In a recent study published in the journal Advances in cardiovascular diseaseresearchers explore whether exercise could be used to treat anxiety.
Study: Is exercise a valid therapy for anxiety? Systematic review of recent literature and critical analysis. Image credit: GP PIXSTOCK/Shutterstock.com
The mental health benefits of exercise
Lifestyle psychiatry recognizes the impact of various health behaviors, such as eating, sleeping, smoking, and physical activity, on mental health.
Exercise is a well-known health behavior that provides both physical and psychological benefits. In fact, exercise is now recommended as the primary treatment for mild to moderate depression and as an adjunctive treatment for severe mental illness. However, the impact of exercise on anxiety hasn’t been studied as extensively as its effect on depression.
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The current review included studies that evaluated 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 of MEDLINE, EMBASE, CINAHL, and PsycINFO was conducted in April 2022 for peer-reviewed studies in English. Selected studies obtained measurements from participants for symptoms of anxiety-related disorder or high anxiety symptoms.
Only randomized clinical trials (RCTs) that met 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 18 years or older, at least 30 participants were included in the study, exercise interventions included more than one round of resistance training or aerobic exercise, the primary outcome measure was anxiety, and elevated anxiety symptoms were assessed using a validated assessment tool or diagnosed using an established procedure such as a psychiatric interview.
In addition to inclusion criteria, each selected study provided information on control condition, exercise intervention, participant demographics, attrition rate, primary outcome, anxiety measures, and exercise outcomes. anxiety, including a goal to determine whether 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 looked at 70 studies and 25 RCTs that met the eligibility criteria.
Nineteen of these studies relied on 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 Post Traumatic Stress Disorder (PTSD) Checklist (PCL).
Baseline anxiety was assessed in four studies using structured interviews such as the Clinician Administered PTSD Scale (CAPS), the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the Anxiety Rating Scale of Hamilton (HAM-A).
Seven provided conclusive evidence that exercise intervention groups experienced improvements in their distress or anxiety symptoms compared to controls. In two of 13 studies involving anxious individuals, no clear reductions in anxiety levels were observed for the exercise cohort compared to controls.
Six studies reported little or no change in anxiety levels between those who exercised and those who didn’t. In 12 studies, including eight studies involving anxious individuals, the results were considered inconclusive or equivocal. Most studies have produced conflicting results, as a reduction in anxiety has been observed for certain measures or evaluation periods.
Three studies reported positive results; however, due to significant methodological limitations, it was difficult to determine whether exercise equivocally reduced anxiety. Additionally, four studies investigated potential mediators or moderators of the anxiety-exercise correlation.
Three studies found that the level of anxiety reduction due to exercise was influenced by the number of exercise sessions attended or by the initial level of anxiety. Specifically, participating in more exercise sessions was related to greater reductions in anxiety, while higher baseline anxiety levels were also related to greater reductions in anxiety.
Two studies looked at potential mediators, including participants’ daily steps and increased aerobic fitness levels; however, these analyzes did not produce a significant result.
The limited number of reliable studies and the absence of positive results in more than half of the studies reviewed limit the ability to draw definitive 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. Physicians who recommend exercise as a therapy for anxiety should prioritize patient safety, set clear and achievable exercise goals, and closely monitor symptoms.
- Stonerock, GL, Gupta, RP & Blumenthal, JA (2023). Is exercise a valid therapy for anxiety? Systematic review of recent literature and critical analysis. Advances in cardiovascular disease. doi:10.1016/j.pcad.2023.05.006
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