Background Anxiety often remains unrecognized or untreated among patients with a chronic illness. Exercise training may help improve anxiety symptoms among patients. We estimated the population effect size for exercise training effects on anxiety and determined whether selected variables of theoretical or practical importance moderate the effect.
Methods Articles published from January 1995 to August 2007 were located using the Physical Activity Guidelines for Americans Scientific Database, supplemented by additional searches through December 2008 of the following databases: Google Scholar, MEDLINE, PsycINFO, PubMed, and Web of Science. Forty English-language articles in scholarly journals involving sedentary adults with a chronic illness were selected. They included both an anxiety outcome measured at baseline and after exercise training and random assignment to either an exercise intervention of 3 or more weeks or a comparison condition that lacked exercise. Two co-authors independently calculated the Hedges d effect sizes from studies of 2914 patients and extracted information regarding potential moderator variables. Random effects models were used to estimate sampling error and population variance for all analyses.
Results Compared with no treatment conditions, exercise training significantly reduced anxiety symptoms by a mean effect Δ of 0.29 (95% confidence interval, 0.23-0.36). Exercise training programs lasting no more than 12 weeks, using session durations of at least 30 minutes, and an anxiety report time frame greater than the past week resulted in the largest anxiety improvements.
Conclusion Exercise training reduces anxiety symptoms among sedentary patients who have a chronic illness.
Anxiety, an unpleasant mood characterized by thoughts of worry, is an adaptive response to perceived threats that can develop into a maladaptive anxiety disorder if it becomes severe and chronic. Anxiety symptoms and disorders are common among individuals with a chronic illness, yet health care providers often fail to recognize or treat anxiety and may consider it to be an unimportant response to a chronic illness.
Anxiety symptoms can have a negative impact on treatment outcomes in part because anxious patients can be less likely to adhere to prescribed medical treatments. Personal costs of anxiety among patients include reduced health-related quality of life and increased disability, role impairment, and health care visits
Adequate evidence is available to justify screening for anxiety problems in primary care settings and prescribing effective treatments for those likely to benefit. While pharmacological and cognitive behavioral therapies are both efficacious in reducing anxiety, there continues to be interest in alternative therapies such as relaxation and exercise.
Exercise training is a healthful behavior with a minimal risk of adverse events that could be an effective and practical tool for reducing anxiety among patients. Meta-analytic reviews have summarized the association between exercise and anxiety symptoms both in samples of primarily healthy adults and exercise training studies of patients with fibromyalgia and cardiovascular disease, but these analyses did not focus on the best available evidence.
We used the results from randomized controlled trials to evaluate the effects of exercise training on anxiety. One goal was to estimate the population effect size for anxiety outcomes. A second goal was to learn whether variables of theoretical or practical importance, such as features of the exercise stimulus and the method for measuring anxiety, account for variation in the estimated population effect.
Herring, M. P., O’connor, P. J., &Dishman, R. K. (2010). The effect of exercise training on anxiety symptoms among patients: a systematic review. Archives of internal medicine, 170(4), 321-331.
doi:10.1001/archinternmed.2009.530
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