A new study, which analyzed data from hundreds of thousands of Swedes, provides evidence that regularly engaging in physical activity can decrease the risk of being diagnosed with an anxiety disorder. The findings have been published in Frontiers in Psychiatry.

“Previous studies suggested that the preventive potential of physical activity for mental health could be substantial. My co-author Tomas Deierborg and I were both interested in investigating this at a larger level,” said study author Martina Svensson, an associate researcher in the Experimental Neuroinflammation Laboratory.

“Most previous research has been focused on depression or mental illness as a whole and not specifically on diagnosed anxiety disorders. Moreover, some of the largest studies only include men and this is problematic since the prevalence of anxiety differs between sexes and also that physical activity may affect anxiety differently in men and women.”

To investigate the association between a physically active lifestyle and future development of anxiety disorders in men and women, the researchers followed 197,685 individuals who participated in the world’s largest long-distance cross-country ski race — an event called the Vasaloppet. Previous research had indicated that most Vasaloppet skiers exercise for at least 4 hours a week and tend to have a higher fitness levels than the general population. The skiers were matched with a control group of 197,684 individuals.

The researchers drew on data from Statistics Sweden and the Swedish National Patient Registry, which tracks socio-economic data and compiles information about psychiatric and medical diagnoses, respectively.

“We found that the group with a more physically active lifestyle had an almost 60% lower risk of developing anxiety disorders over a follow-up period of up to 21 years. This association between a physically active lifestyle and a lower risk of anxiety was seen in both men and women,” Svensson told PsyPost.

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.)

The findings are in line with the researchers’ previous work, which found that the skiers had a lower incidence of depression compared to the non-skier control group.

But the researchers found a surprising difference between male and female skiers in how their performance was related to the risk of developing anxiety.

“Interestingly, there was a sex-specific association between the physical performance level and the risk of anxiety,” Svensson explained. “Among the males, the physical performance level did not affect the risk of developing anxiety. However, among women, the highest performing group had almost the double risk of developing anxiety disorders compared to the group which was physically active at a lower performance level. Importantly, the total risk of getting anxiety among high-performing women was still lower compared to the more physically inactive women in the general population.”

“Taken together, our study supports the recommendations of being physically active to reduce the risk of anxiety in both men and women, even though the optimal intensity level may differ.”

The researchers controlled for age, sex, and education. But the observational nature of the study comes with some limitations.

“We are not able to investigate the mechanisms behind the potential protective effects of exercise on the development of anxiety in our study. That needs to be unraveled. Furthermore, our study does not control for personality traits, diet, and other lifestyle habits that may be linked to an active lifestyle,” Svensson said.

“Additionally, our study does not investigate why faster skiing is associated with an increased risk of developing anxiety compared to slower skiers among women. Hence future studies considering the impact of exercise intensity on the risk of developing anxiety disorders in men and women separately are warranted, especially with designs allowing for conclusions about directionality and causality of the association between physical activity and anxiety.”

“Our results suggest that the relation between symptoms of anxiety and exercise behavior may not be linear,” Svensson said. “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.”

The study, “Physical Activity Is Associated With Lower Long-Term Incidence of Anxiety in a Population-Based, Large-Scale Study“, was authored by Martina Svensson, Lena Brundin, Sophie Erhardt, Ulf Hållmarker, Stefan James, and Tomas Deierborg.

Huge study suggests a physically active lifestyle substantially lowers the risk of developing anxiety