The Effect of Exercise Training on Anxiety Symptoms Among Patients: A Systematic Review
Abstract
BACKGROUND: Anxiety often remains unrecognized or untreated among patients with a chronic illness. Exercise training may help improve anxiety symptoms among patients. We estimated the population effect size for exercise training effects on anxiety and determined whether selected variables of theoretical or practical importance moderate the effect. METHODS: Articles published from January 1995 to August 2007 were located using the Physical Activity Guidelines for Americans Scientific Database, supplemented by additional searches through December 2008 of the following databases: Google Scholar, MEDLINE, PsycINFO, PubMed, and Web of Science. Forty English-language articles in scholarly journals involving sedentary adults with a chronic illness were selected. They included both an anxiety outcome measured at baseline and after exercise training and random assignment to either an exercise intervention of 3 or more weeks or a comparison condition that lacked exercise. Two co-authors independently calculated the Hedges d effect sizes from studies of 2914 patients and extracted information regarding potential moderator variables. Random effects models were used to estimate sampling error and population variance for all analyses. RESULTS: Compared with no treatment conditions, exercise training significantly reduced anxiety symptoms by a mean effect Delta of 0.29 (95% confidence interval, 0.23-0.36). Exercise training programs lasting no more than 12 weeks, using session durations of at least 30 minutes, and an anxiety report time frame greater than the past week resulted in the largest anxiety improvements. CONCLUSION: Exercise training reduces anxiety symptoms among sedentary patients who have a chronic illness.
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Physical activity-based interventions reduce anxiety symptoms in patients with chronic physical health conditions.
“PA-based interventions have also been found to reduce anxiety symptoms in patients with chronic physical health conditions [69].”
From Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety (2018) · cites this paper as [69]
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Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases
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Chekroud, S. R., Gueorguieva, R., Zheutlin, A. B., Paulus, M., Krumholz, H. M., Krystal, J. H., & Chekroud, A. M. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30227-x · Cited by 1,172 · see citing works
Baldwin, D. S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den Boer, J. A., Christmas, D. M., Davies, S., Fineberg, N., Lidbetter, N., et al. (2014) · Journal of Psychopharmacology · doi:10.1177/0269881114525674 · Cited by 676 · see citing works
Stubbs, B., Vancampfort, D., Rosenbaum, S., Firth, J., Cosco, T., Veronese, N., Salum, G. A., & Schuch, F. B. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2016.12.020 · Cited by 666 · see citing works
Physical activity protects from incident anxiety: A meta‐analysis of prospective cohort studies
Schuch, F. B., Stubbs, B., Meyer, J., Heissel, A., Zech, P., Vancampfort, D., Rosenbaum, S., Deenik, J., Firth, J., Ward, P. B., et al. (2019) · Depression and Anxiety · doi:10.1002/da.22915 · Cited by 427 · see citing works
Biological mechanisms underlying the role of physical fitness in health and resilience
Silverman, M. N., & Deuster, P. A. (2014) · Interface Focus · doi:10.1098/rsfs.2014.0040 · Cited by 416 · see citing works
Physical Activity and Anxiety: A Systematic Review and Meta-analysis of Prospective Cohort Studies
McDowell, C. P., Dishman, R. K., Gordon, B. R., & Herring, M. P. (2019) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2019.05.012 · Cited by 385 · see citing works
Self-citationExercise as Treatment for Anxiety: Systematic Review and Analysis
Stonerock, G. L., Hoffman, B. M., Smith, P. J., & Blumenthal, J. A. (2015) · Annals of Behavioral Medicine · doi:10.1007/s12160-014-9685-9 · Cited by 363 · see citing works
Herring, M. P. (2012) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.696 · Cited by 362 · see citing works
Self-citationPhysical activity and anxiety: A perspective from the World Health Survey
Stubbs, B., Koyanagi, A., Hallgren, M., Firth, J., Richards, J., Schuch, F., Rosenbaum, S., Mugisha, J., Veronese, N., Lahti, J., et al. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.10.028 · Cited by 324 · see citing works
Azevedo Da Silva, M., Singh-Manoux, A., Brunner, E. J., Kaffashian, S., Shipley, M. J., Kivimäki, M., & Nabi, H. (2012) · European Journal of Epidemiology · doi:10.1007/s10654-012-9692-8 · Cited by 324 · see citing works
Gordon, B. R., McDowell, C. P., Lyons, M., & Herring, M. P. (2017) · Sports Medicine · doi:10.1007/s40279-017-0769-0 · Cited by 306 · see citing works
Self-citationExercise for anxiety disorders: systematic review
Jayakody, K., Gunadasa, S., & Hosker, C. (2014) · British Journal of Sports Medicine · doi:10.1136/bjsports-2012-091287 · Cited by 310 · see citing works
Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety
Kandola, A., Vancampfort, D., Herring, M., Rebar, A., Hallgren, M., Firth, J., & Stubbs, B. (2018) · Current Psychiatry Reports · doi:10.1007/s11920-018-0923-x · Cited by 291 · see citing works
Self-citationHartescu, I., Morgan, K., & Stevinson, C. D. (2015) · Journal of Sleep Research · doi:10.1111/jsr.12297 · Cited by 273 · see citing works
Spruit, A., Assink, M., van Vugt, E., van der Put, C., & Stams, G. J. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.03.006 · Cited by 250 · see citing works
Aylett, E., Small, N., & Bower, P. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3313-5 · Cited by 242 · see citing works
A Randomized Trial of MBSR Versus Aerobic Exercise for Social Anxiety Disorder
Jazaieri, H., Goldin, P. R., Werner, K., Ziv, M., & Gross, J. J. (2012) · Journal of Clinical Psychology · doi:10.1002/jclp.21863 · Cited by 210 · see citing works
Exosomes as Mediators of the Systemic Adaptations to Endurance Exercise
Safdar, A., & Tarnopolsky, M. A. (2018) · Cold Spring Harbor Perspectives in Medicine · doi:10.1101/cshperspect.a029827 · Cited by 203 · see citing works
Herring, M. P., Jacob, M. L., Suveg, C., Dishman, R. K., & O’Connor, P. J. (2012) · Psychotherapy and Psychosomatics · doi:10.1159/000327898 · Cited by 200 · see citing works
Self-citationLifestyle choices and mental health: a representative population survey
Velten, J., Lavallee, K. L., Scholten, S., Meyer, A. H., Zhang, X.-C., Schneider, S., & Margraf, J. (2014) · BMC Psychology · doi:10.1186/s40359-014-0055-y · Cited by 174 · see citing works
Marques, A. H., Bjørke-Monsen, A.-L., Teixeira, A. L., & Silverman, M. N. (2015) · Brain Research · doi:10.1016/j.brainres.2014.10.051 · Cited by 166 · see citing works
Coventry, P. A., Bower, P., Keyworth, C., Kenning, C., Knopp, J., Garrett, C., Hind, D., Malpass, A., & Dickens, C. (2013) · PLoS ONE · doi:10.1371/journal.pone.0060532 · Cited by 157 · see citing works
Moylan, S., Eyre, H. A., Maes, M., Baune, B. T., Jacka, F. N., & Berk, M. (2013) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2013.02.003 · Cited by 155 · see citing works
Mental Health Benefits of Strength Training in Adults
O'Connor, P. J., Herring, M. P., & Caravalho, A. (2010) · American Journal of Lifestyle Medicine · doi:10.1177/1559827610368771 · Cited by 153 · see citing works
Self-citationAerobic exercise reduces symptoms of posttraumatic stress disorder: a randomized controlled trial
Fetzner, M. G., & Asmundson, G. J. G. (2015) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2014.916745 · Cited by 139 · see citing works
Schoenfeld, T. J., Rada, P., Pieruzzini, P. R., Hsueh, B., & Gould, E. (2013) · The Journal of Neuroscience · doi:10.1523/jneurosci.5352-12.2013 · Cited by 138 · see citing works
Is exercise an alternative treatment for chronic insomnia?
Passos, G. S., Poyares, D. L. R., Santana, M. G., Tufik, S., & de Mello, M. T. (2012) · Clinics · doi:10.6061/clinics/2012(06)17 · Cited by 131 · see citing works
“The anxiety reducing effects of exercise are well established (45).”
BackgroundA Practical and Evidence-Based Approach to Common Symptoms: A Narrative Review
Kroenke, K. (2014) · Annals of Internal Medicine · doi:10.7326/m14-0461 · Cited by 132 · see citing works
Accortt, E. E., & Wong, M. S. (2017) · Obstetrical & Gynecological Survey · doi:10.1097/ogx.0000000000000477 · Cited by 122 · see citing works
Does exercise improve sleep for adults with insomnia? A systematic review with quality appraisal
Lowe, H., Haddock, G., Mulligan, L. D., Gregg, L., Fuzellier-Hart, A., Carter, L.-A., & Kyle, S. D. (2019) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.11.002 · Cited by 121 · see citing works
Do workplace physical activity interventions improve mental health outcomes
Chu, A. H. Y., Koh, D., Moy, F. M., & Muller-Riemenschneider, F. (2014) · Occupational Medicine · doi:10.1093/occmed/kqu045 · Cited by 111 · see citing works
Vancampfort, D., Koyanagi, A., Hallgren, M., Probst, M., & Stubbs, B. (2017) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2016.11.002 · Cited by 108 · see citing works
Effects of short-term exercise training on signs and symptoms of generalized anxiety disorder
Herring, M. P., Jacob, M. L., Suveg, C., & O’Connor, P. J. (2011) · Mental Health and Physical Activity · doi:10.1016/j.mhpa.2011.07.002 · Cited by 93 · see citing works
Self-citationHare, B. D., Beierle, J. A., Toufexis, D. J., Hammack, S. E., & Falls, W. A. (2014) · Neuropsychopharmacology · doi:10.1038/npp.2013.329 · Cited by 85 · see citing works
The Effect of Exercise on Mental Health
Dunn, A. L., & Jewell, J. S. (2010) · Current Sports Medicine Reports · doi:10.1249/jsr.0b013e3181e7d9af · Cited by 79 · see citing works
Lindheimer, J. B., Szabo, A., Raglin, J. S., & Beedie, C. (2020) · European Journal of Sport Science · doi:10.1080/17461391.2019.1632937 · Cited by 64 · see citing works
Kayambu, G., Boots, R. J., & Paratz, J. D. (2011) · BMC Anesthesiology · doi:10.1186/1471-2253-11-21 · Cited by 37 · see citing works
BEHAVIORAL STRATEGIES, INCLUDING EXERCISE, FOR ADDRESSING INSOMNIA
Markwald, R. R., Iftikhar, I., & Youngstedt, S. D. (2018) · ACSM'S Health & Fitness Journal · doi:10.1249/fit.0000000000000375 · Cited by 31 · see citing works
“It is wellestablished that exercise has anxiolytic effects which could facilitate sleep (48, 57,58).”
BackgroundExercise for the Management of Anxiety and Stress-Related Disorders
Herring, M. P. (2018) · Exercise-Based Interventions for Mental Illness · doi:10.1016/b978-0-12-812605-9.00002-2 · Cited by 15 · see citing works
Self-citationAlizadeh, Z., Feizi, A., Rejali, M., Afshar, H., Keshteli, A. H., Abdollahi, M., & Adibi, P. (2020) · Serbian Journal of Experimental and Clinical Research · doi:10.2478/sjecr-2018-0079 · Cited by 10 · see citing works
Gonzalez-Sanchez, J., Recio-Rodriguez, J. I., Gomez-Marcos, M. A., Patino-Alonso, M. C., Agudo-Conde, C., & Garcia-Ortiz, L. (2019) · Medicina Clínica · doi:10.1016/j.medcli.2018.06.029 · Cited by 9 · see citing works
- Authors
- Herring, M. P.
- Affiliations
- University of Georgia (US)
- Corresponding author
- Herring, Matthew P.
- ORCID
- Herring, Matthew P.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2010-02-22
- Volume
- 170
- Issue
- 4
- Pages
- 321
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2088436478
- Cited by
- 446
- References
- 101
- Citations by year
- 2026: 20 · 2025: 21 · 2024: 20 · 2023: 23 · 2022: 31 · 2021: 30 · 2020: 36 · 2019: 22 · 2018: 35 · 2017: 25 · 2016: 28 · 2015: 27 · 2014: 31 · 2013: 31 · 2012: 28
- FWCI
- 20.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- exercise training, anxiety symptoms, chronic disease, sedentary adults, moderators, physical activity interventions
- MeSH terms
- Adult, Anxiety Disorders, Chronic Disease, Female, Humans, Male, Middle Aged, Exercise, Treatment Outcome, Exercise Tolerance
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