Is exercise a viable therapy for anxiety? Systematic review of recent literature and critical analysis

Highlights

• Twenty-five randomized clinical trials (RCTs) of exercise interventions from January 2014 to December 2021 were identified.

• Thirteen trials enrolled participants with heightened anxiety at baseline.

• Twelve trials enrolled participants in which high anxiety was not a prerequisite but served as a primary outcome.

• Eighteen of 25 RCTs either had equivocal findings or found that exercise did not improve anxiety.

• Taken together, available evidence does not provide strong support for the efficacious use of exercise to treat anxiety.

Abstract

Objectives

Exercise has been promoted as a treatment for a variety of psychiatric conditions. The benefits of exercise for depression are widely recognized, but the benefits of exercise for anxiety are uncertain. Although several reviews promoted exercise as a treatment for anxiety, concerns about the quality of studies prompted us to provide a critical review of the recent literature to re-assess the value of exercise for treating anxiety.

Methods and materials

We conducted a systematic review of all peer-reviewed randomized clinical trials (RCTs) among adults, published between January 2014 and December 2021, with an exercise intervention and anxiety as the a priori primary outcome. Two reviewers independently extracted data from studies meeting inclusion criteria, including sample characteristics, exercise intervention, control conditions, primary anxiety measure, relevant findings, and methodological quality quantified by PEDro scores.

Results

7240 published studies from CINAHL, EMBASE, MEDLINE, and PsycINFO were screened in April 2022, with 1831 participants across 25 eligible RCTs, of which 13 included elevated anxiety at study entry as an eligibility criterion. Only two of these 13 studies, and five of 12 studies of non-anxious individuals, found anxiety to be reduced unequivocally with exercise. Most studies suffered from significant methodological limitations including concurrent therapies and lack of intention-to-treat analyses.

Conclusion

There remains considerable uncertainty about the value of exercise in reducing symptoms of anxiety, particularly among anxious individuals. The paucity of methodologically sound studies of patients with anxiety represents a significant gap in our knowledge and calls for more research in the area.

Word count: 249.