Exercise as Treatment for Anxiety: Systematic Review and Analysis
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ORIGINAL ARTICLE
Exercise as Treatment for Anxiety: Systematic Review and Analysis Gregory L. Stonerock, Ph.D. & Benson M. Hoffman, Ph.D. & Patrick J. Smith, Ph.D. & James A. Blumenthal, Ph.D.
# The Society of Behavioral Medicine 2015
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.
Keywords Exercise . Physical activity . Anxiety . Anxiety disorders . Systematic review
G. L. Stonerock (*) : B. M. Hoffman : P. J. Smith : J. A. Blumenthal Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3119, Durham, NC 27710, USA e-mail: [email protected]
Introduction Anxiety, a psychological state characterized by apprehensive expectation or fear, is among the most commonly experienced psychiatric symptoms [1]. Data from the National Comorbidity Study-Replication suggest that in the USA, the lifetime prevalence of any anxiety disorder is approximately one in three, more than any other diagnostic category [2]. Some elevation in anxiety symptoms, whether affective (fear, apprehension) or physiological (racing heart, trembling, etc.), is a criterion common to all of these disorders. However, other diagnostic criteria for anxiety disorders can be quite heterogeneous, such as the frequency and severity of symptoms as well as whether triggers for these symptoms are specific or more generalized. Subsyndromal anxiety symptoms also can impair individuals’ psychosocial functioning and can necessitate use of health care resources [3]. Anxiety represents a risk factor for lower health-related quality of life [4], increased risk of allcause mortality [5], and a variety of physical health problems, particularly cardiovascular disease (CVD). Findings from a number of prospective epidemiological studies report a strong association of anxiety with mortality in healthy individuals [5–7] and in CVD patients [8–14]. It has been shown that elevated anxiety scores were associated with increased risk of mortality after accounting for established risk fact
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