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Cited by 291Physical Activity and HealthAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesCardiac Health and Mental Health

Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety

Open access
Kandola, Aaron, Vancampfort, Davy, Herring, Matthew, Rebar, Amanda, Hallgren, Mats, Firth, Joseph, Stubbs, Brendon·2018·Current Psychiatry Reports
DOI 10.1007/s11920-018-0923-xPMC PMC6061211
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Abstract

PURPOSE OF REVIEW: The purpose of this paper was to provide a comprehensive narrative review of the relationship between physical activity (PA) and anxiety and the rationale for including it as a treatment option for anxiety disorders. Several gaps in the literature are highlighted alongside recommendations for future research. RECENT FINDINGS: PA in the general population has established efficacy in preventing and managing cardiovascular disease and improving wellbeing. Recent epidemiological data further suggests that people who are more active may be less likely to have anxiety disorders. In addition, evidence from systematic reviews of randomised control trials suggests that exercise training, a subset of PA, can reduce symptoms in anxiety and stress-related disorders, such as post-traumatic stress disorder, agoraphobia and panic disorder. Anxiety disorders are common, burdensome and costly to individuals and wider society. In addition to the profound negative impact on individuals' wellbeing and functioning, they are associated with worsened physical health, including a higher risk for cardiovascular diseases and premature mortality. Although pharmacotherapy and psychological interventions are helpful for many, these treatment approaches are not effective for everyone and are insufficient to address common physical health complications, such as the elevated risk of cardiovascular disease. Given the combined anxiolytic and physical health benefits of increased activity, PA presents a promising additional treatment option for people with anxiety disorders. However, there remain key gaps in the literature regarding the mechanisms underlying the effects of PA, optimal PA protocols, methods of improving adherence and the importance of physical fitness. These must be addressed for PA to be successfully implemented in mental health services.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review argues that physical activity (PA) is associated with reduced anxiety symptoms and may be a promising adjunctive or preventive treatment for anxiety disorders, with additional physical-health benefits. It highlights major gaps in mechanisms, optimal protocols, adherence, and the role of physical fitness that must be addressed before PA can be implemented in mental health services.

Key findings

  • Anxiety disorders are highly prevalent, with global estimates ranging from 3.8 to 25% across countries and up to 70% in people with chronic health conditions; they are the sixth leading cause of global disability, accounting for 26.8 million disability-adjusted life years.
  • People with anxiety disorders are 52% more likely to develop cardiovascular disease than the general population, and traditional treatments leave up to one-third of patients not responding.
  • PA, typically exercise-based interventions, has small-to-moderate effects on reducing anxiety symptoms in clinical and non-clinical populations, and may reduce symptoms in trauma/stress-related disorders such as PTSD, panic disorder, and agoraphobia.
  • A small study (N = 18) found less panic reaction to CO2 in patients performing moderate-to-vigorous intensity exercise versus very light intensity, but the paper notes it is likely underpowered and not designed for causal inference.

Methods

  • Design: comprehensive narrative review of the relationship between PA and anxiety and the rationale for including PA as a treatment option for anxiety disorders.
  • Data/sample: no primary data collection; synthesizes epidemiological studies, systematic reviews, meta-analyses, and randomised controlled trials (RCTs) on PA/exercise and anxiety across clinical and non-clinical populations.
  • Analysis: narrative synthesis of evidence on prevalence, treatment gaps, mechanisms, optimal PA protocols, adherence, and physical fitness, with recommendations for future research.

Limitations

  • The paper states that the precise mechanisms by which PA reduces anxiety remain unclear, including HPA-axis, neurogenic, inflammatory, endocannabinoid, and psychological pathways.
  • The paper states that optimal PA protocols are unknown, including frequency, intensity, duration, type, dose-response, and comparative effects of aerobic versus resistance training; adherence is often poor, and dropout rates are traditionally high in mental health populations.
  • The paper states that few studies account for baseline or changes in physical fitness, and there is a lack of RCTs measuring physical health outcomes in people with anxiety disorders. Evident from the text: as a narrative review, it does not describe a systematic search strategy or formal quality appraisal, so conclusions depend on the selected cited literature.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s11920-018-0923-x

Cites

114 of 114 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 106 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    Physical activity is associated with reduced symptoms of anxiety in the general population.

    “There is a growing basis of evidence to suggest that PA is associated with reduced symptoms of anxiety in the general population”
    Quote in the paperSubstantial claim
  • Findingnone given

    Relatively little is known about the benefits of physical activity on physical health and cardiovascular disease in people with anxiety disorders.

    “However, despite the physical health burden in people with anxiety disorders, relatively, little is known about the benefits of PA on physical health and cardiovascular disease in this population.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Physical activity-based interventions have demonstrated efficacy in treating symptoms of several mental health conditions ranging from psychosis to dementia.

    “Physical activity (PA)-based interventions represent a novel approach that have demonstrated efficacy in treating symptoms of several mental health conditions ranging from psychosis (e.g. [28, 29])⁠ to dementia (e.g. [30])⁠.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [28] Firth J, Cotter J, Elliott R, French P, Yung AR. A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychol Med. 2015;45(7):1343–61. source

      Not checked in the free run.

    • cites [29] Firth J, Stubbs B, Rosenbaum S, Vancampfort D, Malchow B, Schuch F, et al. Aerobic exercise improves cognitive functioning in people with schizophrenia: a systematic review and meta-analysis. Schizophr Bull. 2016;43(3):sbw115. source

      Not checked in the free run.

    • cites [30] Ahlskog JE, Geda YE, Graff-Radford NR, Petersen RC. Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. Mayo Clin Proc. 2011;86(9):876–84. source

      Not checked in the free run.

  • Premisecitation

    People who are more physically active may be less likely to have anxiety disorders.

    “Recent epidemiological data further suggests that people who are more active may be less likely to have anxiety disorders.”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [47] Baumeister SE, Leitzmann MF, Bahls M, Dörr M, Schmid D, Schomerus G, et al. Associations of leisure-time and occupational physical activity and cardiorespiratory fitness with incident and recurrent major depressive disorder, depressive symptoms, and incident anxiety in a general population. J Clin Psychiatry. 2017;78(1):e41–7. source

      Not checked in the free run.

    • cites [48] Azevedo Da Silva M, Singh-Manoux A, Brunner EJ, Kaffashian S, Shipley MJ, Kivimäki M, et al. Bidirectional association between physical activity and symptoms of anxiety and depression: the Whitehall II study. Eur J Epidemiol. 2012;27(7):537–46. source

      Not checked in the free run.

    • cites [49] De Mello MT, Lemos V de A, HKM A, Bittencourt L, Santos-Silva R, Tufik S. Relationship between physical activity and depression and anxiety symptoms: a population study. J Affect Disord. 2013;149(1–3):241–6. source

      Not checked in the free run.

    • cites [50] De Moor MHM, Beem AL, Stubbe JH, Boomsma DI, De Geus EJC. Regular exercise, anxiety, depression and personality: a population-based study. Prev Med (Baltim). 2006;42(4):273–9. source

      Not checked in the free run.

    • cites [51] Goodwin RD. Association between physical activity and mental disorders among adults in the United States. Prev Med (Baltim). 2003;36(6):698–703. source

      Not checked in the free run.

    • cites [52] Lindwall M, Gerber M, Jonsdottir IH, Börjesson M, Ahlborg G. The relationships of change in physical activity with change in depression, anxiety, and burnout: a longitudinal study of Swedish healthcare workers. Health Psychol. 2014;33(11):1309–18. source

      Not checked in the free run.

  • Premisecitation

    Exercise training produces improved neurocognitive performances in people with mental health conditions such as schizophrenia or depression.

    “In addition to having few adverse side effects, PA may have further benefits for daily functioning as research has found exercise training to produce improved neurocognitive performances in people with mental health conditions such as schizophrenia or depression [44, 45].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [44] Greer TL, Grannemann BD, Chansard M, Karim AI, Trivedi MH. Dose-dependent changes in cognitive function with exercise augmentation for major depression: results from the TREAD study. Eur Neuropsychopharmacol. 2015;25(2):248–56. source

      Not checked in the free run.

    • cites [45] Oertel-Knochel V, Mehler P, Thiel C, Steinbrecher K, Malchow B, Tesky V, et al. Effects of aerobic exercise on cognitive performance and individual psychopathology in depressive and schizophrenia patients. Eur Arch Psychiatry Clin Neurosci. 2014;264(7):589–604. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. 11
  • May combine two claims. 21

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    The underlying mechanisms for the effects of physical activity on anxiety symptoms have not been elucidated.

    “The underlying mechanisms for the effects of PA on anxiety symptoms have not been elucidated.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingnone given

    Research assessing the optimal physical activity protocols for reducing symptoms or on promoting adherence to physical activity has been lacking.

    “Similarly, research assessing the optimal PA protocols for reducing symptoms or on promoting adherence to PA have been lacking.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In mental health conditions, physical activity has wider benefits including improved quality of life, less psychological distress and improved physical health.

    “In such mental health conditions, PA has been shown to have wider benefits to peoples’ wellbeing, including an improved quality of life, less psychological distress and, importantly, improved physical health [28, 29, 38–43]⁠.”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [28] Firth J, Cotter J, Elliott R, French P, Yung AR. A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychol Med. 2015;45(7):1343–61. source

      Not checked in the free run.

    • cites [29] Firth J, Stubbs B, Rosenbaum S, Vancampfort D, Malchow B, Schuch F, et al. Aerobic exercise improves cognitive functioning in people with schizophrenia: a systematic review and meta-analysis. Schizophr Bull. 2016;43(3):sbw115. source

      Not checked in the free run.

    • cites [38] Broderick J, Knowles A, Chadwick J, Vancampfort D. Yoga versus standard care for schizophrenia. In: Broderick J, editor. Cochrane Database Syst RevCochrane Database of Systematic Reviews. Chichester: Wiley; 2015.

      Not checked in the free run.

    • cites [39] Fiuza-Luces C, Garatachea N, Berger NA, Lucia A. Exercise is the real polypill. Physiology (Bethesda). 2013;28(5):330–58.

      Not checked in the free run.

    • cites [40] Schuch FB, Vasconcelos-Moreno MP, Borowsky C, Zimmermann AB, Rocha NS, Fleck MP. Exercise and severe major depression: effect on symptom severity and quality of life at discharge in an inpatient cohort. J Psychiatr Res. 2015;61:25–32. source

      Not checked in the free run.

    • cites [41] Schuch FB, Vancampfort D, Rosenbaum S, Richards J, Ward PB, Stubbs B. Exercise improves physical and psychological quality of life in people with depression: a meta-analysis including the evaluation of control group response. Psychiatry Res. 2016;241:47–54. source

      Not checked in the free run.

    • cites [42] Vancampfort D, Probst M, Helvik Skjaerven L, Catalán-Matamoros D, Lundvik-Gyllensten A, Gómez-Conesa A, et al. Systematic review of the benefits of physical therapy within a multidisciplinary care approach for people with schizophrenia. Phys Ther. 2012;92(1):11–23. source

      Not checked in the free run.

    • cites [43] Vancampfort D, Rosenbaum S, Ward PB, Stubbs B. Exercise improves cardiorespiratory fitness in people with schizophrenia: a systematic review and meta-analysis. Schizophr Res. 2015;169(1):453–7. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Anxiety disorders are common, burdensome and costly to individuals and wider society.

    “Anxiety disorders are common, burdensome and costly to individuals and wider society.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [2] Remes O, Brayne C, van der Linde R, Lafortune L. A systematic review of reviews on the prevalence of anxiety disorders in adult populations. Brain Behav. 2016;6(7):e00497. source

      Not checked in the free run.

    • cites [3] Simpson HB, Neria Y, Lewis-Fernández R, Schneier F. Anxiety disorders: theory, research, and clinical perspectives. In: Simpson HB, Neria Y, Lewis-Fernandez R, Schneier F, editors. Anxiety Disorders: theory, research, and clinical Perspectives. Cambridge: Cambridge University Press; 2010. p. 1–378. source

      Not checked in the free run.

    • cites [4] Baxter AJ, Vos T, Scott KM, Ferrari AJ, Whiteford HA. The global burden of anxiety disorders in 2010. Psychol Med. 2014;44(11):2363–74. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Several studies of the general population have found that people who engage in more physical activity have a reduced risk of being diagnosed with an anxiety disorder and less frequent and severe anxiety symptoms.

    “Several studies of the general population have found that people who engage in more PA have a reduced risk of being diagnosed with an anxiety disorder and less frequent and severe anxiety symptoms [47–52]⁠.”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [47] Baumeister SE, Leitzmann MF, Bahls M, Dörr M, Schmid D, Schomerus G, et al. Associations of leisure-time and occupational physical activity and cardiorespiratory fitness with incident and recurrent major depressive disorder, depressive symptoms, and incident anxiety in a general population. J Clin Psychiatry. 2017;78(1):e41–7. source

      Not checked in the free run.

    • cites [48] Azevedo Da Silva M, Singh-Manoux A, Brunner EJ, Kaffashian S, Shipley MJ, Kivimäki M, et al. Bidirectional association between physical activity and symptoms of anxiety and depression: the Whitehall II study. Eur J Epidemiol. 2012;27(7):537–46. source

      Not checked in the free run.

    • cites [49] De Mello MT, Lemos V de A, HKM A, Bittencourt L, Santos-Silva R, Tufik S. Relationship between physical activity and depression and anxiety symptoms: a population study. J Affect Disord. 2013;149(1–3):241–6. source

      Not checked in the free run.

    • cites [50] De Moor MHM, Beem AL, Stubbe JH, Boomsma DI, De Geus EJC. Regular exercise, anxiety, depression and personality: a population-based study. Prev Med (Baltim). 2006;42(4):273–9. source

      Not checked in the free run.

    • cites [51] Goodwin RD. Association between physical activity and mental disorders among adults in the United States. Prev Med (Baltim). 2003;36(6):698–703. source

      Not checked in the free run.

    • cites [52] Lindwall M, Gerber M, Jonsdottir IH, Börjesson M, Ahlborg G. The relationships of change in physical activity with change in depression, anxiety, and burnout: a longitudinal study of Swedish healthcare workers. Health Psychol. 2014;33(11):1309–18. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Exercise-based interventions have an antidepressant effect in people with depression, with some studies reporting treatment efficacy comparable to antidepressant medications or psychotherapy.

    “Most notably, exercise-based interventions have been consistently demonstrated as having an antidepressant effect in people with depression [33, 34]⁠, with some studies reporting a treatment efficacy comparable to antidepressant medications or psychotherapy [35–37]⁠.”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [33] Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, et al. Exercise for depression. Cochrane Database Syst Rev. 2013;(9) source

      Not checked in the free run.

    • cites [34] Schuch FB, Vancampfort D, Richards J, Rosenbaum S, Ward PB, Stubbs B. Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J Psychiatr Res. 2016;77:42–51. source

      Not checked in the free run.

    • cites [35] Blumenthal JA, Babyak MA, Doraiswamy PM, Watkins L, Hoffman BM, Barbour KA, et al. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med. 2007;69(7):587–96. source

      Not checked in the free run.

    • cites [36] Brosse AL, Sheets ES, Lett HS, Blumenthal JA. Exercise and the treatment of clinical depression in adults. Sports Med. 2002;32(12):741–60. source

      Not checked in the free run.

    • cites [37] Kvam S, Kleppe CL, Nordhus IH, Hovland A. Exercise as a treatment for depression: a meta-analysis. J Affect Disord. 2016;202:67–86. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Physical activity in the general population has established efficacy in preventing and managing cardiovascular disease and improving wellbeing.

    “PA in the general population has established efficacy in preventing and managing cardiovascular disease and improving wellbeing.”
    Quote in the paperNot a substantial claim0 of 8 sources checked
    • cites [28] Firth J, Cotter J, Elliott R, French P, Yung AR. A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychol Med. 2015;45(7):1343–61. source

      Not checked in the free run.

    • cites [29] Firth J, Stubbs B, Rosenbaum S, Vancampfort D, Malchow B, Schuch F, et al. Aerobic exercise improves cognitive functioning in people with schizophrenia: a systematic review and meta-analysis. Schizophr Bull. 2016;43(3):sbw115. source

      Not checked in the free run.

    • cites [38] Broderick J, Knowles A, Chadwick J, Vancampfort D. Yoga versus standard care for schizophrenia. In: Broderick J, editor. Cochrane Database Syst RevCochrane Database of Systematic Reviews. Chichester: Wiley; 2015.

      Not checked in the free run.

    • cites [39] Fiuza-Luces C, Garatachea N, Berger NA, Lucia A. Exercise is the real polypill. Physiology (Bethesda). 2013;28(5):330–58.

      Not checked in the free run.

    • cites [40] Schuch FB, Vasconcelos-Moreno MP, Borowsky C, Zimmermann AB, Rocha NS, Fleck MP. Exercise and severe major depression: effect on symptom severity and quality of life at discharge in an inpatient cohort. J Psychiatr Res. 2015;61:25–32. source

      Not checked in the free run.

    • cites [41] Schuch FB, Vancampfort D, Rosenbaum S, Richards J, Ward PB, Stubbs B. Exercise improves physical and psychological quality of life in people with depression: a meta-analysis including the evaluation of control group response. Psychiatry Res. 2016;241:47–54. source

      Not checked in the free run.

    • cites [42] Vancampfort D, Probst M, Helvik Skjaerven L, Catalán-Matamoros D, Lundvik-Gyllensten A, Gómez-Conesa A, et al. Systematic review of the benefits of physical therapy within a multidisciplinary care approach for people with schizophrenia. Phys Ther. 2012;92(1):11–23. source

      Not checked in the free run.

    • cites [43] Vancampfort D, Rosenbaum S, Ward PB, Stubbs B. Exercise improves cardiorespiratory fitness in people with schizophrenia: a systematic review and meta-analysis. Schizophr Res. 2015;169(1):453–7. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pharmacotherapy and psychological interventions are helpful for many but are not effective for everyone and are insufficient to address common physical health complications such as elevated cardiovascular disease risk.

    “Although pharmacotherapy and psychological interventions are helpful for many, these treatment approaches are not effective for everyone and are insufficient to address common physical health complications, such as the elevated risk of cardiovascular disease.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [18] Ori R, Amos T, Bergman H, Soares-Weiser K, Ipser JC, Stein DJ. Augmentation of cognitive and behavioural therapies (CBT) with d-cycloserine for anxiety and related disorders. Cochrane Database Syst Rev. 2015;5:CD007803.

      Not checked in the free run.

    • cites [19] de Vries YA, de Jonge P, van den Heuvel E, Turner EH, Roest AM. Influence of baseline severity on antidepressant efficacy for anxiety disorders: meta-analysis and meta-regression. Br J Psychiatry. 2016;208(6):515–21. source

      Not checked in the free run.

    • cites [20] Hofmann SG, Smits JAJ. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008;69(4):621–32. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There is a lack of randomised controlled trials comparing the response of people with different types of anxiety disorders to physical activity or the impact of related psychiatric problems.

    “There is a lack of RCTs comparing the response of people with different types of anxiety disorders to PA [32••]⁠ or in the impact of related psychiatric problems (e.g. substance misuse).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 32••

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Physical activity may operate through the endocannabinoid system by up-regulating circulating endocannabinoids such as anandamide, which can produce anxiolytic effects by regulating dopamine.

    “For example, PA has been shown to up-regulate circulating endocannabinoids such as anandamide, which can produce anxiolytic effects by regulating other neurotransmitters, such as dopamine [84]⁠.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] Tantimonaco M, Ceci R, Sabatini S, Catani MV, Rossi A, Gasperi V, et al. Physical activity and the endocannabinoid system: an overview. Cell Mol Life Sci. 2014;71(14):2681–98. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    LeBouthillier and colleagues demonstrated that both aerobic and resistance exercise were efficacious in improving disorder status, but only aerobic exercise improved general psychological distress and anxiety, while only resistance training improved anxiety sensitivity, distress tolerance and intolerance of uncertainty.

    “For example, LeBouthillier and colleagues [92•]⁠ demonstrated that while both exercise modalities were efficacious in improving disorder status, only aerobic exercise improved general psychological distress and anxiety, while only resistance training improved anxiety sensitivity, distress tolerance and intolerance of uncertainty.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 92•

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Physical activity is known to have anti-inflammatory properties and may exert a positive impact on treating anxiety disorders by mediating inflammatory pathways.

    “PA is known to have anti-inflammatory properties and may exert a positive impact on treating anxiety disorders by mediating inflammatory pathways [83]⁠.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [83] Moylan S, Eyre HA, Maes M, Baune BT, Jacka FN, Berk M. Exercising the worry away: how inflammation, oxidative and nitrogen stress mediates the beneficial effect of physical activity on anxiety disorder symptoms and behaviours. Neurosci Biobehav Rev. 2013;37(4):573–84. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Anxiety disorders are associated with elevated levels of the pro-inflammatory cytokine C-reactive protein, which can cause chronic inflammation and contribute towards disorder development.

    “Specifically, anxiety disorders are associated with elevated levels of the pro-inflammatory cytokine C-reactive protein (CRP), which can cause chronic inflammation and contribute towards the disorder development [81]⁠.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [81] Vogelzangs N, Beekman ATF, de Jonge P, Penninx BWJH. Anxiety disorders and inflammation in a large adult cohort. Transl Psychiatry. 2013;3(4):e249–9. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Physical activity has a particularly potent impact on improving hippocampal functioning, which may support stress response regulation and reduce post-traumatic stress disorder symptoms.

    “PA has a particularly potent impact on improving hippocampal functioning [75]⁠, which may support stress response regulation and reduce PTSD symptoms.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] Voss MW, Vivar C, Kramer AF, Van PH. Bridging animal and human models of exercise-induced brain plasticity. Trends Cogn Sci. 2013:1–20. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Recent reviews have found physical activity, typically exercise-based interventions, to be effective as standalone or adjunctive therapies for reducing anxiety symptoms, with small to moderate effect sizes in people with and without a diagnosed anxiety disorder.

    “Nonetheless, recent reviews have found PAs, typically exercise-based interventions, are effective as standalone or adjunctive therapies for reducing anxiety symptoms, with effect sizes ranging from small to moderate in people with [32••, 46••, 59–61]⁠ and without [32••, 62–65]⁠ a diagnosed anxiety disorder.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites 32••

      Not checked in the free run.

    • cites 46••

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    • cites [59] Bartley CA, Hay M, Bloch MH. Meta-analysis: aerobic exercise for the treatment of anxiety disorders. Prog Neuro-Psychopharmacol Biol Psychiatry. 2013;45:34–9. source

      Not checked in the free run.

    • cites [60] Jayakody K, Gunadasa S, Hosker C. Exercise for anxiety disorders: systematic review. Br J Sports Med. 2014;48(3):187–96. source

      Not checked in the free run.

    • cites [61] Pedersen BK, Saltin B. Exercise as medicine—evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25:1–72. source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Physical activity may act through a range of physiological and psychological mechanisms, but the precise mechanism by which physical activity reduces anxiety is less clear.

    “PA may act through a range of different physiological and psychological mechanisms, but the precise mechanism by which PA reduces anxiety is less clear.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Because physical activity is low-cost and low-risk, such interventions could be a useful treatment option for anxiety.

    “The low-cost, low-risk nature of PA means that such interventions could be a useful treatment option for anxiety.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Physical activity has few adverse side effects.
    • Rests on an assumption: Physical activity-based interventions are low-cost.

  • May combine two claims.

    Premisecitation

    Studies of physical activity-based interventions in anxiety disorders rarely record physical health outcomes, and little work directly assesses the capacity for physical activity to reduce physical health risks in people with anxiety disorders.

    “However, studies of PA-based interventions in anxiety disorders rarely record physical health outcomes [32••],⁠ and little work has been conducted to directly assess the capacity for PA to reduce physical health risks in people with anxiety disorders.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 32••

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Aerobic exercise in addition to cognitive behavioural therapy improved symptoms in people with panic disorder and agoraphobia, possibly acting through the breathing hypotheses.

    “An innovative recent study found that aerobic exercise in addition to cognitive behavioural therapy improved symptoms in people with panic disorder and agoraphobia, possibly acting through the “breathing hypotheses” [68].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [68] Bischoff S, Wieder G, Einsle F, Petzold MB, Janßen C, Mumm JLM, et al. Running for extinction? Aerobic exercise as an augmentation of exposure therapy in panic disorder with agoraphobia. J Psychiatr Res. 2018;101:34–41. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    An earlier study reported that resistance exercise elicited notably greater reductions in signs and symptoms of generalised anxiety disorder than aerobic exercise.

    “An earlier study reported that resistance exercise elicited notably greater reductions in signs and symptoms of GAD, than aerobic exercise [93]⁠.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [93] Herring MP, Jacob ML, Suveg C, O’Connor PJ. Effects of short-term exercise training on signs and symptoms of generalized anxiety disorder. Ment Health Phys Act. 2011;4(2):71–7. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Promoting physical activity has already been suggested as a promising preventative strategy for other mental health conditions such as depression.

    “Promoting PA has already been suggested as a promising preventative strategy for other mental health conditions such as depression [109]⁠”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [109] Harvey SB, Øverland S, Hatch SL, Wessely S, Mykletun A, Hotopf M. Exercise and the prevention of depression: results of the HUNT Cohort Study. Am J Psychiatry. 2018;175(1):28–36. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Research in people with serious mental illness has shown that physical activity-based interventions can improve physical health and may have a similar effect in people with anxiety disorders.

    “Research in people with serious mental illness has shown PA-based interventions can improve physical health [28, 43]⁠ and may have a similar effect in people with anxiety disorders.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [28] Firth J, Cotter J, Elliott R, French P, Yung AR. A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychol Med. 2015;45(7):1343–61. source

      Not checked in the free run.

    • cites [43] Vancampfort D, Rosenbaum S, Ward PB, Stubbs B. Exercise improves cardiorespiratory fitness in people with schizophrenia: a systematic review and meta-analysis. Schizophr Res. 2015;169(1):453–7. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    There remain key gaps in the literature regarding the mechanisms underlying the effects of physical activity, optimal physical activity protocols, methods of improving adherence and the importance of physical fitness.

    “However, there remain key gaps in the literature regarding the mechanisms underlying the effects of PA, optimal PA protocols, methods of improving adherence and the importance of physical fitness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Physical inactivity is a significant but modifiable cardiovascular risk factor that is widespread in people with mental health problems, including anxiety disorders.

    “Factors such as physical inactivity represent a significant, but modifiable cardiovascular risk factor that is widespread in people with mental health problems [107]⁠, including anxiety disorders [25•, 53]⁠.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [107] Vancampfort D, Firth J, Schuch FB, Rosenbaum S, Mugisha J, Hallgren M, et al. Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis. World Psychiatry. 2017;16(3):308–15. source

      Not checked in the free run.

    • cites 25•

      Not checked in the free run.

    • cites [53] Teychenne M, Costigan SA, Parker K. The association between sedentary behaviour and risk of anxiety: a systematic review. BMC Public Health. 2015;15(1):513. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Stark health inequalities associated with mental illness more broadly appear to be worsening.

    “Such research is important for the wellbeing of those with anxiety disorders, but would also help to address the stark health inequalities associated with mental illness more broadly, which appears to be worsening [104••]⁠.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [104••]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Mental illness is broadly associated with poorer physical health outcomes, epitomised by a 15- to 20-year mortality gap between individuals with serious mental illness and the general population.

    “Mental illness is broadly associated with poorer physical health outcomes; the severity of which is epitomised by a 15- to 20-year mortality gap between individuals with serious mental illness and the general population [104••, 105, 106]⁠.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites 104••

      Not checked in the free run.

    • cites [105] Laursen TM, Wahlbeck K, Hällgren J, Westman J, Ösby U, Alinaghizadeh H, et al. Life expectancy and death by diseases of the circulatory system in patients with bipolar disorder or schizophrenia in the Nordic countries. Mazza M, editor. PLoS One. 2013;8(6):e67133. source

      Not checked in the free run.

    • cites [106] Wahlbeck K, Westman J, Nordentoft M, Gissler M, Laursen TM. Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. Br J Psychiatry. 2011;199(6):453–8. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Physical activity may have further benefits to physical health and wellbeing.

    “Moreover, PA may have further benefits to physical health and wellbeing.”
    Quote in the paperNot a substantial claim
27 of 27

  • The paper relies on this without support.

    Physical activity has few adverse side effects.

    “In addition to having few adverse side effects, PA may have further benefits for daily functioning as research has found exercise training to produce improved neurocognitive performances in people with mental health conditions such as schizophrenia or depression [44, 45].”

  • The paper relies on this without support.

    Physical activity-based interventions are low-cost.

    “The low-cost, low-risk nature of PA means that such interventions could be a useful treatment option for anxiety.”

  • The paper relies on this without support.

    Physical health problems associated with anxiety disorders and comorbidities are not directly caused by anxiety.

    “Given that the physical health problems associated with anxiety disorders and comorbidities, and not directly caused by anxiety, improving the poor physical health, outcomes associated with anxiety disorders cannot be achieved using pharmacotherapy or CBT alone.”

  • The paper relies on this without support.

    Preventative strategies effective for other mental health conditions such as depression are likely to be effective for anxiety.

    “Promoting PA has already been suggested as a promising preventative strategy for other mental health conditions such as depression [109]⁠ and may represent a cost-effective and practical method of reducing the prevalence of anxiety and anxiety-related disorders.”

  • The paper relies on this without support.

    People with anxiety disorders have a significant physical health burden.

    “However, despite the physical health burden in people with anxiety disorders, relatively, little is known about the benefits of PA on physical health and cardiovascular disease in this population.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Reference 97 is not an American College of Sports Medicine guideline

    Minor

    The text cites reference 97 as an example of a public-health guideline from the American College of Sports Medicine, but the listed reference is a study of exercise intensity and depressed mood.

1 of 1

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1 of the 115 references couldn’t be matched to a known paper.

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Related

Authors
Kandola, A., Vancampfort, D., Herring, M., Rebar, A., Hallgren, M., Firth, J., & Stubbs, B.
Affiliations
  • South London and Maudsley NHS Foundation Trust (GB)
  • KU Leuven (BE)
  • University of Limerick (IE)
  • Central Queensland University (AU)
  • Karolinska Institutet (SE)
  • University of Manchester (GB)
  • King's College London (GB)
Corresponding author
Kandola, Aaron
ORCID
Venue
Current Psychiatry Reports
Publisher
Springer Science and Business Media LLC
Published
2018-07-24
Volume
20
Issue
8
Pages
63-63
ISSN
  • 1523-3812 (ISSN-L)
  • 1535-1645
DOI
10.1007/s11920-018-0923-x
PMC
PMC6061211
OpenAlex
W2884190723
Semantic Scholar
38a853ecb61fd7f5545a2f61e5786e59ef30f2b7
Cited by
291
References
115
Citations by year
2026: 30 · 2025: 41 · 2024: 56 · 2023: 45 · 2022: 44 · 2021: 49 · 2020: 19 · 2019: 5 · 2018: 2
FWCI
2.47
Type
journal article
Language
en
Open access
Licence
Locations
  • Current Psychiatry Reports (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (publishedVersion, cc-by)
  • Research Explorer (The University of Manchester) (publishedVersion, other-oa)
  • University of Limerick Institutional Repository (University of Limerick) (acceptedVersion, cc-by-nc-sa)
  • University of Limerick Institutional Repository (University of Limerick) (acceptedVersion, other-oa)
  • Lirias (KU Leuven) (submittedVersion, cc-by)
  • Acquire (CQUniversity) (submittedVersion, other-oa)
  • Arrow@dit (Dublin Institute of Technology) (submittedVersion, cc-by-nc-sa)
  • Figshare (submittedVersion, cc-by)
  • Figshare (submittedVersion, cc-by-nc-sa)
  • University of Limerick Institutional Repository (University of Limerick)
Funders
King's College London
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, anxiety disorders, exercise training, post-traumatic stress disorder, agoraphobia, panic disorder, cardiovascular disease, physical fitness, exercise adherence, mental health services, stress-related disorders
MeSH terms
Anxiety, Anxiety Disorders, Exercise Therapy, Humans, Mental Health, Stress Disorders, Post-Traumatic, Exercise

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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