions are increasingly being employed to reduce these symptoms. What this study adds – summarise what we now know as a result of this study that we did not know before This study extends existing research by showing that higher step counts were associated with fewer depressive symptoms in older adults at risk of developing dementia (i.e., with subjective cognitive decline [SCD] or mild cognitive impairment [MCI]). However, contrary to existing research, higher step counts were associated with more anxiety symptoms in this population. Self-perceived mobility problems fully mediated the association between step count and depressive symptoms, but did not mediate the association with anxiety symptoms, suggesting that the mechanisms linking step count with depressive and anxiety symptoms differ in older adults at risk of dementia. In longitudinal analyses, neither the intervention nor change in step count was associated with change in symptoms, indicating that step count may be a correlate of symptoms rather than a modifiable target in this population.
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APA 7th
Lau, Y., Phannarus, H., Cooper, C., Walker, Z., Demnitz-King, H., & Marchant, N. L. (2026). Differential association of step count with depressive and anxiety symptoms in older adults at risk of dementia. medRxiv. https://doi.org/10.64898/2026.07.12.26357854
Vancouver
Lau Y, Phannarus H, Cooper C, Walker Z, Demnitz-King H, Marchant NL. Differential association of step count with depressive and anxiety symptoms in older adults at risk of dementia. medRxiv. 2026. doi:10.64898/2026.07.12.26357854.
BibTeX
@article{lau2026-f3bd773c,
author = {Lau, Y. and Phannarus, H. and Cooper, C. and Walker, Z. and Demnitz-King, H. and Marchant, N. L.},
title = {{Differential association of step count with depressive and anxiety symptoms in older adults at risk of dementia}},
journal = {medRxiv},
year = {2026},
doi = {10.64898/2026.07.12.26357854},
url = {https://doi.org/10.64898/2026.07.12.26357854}
}
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Key findings
- Background Depressive and anxiety symptoms are prevalent among older adults and associated with increased dementia risk.
- In healthy older adults, higher step counts are associated with fewer depressive and anxiety symptoms; whether this holds in individuals with cognitive concerns (subjective cognitive decline [SCD] or mild cognitive impairment [MCI]) is unknown.
- Objective To test whether step count was associated with depressive and anxiety symptoms (cross-sectionally and over 24 months), and whether APPLE-Tree increased step count in participants with clinical anxiety or depression.
- At baseline, higher step counts were associated with fewer depressive symptoms (β = −0.11, 95% CI −0.17 to −0.05, p < 0.001) but, counter to our hypothesis, more anxiety symptoms (β = 0.12, 95% CI 0.06 to 0.19, p = 0.003).
- Over two years, change in step count was not associated with change in depressive or anxiety symptoms (all p ≥ 0.12).
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Study details
- Study designrandomized controlled trial
- Participants629
- Evidence strengthHigh
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 58 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for effect reported because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 36 of the 62 points we could judge it on, which is 58 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 11 / 12 | A randomised controlled trial |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 2 / 4 | 629 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 1 / 2 | Randomised (as stated in the record) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Points | 36 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 36 of the 62 points we could judge it on is 58 out of 100. |
| Total | 58 / 100 | Capped to 16 because this is not a peer-reviewed article. |
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