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Anxiety disorders, typically characterized by hyperarousal, excessive fear, and worry, are pervasive in modern society, with prevalence estimates ranging from 3.8 to 25% across countries and rates as high as 70% in people with chronic health conditions.1 Not only do they have a profound negative impact on an individual’s wellbeing and functioning, these disorders are also associated with a higher risk of cardiovascular diseases and premature mortality.1 Approaches to the treatment of anxiety primarily focus on lessening the symptoms of the disorder through the use of pharmaceuticals, but functional medicine clinicians have long appreciated the benefits of lifestyle modifications like exercise. Regular physical activity is known to help improve symptoms of anxiety,1-4 but limited research exists on whether exercise itself might lower the risk of developing these disorders.5
Now, a new study in Frontiers in Psychiatry details the significant impact regular exercise may have on reducing the onset of anxiety.5 Swedish researchers studied nearly 400,000 people and found that those with an active lifestyle were 60% less likely to develop anxiety compared to less physically active people over a 21-year period. This one of the largest ever population-wide epidemiological studies across genders, involving individuals who took part in the world’s largest long-distance cross-country ski race between 1989 and 2010, together with non-skier controls from the general population.5
The skiers, men and women, had a significantly lower risk of developing anxiety compared to non-skiers in the same time period.5 The results held even after excluding individuals who were diagnosed with anxiety disorders within the first 5 years after study inclusion. This helped to rule out reverse causation (that anxiety prevents individuals from engaging in physical activity, rather than physical activity preventing anxiety).5 The findings are also in line with the authors’ previous research, which found that the skiers had a lower incidence of depression compared to the non-skier control group.6
The authors did, however, find a noticeable difference in exercise performance level and the risk of developing anxiety between male and female skiers.5 For example, while a male skier’s physical performance did not appear to affect the risk of developing anxiety, the highest performing group of female skiers had almost double the risk of developing anxiety disorders compared to the group that was physically active at a lower performance level. Importantly, they said, the total risk of getting anxiety among high-performing women was still lower compared to the more physically inactive women in the general population.5
The discovery of an association between physical performance and the risk of anxiety disorders in women, in particular, also emphasizes the importance of follow-up research.5 “Our results suggest that the relation between symptoms of anxiety and exercise behavior may not be linear,” said study author Martina Svensson, an associate researcher in the Experimental Neuroinflammation Laboratory at Lund University in Sweden. “Exercise behaviors and anxiety symptoms are likely to be affected by genetics, psychological factors, and personality traits, confounders that were not possible to investigate in our cohort. Studies investigating the driving factors behind these differences between men and women when it comes to extreme exercise behaviors and how it affects the development of anxiety are needed.”5
Furthermore, the positive effect of physical activity on anxiety was observed in people immersed in nature, and this could be an important controlling factor as being in a natural landscape may influence mental health outcomes.7 Furthermore, limitations of the study include that the physical activity level of the skiing population does not match non-skiers in the general population, with skiers also smoking less and having a better diet compared to the control population of non-skiers. Physical activity was not controlled for, as the authors lacked data on lifestyle habits for the majority of participants. Randomized intervention trials, as well as long-term objective measurements of physical activity in prospective studies, are needed to assess the validity and causality of the association they reported.5
That said, the low-cost, low-risk nature of regular exercise means that such interventions could be a useful treatment option for patients suffering from anxiety. Whether structured, as in exercise programs, or unstructured, as brief interruptions of sedentary behavior, it’s important for clinicians to engage and empower patients to leverage movement. Functional medicine teaches clinicians the multifocal mechanisms by which movement can reverse the major underlying causes of disease and how to effectively motivate patients to move well for their health.
- Kandola A, Vancampfort D, Herring M, et al. Moving to beat anxiety: epidemiology and therapeutic issues with physical activity for anxiety. Curr Psychiatry Rep. 2018;20(8):63. doi:1007%2Fs11920-018-0923-x.
- Nyberg J, Henriksson M, Aberg MAI, et al. Cardiovascular fitness in late adolescent males and later risk of serious non-affective mental disorders: a prospective, population-based study. Psychol Med.2018;48(3):416-425. doi:1017/s0033291717001763.
- Strohle A, Hofler M, Pfister H, et al. Physical activity and prevalence and incidence of mental disorders in adolescents and young adults. Psychol Med.2007;37:1657-1666. doi:1017/s003329170700089x.
- Teychenne M, White RL, Richards J, Schuch FB, Rosenbaum S, Bennie JA. Do we need physical activity guidelines for mental health: what does the evidence tell us? Mental Health Phys Act. 2020;18:100315 doi:1016/j.mhpa.2019.100315.
- Svensson M, Brundin L, Erhardt S, Hållmarker U, James S, Deierborg T. Physical activity is associated with lower long-term incidence of anxiety in a population-based, large-scale study. Front Psychiatry.2021;12:714014. doi:3389/fpsyt.2021.714014.
- Svensson M, Brundin L, Erhardt S, et al. Long distance ski racing is associated with lower long-term incidence of depression in a population based, large-scale study. Psychiatry Res. 2019;281:112546. doi:1016/j.psychres.2019.112546.
- Tillmann S, Tobin D, Avison W, Gilliland J. Mental health benefits of interactions with nature in children and teenagers: a systematic review. J Epidemiol Community Health. 2018;72(10):958-966. doi:1136/jech-2018-210436.