Prospective cohorts have suggested that physical activity (PA) can decrease the risk of incident anxiety. However, no meta‐analysis has been conducted.
To examine the prospective relationship between PA and incident anxiety and explore potential moderators.
Searches were conducted on major databases from inception to October 10, 2018 for prospective studies (at least 1 year of follow‐up) that calculated the odds ratio (OR) of incident anxiety in people with high PA against people with low PA. Methodological quality was assessed using the Newcastle‐Ottawa Scale (NOS). A random‐effects meta‐analysis was conducted and heterogeneity was explored using subgroup and meta‐regression analysis.
Across 14 cohorts of 13 unique prospective studies (N = 75,831, median males = 50.1%) followed for 357,424 person‐years, people with high self‐reported PA (versus low PA) were at reduced odds of developing anxiety (adjusted odds ratio [AOR] = 0.74; 95% confidence level [95% CI] = 0.62, 0.88; crude OR = 0.80; 95% CI = 0.69, 0.92). High self‐reported PA was protective against the emergence of agoraphobia (AOR = 0.42; 95% CI = 0.18, 0.98) and posttraumatic stress disorder (AOR = 0.57; 95% CI = 0.39, 0.85). The protective effects for anxiety were evident in Asia (AOR = 0.31; 95% CI = 0.10, 0.96) and Europe (AOR = 0.82; 95% CI = 0.69, 0.97); for children/adolescents (AOR = 0.52; 95% CI = 0.29, 0.90) and adults (AOR = 0.81; 95% CI = 0.69, 0.95). Results remained robust when adjusting for confounding factors. Overall study quality was moderate to high (mean NOS = 6.7 out of 9).
Evidence supports the notion that self‐reported PA can confer protection against the emergence of anxiety regardless of demographic factors. In particular, higher PA levels protects from agoraphobia and posttraumatic disorder.
Anxiety disorders are common and burdensome across the world (Baxter, Vos, Scott, Norman, et al., 2014; Baxter, Vos, Scott, Ferrari, & Whiteford, 2014). The point prevalence varies across world regions, ranging between 2.1% (range, 1.8–2.5%) in East Asia up to 6.1% (range, 5.1–7.4%) in North Africa/Middle East (Baxter, Vos, Scott, Ferrari, et al., 2014; Baxter, Vos, Scott, Norman, et al., 2014). The prevalence of anxiety symptoms is even higher, at approximately 11% worldwide (Stubbs, Koyanagi et al., 2017). Globally, anxiety disorders are the sixth leading cause of disability regarding years of life lived with disability across all ages, and fourth in adults (18–49 years; Meier et al., 2016). In addition, anxiety disorders are associated with a 39% and 146% increased risk of premature mortality from natural causes and unnatural causes, respectively (Meier et al., 2016). People with anxiety disorders are at higher risk of cardiometabolic diseases, such as diabetes and acute cardiac events (Edmondson & von Kanel, 2017; Smith, Deschenes, & Schmitz, 2018). This is potentially due to shared etiological biological factors between anxiety and cardiovascular disorders (e.g., increased inflammation and oxidative stress; Belem da Silva et al., 2017), but also due to modifiable risk behaviors like lower physical activity (PA) levels and increased sedentary behavior (Stubbs, Koyanagi et al., 2017; Vancampfort, Stubbs, Herring, Hallgren, & Koyanagi, 2018). Although several previous cross‐sectional studies suggest that people with anxiety disorders or higher levels of anxiety symptoms are more likely to engage in lower levels of PA (22.9% versus 16.6%; Dillon, McMahon, O’Regan, & Perry, 2018; Stubbs, Koyanagi et al., 2017) and spend more time in sedentary activities when compared with people without anxiety (Dillon et al., 2018; Teychenne, Costigan, & Parker, 2015; Vancampfort et al., 2016, 2018), PA is not always inversely associated with anxiety symptoms (Nguyen et al., 2013).