Review Article

Physical Activity and Exercise as a Tool to Cure Anxiety and Posttraumatic Stress Disorder

Table 1

Summary of specific studies to assess the effects of exercise on anxiety.

Studies/designTime duration/participantsAssessment scaleIntervention detailsResults

Merom et al., [115]
Group randomized trial
Duration = January 2004 to May 2005
DASS-218 weeks of 30-minute walking sessions, recorded with a pedometer, gradually increased to 5 sessions per week. The intensity was not measured.According to the research, GCBT+EX significantly and favorably affected the signs and symptoms of stress, anxiety, and depression.

Cassidy et al., [85]
Cross-sectional study

Age= 74.6 years (mean)
BDI, BAI, SF-36, CAMCOGPA, ranging from light exercise (e.g., doing housework, walking the dog) to vigorous exercise, such as aerobics. Get 30 minutes of exercise most days of the week.Women who exercised regularly had a lower risk of depression and anxiety (BDI score greater than or equal to 10) (BAI score greater than or equal to 8).
Those who engaged in PA had a lower likelihood of experiencing clinically severe anxiety symptoms (, 95% -0.8).
The results also demonstrate a link between greater anxiety and a sedentary lifestyle.

Backmand et al., [86]
Longitudinal study


Mean age = 68.6
BSI-53
MEI
PA was defined by values of the MET. PA was calculated from the product of intensity times, duration times, and activity frequency. The activity MET index was expressed as the number of MET hours per day.A rise in PA between 1985 and 1995 served as a deterrent against the emergence of anxiety between 1995 and 2001.
The evolution of physical functioning impairments in the elderly and the onset of anxiety appear to be significantly slowed by PA.

Sexton et al., [121]
A controlled follow-up study
Duration = 8 weeks, subsequent 6 months of follow-up

Age = 20-60 years
SCL-90R
STAI, BDI
BPRS, GAS.
The subjects were randomly assigned to either walk or jog. Over a period of 8 weeks, the groups trained three to four times a week for 30 minutes. The joggers were told to jog at a pace appropriate to their PA. Walkers were instructed to walk at their own pace.Frequent mild exercise like walking has similar psychological benefits as frequent vigorous activity like jogging.
Both groups experienced a marked reduction in symptoms of anxiety, depression, and all other symptoms.
Six months later, those with stronger aerobic fitness had much lower anxiety levels. Studies have found the value of exercise as an auxiliary therapy for the treatment of general neurotic symptoms, persistent anxiety, and depressive symptoms.

Zhang et al., [73]
Randomized control study
Duration = 18 months

Age = 60-70
HAMA, HAMDThe subjects were divided into five groups of 30 people each (swimming group, jogging group, square dance group, Tai Chi group, and control group). In groups, the elderly were taught exercise sports such as swimming, tai chi, running, and square dancing. Weekly exercise for four days, ranging from 30 to 60 minutes per day, and an 18-month continuous exercise intervention were carried out at a moderate intensity.After a 12-month intervention, the results showed a significantly lower level of depressive symptoms in comparison to the control group.
Several PA techniques for lowering anxiety symptoms did not show any discernible differences.

Broocks et al., [117]
Randomized control trial
Duration = 10 weeks

Age = 18–50 years
Diagnosis of panic disorder and agoraphobia according to the DSM-III-R and ICD-10 criteriaA four-mile walk followed by three weeks of running three times a week. Also, a training session every week.Regular aerobic activity and clomipramine were linked to a significant reduction in symptoms compared to a placebo. Exercise did not efficiently or promptly relieve anxiety symptoms like clomipramine did.

Kenis-Coskun et al., [122]
A single-blind randomized trial


Age = 6-13
CFQ-R, RCADS, and STAIMultiple rehabilitation exercises repetitions 10 times each: corner pectoral stretch; retraction of the scapula with external rotation; triceps brachii strengthening; bicep strengthening exercise; bicep strengthening exercise; exercise to strengthen the lateral abdominal muscles; pushing up; strengthening of the back extensors.Significant changes in body image improvement occurred in the telerehabilitation group. Similar significant changes were not observed in the control group. The anxiety and depression levels of the caregivers did not change significantly.

Nazari et al., [138]. Randomized control trialDuration = 16 weeks

Age = 8-14
RCMAS & PedsQL20 minutes of pilate exercises, 20 minutes of bodyweight exercises, and 20 minutes of aerobic exercises (V forward, V backward, and march exercises).A 16-week program that includes strength-aerobic exercise can improve QOL and reduce anxiety in children with type 1 diabetes.

Romero-Pérez et al., [145] Randomized control trialDuration = 20 weeks

Age = 10.02 (SD ± 0.79)
RCMAS5-minute warm-up, 40-minute aerobic exercise, weekly 2 sessions.Implementing a physical exercise program in overweight children encourages the emergence of positive thoughts and leads to improvements in their emotional well-being, self-awareness, and self-image. However, it does not result in significant changes in weight, height, anxiety levels, or depressive thoughts.

Naderi et al., [123] Longitudinal studyDuration = 8 weeks

Age= 8-11
STAIAerobic dancing: warm-up (10–15 minutes); basic movements (35–40 minutes); cool-down (10 minutes); weekly 3 sessions.As a result, it is recommended that PA and extracurricular sports activities be designed and implemented in ways that minimize anxiety in child victims of child abuse, consistent with the evidence supporting the benefits of PA in reducing anxiety prove in these people.

Broman-Fulks et al., [78] Randomized control trialDuration= 2 weeks

Age = 18-27
ASI-RWeekly 3 sessions, 20 minutes of aerobic exercise: treadmill running.Results showed that those assigned to the aerobic exercise condition reported significantly lower levels of anxiety sensitivity after exercise, while scores for those who did not exercise did not change significantly.

Katula et al., [118]
Randomized controlled exercise trial


Mean Age= 67.06
SAILight intensity, moderate intensity, and high intensityAnxiety decreased after the low-intensity condition; there were no significant changes in anxiety after the moderate-intensity condition; and anxiety increased after the high-intensity condition.

Gaudlitz et al., [119]
Randomized controlled double-blind design
Duration = 8 weeks, 7 months of follow-up

Age= 18–70
HAMA30 minutes on the treadmill three times a week for 8 weeks.Both high-intensity exercise and low-intensity exercise reduced anxiety levels. Anxiety continued to improve over time, with the effect being moderate in the endurance training group but not in the control group.

Martinsen et al., [120]
Randomized control trial

CPRS, PARSBrisk walking or jogging up to 70% VO2 max, exercised 3 times per week for 8 weeks.At the end of the study, both groups achieved significantly lower values than their starting values. The differences between the groups were not statistically significant as they were minimal.

GCBT+EX: group cognitive behavioral therapy+exercise; GCBT+ED: group cognitive behavioral therapy+educational sessions; DASS-21: Depression, Anxiety, and Stress Scale 21; BDI: Beck Depression Inventory; BAI: Beck Anxiety Inventory; CAMCOG: Cambridge Cognitive Examination for Mental Disorders of Elderly, BSI-53: brief symptom inventory; (MEI) Metabolic Equivalent Index; SCL-90-R: Symptom Checklist-90-R; STAI: State-Trait Anxiety Inventory; BPRS: brief psychiatric rating scale; GAS: Global Assessment Scale; HAMA: Hamilton Anxiety Scale; HAMD: Hamilton Depression Scale; ICD-10: International Classification of Diseases, Tenth Revision; MET: Metabolic Equivalent Index; CFQ-R: Cystic Fibrosis Revised Questionnaire; RCADS: Anxiety and Depression Scale in Children-Revised; RCMAS: Revised Children’s Manifest Anxiety Scale; PedsQL: Pediatric Quality of Life; ASI-R: anxiety sensitivity index-revised; CPRS: Comprehensive Psychopathological Rating Scale; PARS: Phobic Avoidance Rating Scale.