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Exercise probably helps anxiety, but it remains unproven


Tags: treatment, anxiety, exercise, mind, self-treatment

Two articles on PainSci cite Schuch 2019: (1) Anxiety & Chronic Pain(2) Vulnerability to Chronic Pain

PainSci summary of Schuch 2019: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible.

This meta-analysis links high levels of activity to lower rates of anxiety. Many people who exercise will still develop anxiety, but 26% less often than sedentary people. The authors focused on 13 studies with “moderate to high methodological quality and a low risk of bias” with a huge total sample size of 76,000 people, and they made adjustments to eliminate the effect of gender, BMI, and smoking (in other words, they tried to make sure that observed effects were actually due to the activity level, and not those factors).

The simple headline “exercise helps anxiety” could describe the results of this study, and it wouldn’t be a completely unreasonable oversimplification, but the details are devilish as usual, and it’s actually not such a clear win. With such a huge pool of data to play in, the authors decided to break it down into several different types of anxiety, and found that the results were statistically significant only for PTSD and agoraphobia… and not generalized anxiety and a few others. Although activity seemed to help all types of anxiety, there was not actually enough data here to be sure in most cases — a data pie of 76,000 subjects seems big, but it can easily be sliced into pieces too thin to trust. It’s likely that exercise does help most types of anxiety, but it’s hard to actually know it from this data.

And this is why science is slow to be sure of much of anything squishy and complicated.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Prospective cohorts have suggested that physical activity (PA) can decrease the risk of incident anxiety. However, no meta-analysis has been conducted.

AIMS: To examine the prospective relationship between PA and incident anxiety and explore potential moderators.

METHODS: 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.

RESULTS: 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).

CONCLUSION: 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.

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