Can Exercise Relieve Anxiety? Study examines potentials and pitfalls of fitness as therapy

In a recent study published in the journal Advances in Cardiovascular Diseaseresearchers are investigating whether exercise could be used to treat anxiety.

Study: Is exercise a viable therapy for anxiety? Systematic review of recent literature and critical analysis. Image Credit: GP PIXSTOCK / Shutterstock.com

The benefits of exercise on mental health

Way of life psychiatry recognizes the impact of various health-related behaviors, such as nutrition, sleep, smoking, and physical activity on mental health.

Exercising is a well-known health behavior that provides both physical and psychological benefits. In fact, exercise is now recommended as the main treatment for mild to moderate depression and as an adjunct treatment for serious mental illnesses. However, the impact of exercise on anxiety has not been studied as thoroughly as its effect on depression.

About the study

This review included studies that assessed the impact of long-term exercise on anxiety outcomes in people with anxiety disorders or high levels of anxiety symptoms. To this end, a systematic search was conducted in April 2022 of MEDLINE, EMBASE, CINAHL and PsycINFO for peer-reviewed studies in English. The studies selected obtained measures from participants for symptoms of anxiety-related disorders or high anxiety symptoms.

Only randomized clinical trials (RCTs) fulfilling the specified criteria were included in the review. These included articles published in English in a peer-reviewed journal, articles published between January 2014 and December 2021, eligible participants were at least 18 years old, at least 30 participants were enrolled in the study, interventions of exercise included more than one cycle of resistance training or aerobic exercise, the primary outcome was anxiety, and high anxiety symptoms were rated using a validated assessment instrument or diagnosed using an established procedure such as a psychiatric interview.

In addition to the inclusion criteria, any selected study provided information on control condition, exercise intervention, participant demographics, percentage attrition, primary outcome, anxiety measures, and anxiety-related outcomes, including an objective to determine if exercise helped reduce anxiety.

Unclear impact of exercise on anxiety

A total of 7,240 records were identified during the electronic database search; however, after removing 1,952 duplicate entries, 5,288 unique items remained.

Of these, 98.7% were excluded after reviewing the title and abstract. Finally, the review examined 70 studies and 25 RCTs that met the eligibility criteria.

Nineteen of these studies used self-report questionnaires to assess anxiety levels before the intervention. These questionnaires included the Spielberger State-Trait Anxiety Scale (STAI), the Beck Anxiety Inventory (BAI), the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS ), the Anxiety Sensitivity Index (ASI), the Psychiatric Diagnostic Screening Questionnaire (PDSQ), and the Post-Traumatic Stress Disorder (PTSD) Checklist (PCL).

Baseline anxiety was assessed in four studies using structured interviews such as the Clinical-Administered PTSD Scale (CAPS), Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the Hamilton Anxiety Rating Scale (HAM-A).

Seven provided conclusive evidence that exercise intervention groups experienced improvements in their disorder status or anxiety symptoms compared to controls. In two of 13 studies of people with anxiety, no clear reduction in anxiety levels was observed for the exercise cohort compared to controls.

Six studies reported insignificant or no variations in anxiety levels between those who exercised and those who did not. In 12 studies, including eight trials involving people with anxiety, the results were considered inconclusive or equivocal. Most studies had mixed results, as a reduction in anxiety was observed for certain measures or assessment periods.

Three studies reported positive results; however, due to significant methodological limitations, it was unclear whether exercise equivocally reduced anxiety. Additionally, four studies analyzed potential mediators or moderators of the anxiety-exercise correlation.

Three studies found that the level of reduction in exercise anxiety was influenced by the number of exercise sessions taken or the initial level of anxiety. Specifically, attending more exercise sessions was linked to a greater reduction in anxiety, while higher baseline anxiety levels were also linked to a greater reduction in anxiety. .

Two studies examined potential mediators, including participants’ daily steps and increased aerobic fitness levels; however, these analyzes did not produce a significant result.

conclusion

The limited number of reliable studies and the lack of positive results in more than half of the studies reviewed limit the ability to draw firm conclusions about the effectiveness of exercise as a treatment for anxiety in patients.

More research is needed to determine the benefits of exercise for people with anxiety. Clinicians who recommend exercise as a treatment for anxiety should prioritize patient safety, set clear and achievable exercise goals, and monitor symptoms closely.