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Physical Activity and Depression and Anxiety Disorders: A Systematic Review of Reviews and Assessment of Causality
Open accessAbstract
Introduction: Globally, depressive and anxiety disorders are the leading contributors to mental ill health. Physical activity reduces symptoms of depression and anxiety and has been proposed as an adjunct treatment therapy for depression and anxiety. Prospective studies suggest that physical activity may reduce the incidence of depression and anxiety. We conducted a systematic review of reviews with the aim to provide a comprehensive overview of available epidemiologic evidence on the strength of the association between physical activity and incident cases of depression and anxiety and to assess the likelihood of these associations being causal. Methods: We searched Embase and PubMed databases for systematic reviews published between January 1, 2000 and March 19, 2020 that reported findings on the strength of association between physical activity and incidence of depression and anxiety. We updated this search to October 15, 2022. Two reviewers independently assessed the methodologic quality of the included reviews using the Assessment of Multiple Systematic Reviews rating scale. We carried out a narrative synthesis of the evidence. We used the Bradford Hill criteria to assess the likelihood of associations being causal. Results: The initial search yielded 770 articles, of which 4 remained for data extraction. Two of the included reviews were scored as high quality, and 2 were scored as low quality. From the 2 included reviews that reported pooled estimates, people with high physical activity levels were found to have a decreased risk of incident depression (adjusted RR=0.83, 95% CI=0.76, 0.90) and reduced odds of developing anxiety (adjusted OR=0.74,95% CI=0.62, 0.88) when compared with those with low physical activity levels. We assessed physical activity to be probably causally related to both depression and anxiety. Discussion: Our evidence is drawn from systematic reviews of observational data. Further high-quality studies, such as randomized control trials, would help to strengthen the evidence base of the associations between physical activity and depression and anxiety. Nonetheless, our findings provide empirical support for the consideration of physical activity in strategies for the prevention of mental ill health.
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“Findings from this study support earlier studies indicating that regular PA is associated with higher PWB levels [16,43].”
From Relationships Between Physical Activity, Sleep, Psychological Well-Being, and Academic Performance Among Native American College Students (2026) · cites this paper as [16]
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“Lifestyle factors, such as physical activity (PA) and sleep duration, may play an important role in shaping psychological well-being (PWB) [13,14,15,16].”
From Relationships Between Physical Activity, Sleep, Psychological Well-Being, and Academic Performance Among Native American College Students (2026) · cites this paper as [16]
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The PRISMA 2020 statement: An updated guideline for reporting systematic reviews
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., et al. (2021) · BMJ · doi:10.1136/bmj.n71 · Cited by 108,283
PRISMA-P Group, Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., & Stewart, L. A. (2015) · Systematic Reviews · doi:10.1186/2046-4053-4-1 · Cited by 26,223
Vos, T., Lim, S. S., Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., Abbasi-Kangevari, M., Abbastabar, H., Abd-Allah, F., Abdelalim, A., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30925-9 · Cited by 19,358
Cochrane Handbook for Systematic Reviews of Interventions
(2019) · doi:10.1002/9781119536604 · Cited by 14,828
World Health Organization 2020 guidelines on physical activity and sedentary behaviour
Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J.-P., Chastin, S., Chou, R., et al. (2020) · British Journal of Sports Medicine · doi:10.1136/bjsports-2020-102955 · Cited by 11,657
Shea, B. J., Reeves, B. C., Wells, G., Thuku, M., Hamel, C., Moran, J., Moher, D., Tugwell, P., Welch, V., Kristjansson, E., et al. (2017) · BMJ · doi:10.1136/bmj.j4008 · Cited by 10,636
Lee, I.-M., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., & Katzmarzyk, P. T. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61031-9 · Cited by 8,215
Santomauro, D. F., Mantilla Herrera, A. M., Shadid, J., Zheng, P., Ashbaugh, C., Pigott, D. M., Abbafati, C., Adolph, C., Amlag, J. O., Aravkin, A. Y., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)02143-7 · Cited by 5,444
Guthold, R., Stevens, G. A., Riley, L. M., & Bull, F. C. (2018) · The Lancet Global Health · doi:10.1016/s2214-109x(18)30357-7 · Cited by 4,819
Correlates of physical activity: why are some people physically active and others not?
Bauman, A. E., Reis, R. S., Sallis, J. F., Wells, J. C., Loos, R. J., & Martin, B. W. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60735-1 · Cited by 4,151
Research works printed but not linked: 1
- Covidence Systematic Review Software. Veritas Health Innovation. www.covidence.org.
Cited by
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Anghel, L., Ciubară, A., Pătraș, D., & Ciubară, A. B. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14061809 · Cited by 48
Guerrera, C. S., Platania, G. A., Boccaccio, F. M., Sarti, P., Varrasi, S., Colliva, C., Grasso, M., Vivo, S. D., Cavallaro, D., Tascedda, F., et al. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05300-y · Cited by 31
Liu, Y., Wang, P., Duan, L., Shen, Q., Xu, L., & Zhang, T. (2025) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12580 · Cited by 30
Căliman-Sturdza, O. A., Gheorghita, R. E., & Lobiuc, A. (2025) · Life · doi:10.3390/life15030439 · Cited by 32
Yuan, Y., Yang, J., Huang, W., Hu, C., Zhang, W., & Chen, B. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1694344 · Cited by 20
Metadata
- Authors
- Wanjau, M. N., Möller, H., Haigh, F., Milat, A., Hayek, R., Lucas, P., & Veerman, J. L.
- Affiliations
- Griffith University (AU)
- UNSW Sydney (AU)
- The University of Sydney (AU)
- New South Wales Department of Health (AU)
- Venue
- AJPM Focus
- Publisher
- Elsevier BV
- Published
- 2023-06
- Volume
- 2
- Issue
- 2
- Pages
- 100074
- ISSN
- 2773-0654 (ISSN-L)
- PMC
- PMC10546525
- OpenAlex
- W4319065961
- Cited by
- 111
- References
- 45
- Citations by year
- 2026: 40 · 2025: 43 · 2024: 19 · 2023: 8
- FWCI
- 3.92
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- AJPM Focus (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Griffith Research Online (submittedVersion, cc-by-nc-nd)
- Funders
- Griffith University
- NSW Ministry of Health
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- physical activity, depression, anxiety disorders, depression incidence, causal inference, Bradford Hill criteria, mental illness prevention, methodological quality of systematic reviews
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