Exercise as Treatment for Anxiety: Systematic Review and Analysis

Stonerock, Gregory L.; Hoffman, Benson M.; Smith, Patrick J.; Blumenthal, James A.

doi:10.1007/s12160-014-9685-9

Cited by 363Physical Activity and HealthAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesCardiac Health and Mental Health

Exercise as Treatment for Anxiety: Systematic Review and Analysis

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Stonerock, Gregory L., Hoffman, Benson M., Smith, Patrick J., Blumenthal, James A.·2015·Annals of Behavioral Medicine

DOI 10.1007/s12160-014-9685-9PMC PMC4498975

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Abstract

BACKGROUND: Exercise has been shown to reduce symptoms of anxiety, but few studies have studied exercise in individuals preselected because of their high anxiety. PURPOSE: The objective of this study is to review and critically evaluate studies of exercise training in adults with either high levels of anxiety or an anxiety disorder. METHODS: We conducted a systematic review of randomized clinical trials (RCTs) in which anxious adults were randomized to an exercise or nonexercise control condition. Data were extracted concerning anxiety outcomes and study design. Existing meta-analyses were also reviewed. RESULTS: Evidence from 12 RCTs suggested benefits of exercise, for select groups, similar to established treatments and greater than placebo. However, most studies had significant methodological limitations, including small sample sizes, concurrent therapies, and inadequate assessment of adherence and fitness levels. CONCLUSIONS: Exercise may be a useful treatment for anxiety, but lack of data from rigorous, methodologically sound RCTs precludes any definitive conclusions about its effectiveness.

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Rodriguez-Ayllon et al. (2019) and Stonerock et al. (2015) reported beneficial but heterogeneous effects of physical activity on psychological well-being.
“Rodriguez-Ayllon et al. (2019) and Stonerock et al. (2015) reported beneficial but heterogeneous effects of physical activity on psychological well-being”
From Anxiety, Academic Performance, and Physical Activity in University Students: A Scoping Review (2025) · cites this paper as Stonerock et al. (2015)
The Results of the Exercise Interventions report that some trials found better anxiety outcomes with exercise, while others found no significant difference; the Discussion also describes substantial variation in interventions and outcome measures (page unavailable). This supports beneficial but heterogeneous effects on anxiety, but the paper does not establish effects on psychological well-being more broadly. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Consistent with previous reviews, methodological shortcomings such as non-random sampling, lack of control groups, and unvalidated measurement tools remain barriers to drawing definitive conclusions.
“Consistent with previous reviews (Rodriguez-Ayllon et al., 2019; Stonerock et al., 2015), methodological shortcomings such as non-random sampling, lack of control groups, and unvalidated measurement tools remain barriers to drawing definitive conclusions.”
From Anxiety, Academic Performance, and Physical Activity in University Students: A Scoping Review (2025) · cites this paper as Stonerock et al., 2015
The Discussion (page not provided) says methodological weaknesses in the reviewed trials limit definitive conclusions. But the paper does not identify non-random sampling or unvalidated measurement tools as those weaknesses, and its Methods state that studies without a control or comparison group were excluded. Its reported concerns include concurrent treatments, attrition, and reliance on self-report outcomes. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Exercise may incorporate gradual exposure with response prevention in the context of training, similar to conventional psychotherapy paradigms using desensitization techniques through gradual exposure.
“Exercise may therefore incorporate gradual exposure with response prevention in the context of training, similar to conventional psychotherapy paradigms using desensitization techniques through gradual exposure (80–82).”
From The Role of Exercise in Management of Mental Health Disorders: An Integrative Review (2021) · cites this paper as [82]

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Authors: Stonerock, G. L., Hoffman, B. M., Smith, P. J., & Blumenthal, J. A.
Affiliations: Duke University (US)
Corresponding author: Stonerock, Gregory L.
ORCID: Smith, Patrick J.
Blumenthal, James A.
Venue: Annals of Behavioral Medicine
Publisher: Oxford University Press (OUP)
Published: 2015-02-20
Volume: 49
Issue: 4
Pages: 542-556
ISSN: 0742-5554 (ISSN-L)
0883-6612
1532-4796
DOI: 10.1007/s12160-014-9685-9
PMC: PMC4498975
OpenAlex: W2028247430
Cited by: 363
References: 127
Citations by year: 2026: 19 · 2025: 38 · 2024: 38 · 2023: 48 · 2022: 38 · 2021: 45 · 2020: 46 · 2019: 26 · 2018: 25 · 2017: 19 · 2016: 12 · 2015: 8
FWCI: 2.62
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Annals of Behavioral Medicine (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health
National Heart, Lung, and Blood Institute (R01HL093374, HL080664-01, R01HL080664)
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: exercise training, anxiety disorders, anxiety symptoms, exercise therapy, methodological limitations, exercise adherence, physical fitness
MeSH terms: Anxiety, Anxiety Disorders, Combined Modality Therapy, Exercise Therapy, Humans

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Exercise as Treatment for Anxiety: Systematic Review and Analysis

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