Physical activity protects from incident anxiety: A meta‐analysis of prospective cohort studies
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BACKGROUND: Prospective cohorts have suggested that physical activity (PA) can decrease the risk of incident anxiety. However, no meta-analysis has been conducted. AIMS: To examine the prospective relationship between PA and incident anxiety and explore potential moderators. METHODS: Searches were conducted on major databases from inception to October 10, 2018 for prospective studies (at least 1 year of follow-up) that calculated the odds ratio (OR) of incident anxiety in people with high PA against people with low PA. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was conducted and heterogeneity was explored using subgroup and meta-regression analysis. RESULTS: Across 14 cohorts of 13 unique prospective studies (N = 75,831, median males = 50.1%) followed for 357,424 person-years, people with high self-reported PA (versus low PA) were at reduced odds of developing anxiety (adjusted odds ratio [AOR] = 0.74; 95% confidence level [95% CI] = 0.62, 0.88; crude OR = 0.80; 95% CI = 0.69, 0.92). High self-reported PA was protective against the emergence of agoraphobia (AOR = 0.42; 95% CI = 0.18, 0.98) and posttraumatic stress disorder (AOR = 0.57; 95% CI = 0.39, 0.85). The protective effects for anxiety were evident in Asia (AOR = 0.31; 95% CI = 0.10, 0.96) and Europe (AOR = 0.82; 95% CI = 0.69, 0.97); for children/adolescents (AOR = 0.52; 95% CI = 0.29, 0.90) and adults (AOR = 0.81; 95% CI = 0.69, 0.95). Results remained robust when adjusting for confounding factors. Overall study quality was moderate to high (mean NOS = 6.7 out of 9). CONCLUSION: Evidence supports the notion that self-reported PA can confer protection against the emergence of anxiety regardless of demographic factors. In particular, higher PA levels protects from agoraphobia and posttraumatic disorder.
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There was some indication of publication bias, although significant positive effects of physical activity on incident anxiety remained when adjusting for this (OR=0.86, 95% CI: 0.69-0.99).
“There was some indication of publication bias, although significant positive effects of physical activity remained when adjusting for this (OR=0.86, 95% CI: 0.69-0.99).”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [36]
The ‘Physical activity and incident anxiety’ section reports evidence of publication bias and a significant effect after trim-and-fill adjustment, with the quoted estimate and confidence interval. It labels that estimate AOR=0.86, however; the separately reported OR is 0.83 (95% CI 0.72–0.95). (LLM, conf=0.84)
Experimental — accuracy not yet measuredOver an average follow-up period of 3.5 years, higher levels of physical activity significantly reduced incident anxiety (OR=0.748, 95% CI: 0.629-0.889), with low heterogeneity (I2=23.96%).
“Over the average follow-up period of 3.5 years, higher levels of physical activity significantly reduced incident anxiety (OR=0.748, 95% CI: 0.629-0.889), with low heterogeneity (I 2 =23.96%).”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [36]
The ‘Physical activity and incident anxiety’ section reports significantly lower incident anxiety with higher self-reported physical activity, and Table 2 gives the claimed estimate, confidence interval, and I². However, ‘Studies and participants characteristics’ calls 3.5 years the median follow-up, not the average, and Table 2 labels 0.748 an adjusted OR, not a crude OR. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOnly small samples were available for the subgroup analyses of specific anxiety disorders.
“It should be noted, however, that only small samples were available for these subgroup analyses.”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [36]
Examination of specific anxiety disorders indicated risk reduction from physical activity for agoraphobia (n=2, OR=0.43, 95% CI: 0.19-0.99) and post-traumatic stress disorder (n=2, OR=0.58, 95% CI: 0.39-0.86), with no significant effects observed for other disorders.
“Examination of specific anxiety disorders indicated risk reduction from physical activity for agoraphobia (n=2, OR=0.43, 95% CI: 0.19-0.99) and posttraumatic stress disorder (n=2, OR=0.58, 95% CI: 0.39-0.86), with no significant effects observed for other disorders.”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [36]
A recent umbrella review has demonstrated that an exercise intervention may be potentially effective in reducing the incidence of anxiety in the general young population.
“A recent umbrella review has demonstrated that an exercise intervention may be potentially effective in reducing the incidence of anxiety 174 in the general young population.”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [174]
Physical exercise reduces incidence of anxiety disorders.
“Physical exercise (reduced incidence of anxiety disorders) 174 ***”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [174]
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Self-citation
- Authors
- Schuch, F. B., Stubbs, B., Meyer, J., Heissel, A., Zech, P., Vancampfort, D., Rosenbaum, S., Deenik, J., Firth, J., Ward, P. B., Carvalho, A. F., & Hiles, S. A.
- Affiliations
- Universidade Federal de Santa Maria (BR)
- National Health Service (GB)
- Iowa State University (US)
- University of Potsdam (DE)
- KU Leuven (BE)
- Black Dog Institute (AU)
- Maastricht University (NL)
- University of Manchester (GB)
- UNSW Sydney (AU)
- Centre for Addiction and Mental Health (CA)
- University of Newcastle Australia (AU)
- Corresponding author
- Schuch, Felipe B.
- ORCID
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2019-06-17
- Volume
- 36
- Issue
- 9
- Pages
- 846-858
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- OpenAlex
- W2949860729
- Cited by
- 427
- References
- 64
- Citations by year
- 2026: 54 · 2025: 62 · 2024: 54 · 2023: 75 · 2022: 53 · 2021: 70 · 2020: 49 · 2019: 6 · 2018: 1 · 2017: 1
- FWCI
- 5.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Figshare (submittedVersion)
- publish.UP (University of Potsdam) (submittedVersion)
- Lirias (KU Leuven) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Funders
- Maudsley Charity
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- physical activity, agoraphobia, post-traumatic stress disorder, protective effect, children and adolescents, sex differences, age differences, geographic differences, mental health prevention, self-reported physical activity, prospective cohort, risk factors for anxiety, confounding factors, study quality assessment, Newcastle-Ottawa Scale
- MeSH terms
- Agoraphobia, Anxiety, Anxiety Disorders, Asia, Europe, Humans, Prospective Studies, Stress Disorders, Post-Traumatic, Exercise, Odds Ratio, Self Report
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