A review of current advances in the transformative effects of physical exercise on the psychological wellbeing of those suffering from anxiety disorders

  • Saima Sabri School of Psychology, Beijing Sport University, Haidian District, Beijing 100084, China
  • Nadia Rashid Department of Psychology, Bahauddin Zikriya University, Multan 60700, Pakistan
Article ID: 1433
1023 Views, 358 PDF Downloads
Keywords: anxiety disorder; mental health; psychological well-being; physical exercise

Abstract

Background: Anxiety is characterized by excessive worry, fear, or apprehension, often leading to significant impairments in daily functioning, including difficulties maintaining physical health and psychological well-being (PWB). There is a lack of conclusive research regarding the efficacy of physical exercise (PE) as a treatment for anxiety in primary care settings, as well as uncertainty about the specific degree of activity required to produce therapeutic benefits. The goal of this systematic review is to investigate the effects of PE on the PWB of people suffering from anxiety disorders (AD), as well as to compare the benefits of different PE regimens. Method: A systematic literature search was carried out utilizing seven databases (PUBMED, PsycINFO, Science Direct Engine, Semantic Scholar, Google Scholar, Online Library, and other sources such as periodicals). Inclusion and exclusion criteria were based on the PICOS framework, and the risk of bias (ROB) was utilized to assess the quality of eligible research. Result: Aerobic exercise (AE) is the most effective PE modality in reducing anxiety symptoms, while the benefits of resistance exercise (RE) are also notable. Moreover, research suggests that moderate intensity PE (MI-PE) tends to yield superior results over other PE regimens in managing anxiety symptoms. These findings underscore the importance of PE intensity in achieving therapeutic benefits for anxiety management. PE is acknowledged as an effective intervention for lowering anxiety symptoms, making it an attractive therapeutic choice for those with AD. Conclusion: PE is a safe, efficient, and effective therapeutic method for treating anxiety symptoms. However, the majority of published studies contain substantial methodological flaws, necessitating additional research to determine the suitable PE modalities, frequency, duration, and intensity for maximizing the therapeutic effects of PE on AD.

References

[1]Acil, A. A., Dogan, S., & Dogan, O. (2008). The effects of physical exercises to mental state and quality of life in patients with schizophrenia. Journal of Psychiatric and Mental Health Nursing, 15(10), 808–815. Portico. https://doi.org/10.1111/j.1365-2850.2008.01317.x

[2]Aguirre Velasco, A., Cruz, I. S. S., Billings, J., et al. (2020). What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review. BMC Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-02659-0

[3]Anderson, E., & Shivakumar, G. (2013). Effects of Exercise and Physical Activity on Anxiety. Frontiers in Psychiatry, 4. https://doi.org/10.3389/fpsyt.2013.00027

[4]Ashdown-Franks, G., Firth, J., Carney, R., et al. (2019). Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes. Sports Medicine, 50(1), 151–170. https://doi.org/10.1007/s40279-019-01187-6

[5]Asmundson, G. J. G., Fetzner, M. G., DeBoer, L. B., et al. (2013). Let’s get physical: a contemporary review of the anxiolytic effects of exercise for anxiety and its disorders. Depression and Anxiety, 30(4), 362–373. https://doi.org/10.1002/da.22043

[6]Batelaan, N. M., Seldenrijk, A., Bot, M., et al. (2016). Anxiety and new onset of cardiovascular disease: critical review and meta-analysis. British Journal of Psychiatry, 208(3), 223–231. https://doi.org/10.1192/bjp.bp.114.156554

[7]Bhurka, A. A., & Shukla, Y. U. (2023). Effect of Aerobic Exercise Versus Resistance Training on Anxiety and Physical Fitness Among the Post Covid Young Adults - A Comparative Interventional Study. International Journal of Health Sciences and Research, 13(11), 59–75. https://doi.org/10.52403/ijhsr.20231110

[8]Biddle, S. J. H., & Mutrie, N. (2008). Psychology of physical activity: Determinants, well-being, and interventions, 2nd ed. Routledge.

[9]Bischoff, S., Wieder, G., Einsle, F., et al. (2018). Running for extinction? Aerobic exercise as an augmentation of exposure therapy in panic disorder with agoraphobia. Journal of Psychiatric Research, 101, 34-41. https://doi.org/10.1016/j.jpsychires.2018.03.00

[10]Boecker, H., Sprenger, T., Spilker, M. E., et al. (2008). The Runner’s High: Opioidergic Mechanisms in the Human Brain. Cerebral Cortex, 18(11), 2523–2531. https://doi.org/10.1093/cercor/bhn013

[11]Bottoms, L., Prat Pons, M., Fineberg, N. A., et al. (2022). Effects of exercise on obsessive-compulsive disorder symptoms: a systematic review and meta-analysis. International Journal of Psychiatry in Clinical Practice, 27(3), 232–242. https://doi.org/10.1080/13651501.2022.2151474

[12]Broman-Fulks, J. J., Berman, M. E., Rabian, B. A., & Webster, M. J. (2004). Effects of aerobic exercise on anxiety sensitivity. Behaviour Research and Therapy, 42(2), 125-136. https://doi.org/10.1016/S0005-7967(03)00103-7

[13]Brown, R. A., Abrantes, A. M., Strong, D. R., et al. (2007). A Pilot Study of Moderate-Intensity Aerobic Exercise for Obsessive Compulsive Disorder. Journal of Nervous & Mental Disease, 195(6), 514–520. https://doi.org/10.1097/01.nmd.0000253730.31610.6c

[14]Carek, P. J., Laibstain, S. E., & Carek, S. M. (2011). Exercise for the Treatment of Depression and Anxiety. The International Journal of Psychiatry in Medicine, 41(1), 15–28. https://doi.org/10.2190/pm.41.1.c

[15]Clement, S., Schauman, O., Graham, T., et al. (2014). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27. https://doi.org/10.1017/s0033291714000129

[16]Conn, V. S. (2010). Anxiety Outcomes After Physical Activity Interventions. Nursing Research, 59(3), 224–231. https://doi.org/10.1097/nnr.0b013e3181dbb2f8

[17]Craft, L. L., & Landers, D. M. (1998). The Effect of Exercise on Clinical Depression and Depression Resulting from Mental Illness: A Meta-Analysis. Journal of Sport and Exercise Psychology, 20(4), 339–357. https://doi.org/10.1123/jsep.20.4.339

[18]Craske, M. G., & Stein, M. B. (2016). Anxiety. The Lancet, 388(10063), 3048-3059. https://doi.org/10.1016/S0140-6736(16)30381-6

[19]Crombie, K. M., Cisler, J. M., Hillard, C. J., et al. (2021). Aerobic exercise reduces anxiety and fear ratings to threat and increases circulating endocannabinoids in women with and without PTSD. Mental Health and Physical Activity, 20, 100366. https://doi.org/10.1016/j.mhpa.2020.100366

[20]de Souza Moura, A., Lamego, M., Paes, F., et al. (2015). Effects of Aerobic Exercise on Anxiety Disorders: A Systematic Review. CNS & Neurological Disorders - Drug Targets, 14(9), 1184–1193. https://doi.org/10.2174/1871527315666151111121259

[21]DeBoer, L. B., Powers, M. B., Utschig, A. C., et al. (2012). Exploring exercise as an avenue for the treatment of anxiety disorders. Expert Review of Neurotherapeutics, 12(8), 1011–1022. https://doi.org/10.1586/ern.12.73

[22]El-Gabalawy, R., Mackenzie, C. S., Shooshtari, S., et al. (2011). Comorbid physical health conditions and anxiety disorders: a population-based exploration of prevalence and health outcomes among older adults. General Hospital Psychiatry, 33(6), 556–564. https://doi.org/10.1016/j.genhosppsych.2011.07.005

[23]Firth, J., Siddiqi, N., Koyanagi, A., et al. (2019). The Lancet Psychiatry Commission: A blueprint for protecting physical health in people with mental illness. The Lancet Psychiatry, 6(8), 675-712. https://doi.org/10.1016/S2215-0366(19)30132-4

[24]Firth, J., Solmi, M., Wootton, R. E., et al. (2020). A meta‐review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry, 19(3), 360–380. Portico. https://doi.org/10.1002/wps.20773

[25]Gaudlitz, K., Plag, J., Dimeo, F., et al. (2014). Aerobic exercise training facilitates the effectiveness of cognitive behavioral therapy in panic disorder. Depression and Anxiety, 32(3), 221–228. https://doi.org/10.1002/da.22337

[26]Goetter, E. M., Frumkin, M. R., Palitz, S. A., et al. (2020). Barriers to mental health treatment among individuals with social anxiety disorder and generalized anxiety disorder. Psychological Services, 17(1), 5–12. https://doi.org/10.1037/ser0000254

[27]Goldfield, G. S., Kenny, G. P., Alberga, A. S., et al. (2015). Effects of aerobic training, resistance training, or both on psychological health in adolescents with obesity: The HEARTY randomized controlled trial. Journal of Consulting and Clinical Psychology, 83(6), 1123–1135. https://doi.org/10.1037/ccp0000038

[28]Goodwin, R. D. (2003). Association between physical activity and mental disorders among adults in the United States. Preventive Medicine, 36(6), 698-703. https://doi.org/10.1016/S0091-7435(03)00042-2

[29]Gordon, B. R., McDowell, C. P., Lyons, M., et al. (2017). The Effects of Resistance Exercise Training on Anxiety: A Meta-Analysis and Meta-Regression Analysis of Randomized Controlled Trials. Sports Medicine, 47(12), 2521–2532. https://doi.org/10.1007/s40279-017-0769-0

[30]Gordon, B. R., McDowell, C. P., Lyons, M., et al. (2020). Resistance exercise training for anxiety and worry symptoms among young adults: a randomized controlled trial. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-74608-6

[31]Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry, 10(1). https://doi.org/10.1186/1471-244x-10-113

[32]Harvey, A. G., & Gumport, N. B. (2015). Evidence-based psychological treatments for mental disorders: Modifiable barriers to access and possible solutions. Behaviour Research and Therapy, 68, 1–12. https://doi.org/10.1016/j.brat.2015.02.004

[33]Henriksson, M., Wall, A., Nyberg, J., et al. (2022). Effects of exercise on symptoms of anxiety in primary care patients: A randomized controlled trial. Journal of Affective Disorders, 297, 26–34. https://doi.org/10.1016/j.jad.2021.10.006

[34]Herring, M. P. (2010). The Effect of Exercise Training on Anxiety Symptoms Among Patients. Archives of Internal Medicine, 170(4), 321. https://doi.org/10.1001/archinternmed.2009.530

[35]Herring, M. P., Jacob, M. L., Suveg, C., et al. (2011). Effects of short-term exercise training on signs and symptoms of generalized anxiety disorder. Mental Health and Physical Activity, 4(2), 71–77. https://doi.org/10.1016/j.mhpa.2011.07.002

[36]Herring, M. P., Jacob, M. L., Suveg, C., et al. (2012). Feasibility of Exercise Training for the Short-Term Treatment of Generalized Anxiety Disorder: A Randomized Controlled Trial. Psychotherapy and Psychosomatics, 81(1), 21–28. Portico. https://doi.org/10.1159/000327898

[37]Herring, M. P., Johnson, K. E., & O’Connor, P. J. (2016). Exercise training and health-related quality of life in generalized anxiety disorder. Psychology of Sport and Exercise, 27, 138–141. https://doi.org/10.1016/j.psychsport.2016.08.011

[38]Herring, M. P., Kline, C. E., & O’Connor, P. J. (2015). Effects of exercise on sleep among young women with Generalized Anxiety Disorder. Mental Health and Physical Activity, 9, 59–66. https://doi.org/10.1016/j.mhpa.2015.09.002

[39]Higgins, J. P. T., Thomas, J., Chandler, J., et al. (2022). Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration.

[40]Jayakody, K., Gunadasa, S., & Hosker, C. (2013). Exercise for anxiety disorders: systematic review. British Journal of Sports Medicine, 48(3), 187–196. https://doi.org/10.1136/bjsports-2012-091287

[41]Ji, C., Yang, J., Lin, L., et al. (2022). Physical Exercise Ameliorates Anxiety, Depression and Sleep Quality in College Students: Experimental Evidence from Exercise Intensity and Frequency. Behavioral Sciences, 12(3), 61. https://doi.org/10.3390/bs12030061

[42]Kenari, M. A. (2014). Effect of Exercise on Mental Health in the Physical Dimension, Anxiety and Mental Disorder, Social Dysfunction and Depression. Advances in Applied Sociology, 04(03), 63–68. https://doi.org/10.4236/aasoci.2014.43011

[43]Kline, C. E., Sui, X., Hall, M. H., et al. (2012). Dose–response effects of exercise training on the subjective sleep quality of postmenopausal women: exploratory analyses of a randomised controlled trial. BMJ Open, 2(4), e001044. https://doi.org/10.1136/bmjopen-2012-001044

[44]Larun, L., Nordheim, L. V., Ekeland, E., et al. (2006). Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd004691.pub2

[45]LeBouthillier, D. M., & Asmundson, G. J. G. (2017). The efficacy of aerobic exercise and resistance training as transdiagnostic interventions for anxiety-related disorders and constructs: A randomized controlled trial. Journal of Anxiety Disorders, 52, 43–52. https://doi.org/10.1016/j.janxdis.2017.09.005

[46]Lin, Y., & Gao, W. (2023). The effects of physical exercise on anxiety symptoms of college students: A meta-analysis. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1136900

[47]Mahindru, A., Patil, P., & Agrawal, V. (2023). Role of Physical Activity on Mental Health and Well-Being: A Review. Cureus. https://doi.org/10.7759/cureus.33475

[48]Masellis, M., Rector, N. A., & Richter, M. A. (2003). Quality of Life in OCD: Differential Impact of Obsessions, Compulsions, and Depression Comorbidity. The Canadian Journal of Psychiatry, 48(2), 72–77. https://doi.org/10.1177/070674370304800202

[49]Masley, S., Roetzheim, R., & Gualtieri, T. (2009). Aerobic Exercise Enhances Cognitive Flexibility. Journal of Clinical Psychology in Medical Settings, 16(2), 186–193. https://doi.org/10.1007/s10880-009-9159-6

[50]McAuley, E., Szabo, A., Gothe, N., et al. (2011). Self-Efficacy: Implications for Physical Activity, Function, and Functional Limitations in Older Adults. American Journal of Lifestyle Medicine, 5(4), 361–369. https://doi.org/10.1177/1559827610392704

[51]McGranahan, M. J., & O’Connor, P. J. (2021). Exercise training effects on sleep quality and symptoms of anxiety and depression in post-traumatic stress disorder: A systematic review and meta-analysis of randomized control trials. Mental Health and Physical Activity, 20, 100385. https://doi.org/10.1016/j.mhpa.2021.100385

[52]Meyer, J., & Schuch, F. B. (2018). Exercise for the Prevention and Treatment of Depression. Exercise-Based Interventions for Mental Illness, 1–18. https://doi.org/10.1016/b978-0-12-812605-9.00001-0

[53]Mojtabai, R. (2011). Mental illness stigma and willingness to seek mental health care in the European Union. Social Psychiatry and Psychiatric Epidemiology, 46(7), 705-712. https://doi.org/10.1007/s00127-010-0240-8

[54]Newman, C. L., & Motta, R. W. (2007). The effects of aerobic exercise on childhood PTSD, anxiety, and depression. International Journal of Emergency Mental Health, 9(2), 133-158.

[55]Page, M. J., McKenzie, J. E., Bossuyt, P. M., et al. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, n71. https://doi.org/10.1136/bmj.n71

[56]Petruzzello, S. J., Landers, D. M., Hatfield, B. D., et al. (1991). A Meta-Analysis on the Anxiety-Reducing Effects of Acute and Chronic Exercise. Sports Medicine, 11(3), 143–182. https://doi.org/10.2165/00007256-199111030-00002

[57]Plag, J., Schmidt-Hellinger, P., Klippstein, T., et al. (2020). Working out the worries: A randomized controlled trial of high intensity interval training in generalized anxiety disorder. Journal of Anxiety Disorders, 76, 102311. https://doi.org/10.1016/j.janxdis.2020.102311

[58]Rosenbaum, S., Sherrington, C., & Tiedemann, A. (2014). Exercise augmentation compared with usual care for post‐traumatic stress disorder: a randomized controlled trial. Acta Psychiatrica Scandinavica, 131(5), 350–359. Portico. https://doi.org/10.1111/acps.12371

[59]Sabri, S., Rashid, N., & Mao, Z.-X. (2023). Physical Activity and Exercise as a Tool to Cure Anxiety and Posttraumatic Stress Disorder. Mental Illness, 2023, 1–20. https://doi.org/10.1155/2023/4294753

[60]Salmon, P. (2001). Effects of physical exercise on anxiety, depression, and sensitivity to stress: A unifying theory. Clinical Psychology Review, 21(1), 33-61. https://doi.org/10.1016/S0272-7358(99)00032-X

[61]Schuch, F. B., Stubbs, B., Meyer, J., et al. (2019). Physical activity protects from incident anxiety: A meta‐analysis of prospective cohort studies. Depression and Anxiety, 36(9), 846–858. Portico. https://doi.org/10.1002/da.22915

[62]Sharma, A. (2006). Exercise for Mental Health. The Primary Care Companion For CNS Disorders, 8(2). https://doi.org/10.4088/pcc.v08n0208a

[63]Smits, J. A. J., Berry, A. C., Rosenfield, D., et al. (2008). Reducing anxiety sensitivity with exercise. Depression and Anxiety, 25(8), 689–699. https://doi.org/10.1002/da.20411

[64]Sternfeld, B., Guthrie, K. A., Ensrud, K. E., et al. (2014). Efficacy of exercise for menopausal symptoms. Menopause, 21(4), 330–338. https://doi.org/10.1097/gme.0b013e31829e4089

[65]Stubbs, B., Vancampfort, D., Rosenbaum, S., et al. (2017). An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry Research, 249, 102–108. https://doi.org/10.1016/j.psychres.2016.12.020

[66]Szuhany, K. L., Steinberg, M. H., McLaughlin, N. C. R., et al. (2023). Predictors of Long-Term Exercise Engagement in Patients with Obsessive-Compulsive Disorder: The Role of Physical Activity Enjoyment. Behavior Therapy, 54(4), 610–622. https://doi.org/10.1016/j.beth.2022.12.010

[67]Tsatsoulis, A., & Fountoulakis, S. (2006). The Protective Role of Exercise on Stress System Dysregulation and Comorbidities. Annals of the New York Academy of Sciences, 1083(1), 196–213. Portico. https://doi.org/10.1196/annals.1367.020

[68]Tull, M. T., Lee, A. A., Geers, A. L., et al. (2018). Exploring the role of sedentary behavior and physical activity in depression and anxiety symptom severity among patients with substance use disorders. Mental Health and Physical Activity, 14, 98–102. https://doi.org/10.1016/j.mhpa.2018.03.001

[69]Vos, T., Lim, S. S., Abbafati, C., et al. (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet, 396, 1204-1222. https://doi.org/10.1016/S0140-6736(20)30925-9

[70]Weissman, M. M., Bland, R. C., Canino, G. J., et al. (1994). The cross-national epidemiology of obsessive-compulsive disorder. The cross-national collaborative group. Journal of Clinical Psychiatry, 55(Suppl), 5-10.

[71]White, R. L., Babic, M. J., Parker, P. D., et al. (2017). Domain-Specific Physical Activity and Mental Health: A Meta-analysis. American Journal of Preventive Medicine, 52(5), 653–666. https://doi.org/10.1016/j.amepre.2016.12.008

[72]Wipfli, B. M., Rethorst, C. D., & Landers, D. M. (2008). The Anxiolytic Effects of Exercise: A Meta-Analysis of Randomized Trials and Dose–Response Analysis. Journal of Sport and Exercise Psychology, 30(4), 392–410. https://doi.org/10.1123/jsep.30.4.392

[73]Wu, F., Zhang, J., Yang, H., et al. (2022). The Effect of Physical Exercise on the Elderly’s Anxiety: Based on Systematic Reviews and Meta-Analysis. Computational and Mathematical Methods in Medicine, 2022, 1–8. https://doi.org/10.1155/2022/4848290

[74]Youngstedt, S. D. (2005). Effects of Exercise on Sleep. Clinics in Sports Medicine, 24(2), 355–365. https://doi.org/10.1016/j.csm.2004.12.003

[75]Ziebart, C., Bobos, P., MacDermid, J. C., et al. (2022). The efficacy and safety of exercise and physical activity on psychosis: A systematic review and meta-analysis. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.807140

Published
2024-08-19
How to Cite
Sabri , S., & Rashid, N. (2024). A review of current advances in the transformative effects of physical exercise on the psychological wellbeing of those suffering from anxiety disorders. Applied Psychology Research, 3(2), 1433. https://doi.org/10.59400/apr.v3i2.1433
Section
Review