Abstract
There is a general belief that physical activity and exercise have positive effects on mood and anxiety and a great number of studies describe an association of physical activity and general well-being, mood and anxiety. In line, intervention studies describe an anxiolytic and antidepressive activity of exercise in healthy subjects and patients. However, the majority of published studies have substantial methodological shortcomings. The aim of this paper is to critically review the currently available literature with respect to (1) the association of physical activity, exercise and the prevalence and incidence of depression and anxiety disorders and (2) the potential therapeutic activity of exercise training in patients with depression or anxiety disorders. Although the association of physical activity and the prevalence of mental disorders, including depression and anxiety disorders have been repeatedly described, only few studies examined the association of physical activity and mental disorders prospectively. Reduced incidence rates of depression and (some) anxiety disorders in exercising subjects raise the question whether exercise may be used in the prevention of some mental disorders. Besides case series and small uncontrolled studies, recent well controlled studies suggest that exercise training may be clinically effective, at least in major depression and panic disorder. Although, the evidence for positive effects of exercise and exercise training on depression and anxiety is growing, the clinical use, at least as an adjunct to established treatment approaches like psychotherapy or pharmacotherapy, is still at the beginning. Further studies on the clinical effects of exercise, interaction with standard treatment approaches and details on the optimal type, intensity, frequency and duration may further support the clinical administration in patients. Furthermore, there is a lack of knowledge on how to best deal with depression and anxiety related symptoms which hinder patients to participate and benefit from exercise training.
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References
Abu-Omar K, Rütten A, Lehtinen V (2004a) Mental health and physical activity in the European Union. Soz Praventivmed 49:301–309
Abu-Omar K, Rütten A, Robine J-M (2004b) Self-rated health and physical activity in the European Union. Soz Praventivmed 49:235–242
American College of Sports Medicine (1978) The recommended quantity and quality of exercise for developing and maintaining fitness in healthy adults. Med Sci Sports Exerc 10:VII–X
American College of Sports Medicine (1990) Position stand: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc 22:265–274
Babyak M, Blumenthal JA, Herman S et al (2000) Exercise treatment for major depression: maintenance of therapeutic benefits at 10 months. Psychosom Med 62:633–638
Barlow DH, Craske MG (1994) Mastery of your anxiety and panic. Graywind Publications, Albany, NY
Bhui K, Fletcher A (2000) Common mood and anxiety states: gender differences in the protective effect of physical activity. Soc Psychiatry Psychiatr Epidemiol 35(1):28–35
Blumenthal JA, Emery CF, Madden DJ et al (1989) Cardiovascular and behavioral effects of aerobic exercise training in healthy older men and women. J Gerontol 44:M147–M157
Blumenthal JA, Babyak MA, Moore KA et al (1999) Effects of exercise training on patients with major depression. Arch Int Med 159:2349–2356
Blumenthal JA, Michael A, Babyak A et al (2007) Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med 69:587–596
Broocks A, Bandelow B, Pekrun G et al (1998) Comparison of aerobic exercise, clomipramine, and placebo in the treatment if panic disorder. Am J Psychiatry 155:603–609
Camacho TC, Roberts RE, Lazarus NB, Kaplan GA, Cohen RD (1991) Physical activity and depression: evidence from the Alamada County study. Am J Epidiomiol 134(2):220–231
CDC (1996) Physical activity and health: a report of the surgeon general. US Department of Health and Human Services, National Center for Chronic Disease Prevention and Health Promotion, Atlanta
Charney DS (2004) Psychobiological mechanisms of resilience and vulnerability: Implications for successful adaptation to extreme stress. Am J Psychiatry 161:195–216
Cohen S, Rodriguez R (1995) Pathways linking affective disturbances and physical disorders. Health Psychol 15:374–380
Cotman CW, Berchtold NC (2002) Exercise: a behavioral intervention to enhance brain health and plasticity. Trends Neurosci 25(6):295–301
Craft LL, Landers DM (1998) The effects of exercise on clinical depression resulting from mental illness: a meta-analysis. J Sport Exerc Psychol 20:339–357
Craft LL, Perna FM (2004) The benefits of exercise for the clinically depressed. Prim Care Companion J Clin Psychiatry 6:104–111
Craig CI, Marshall AL, Sjostrom M, Baumann AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P (2003) International physical activity questionnaire: 12 country reliability and validity. Med Sci Sports Exerc 35:1381–1395
DiLorenzo TM, Bargman EP, Stucky-Ropp R et al (1999) Long-term effects of aerobic exercise on psychological outcomes. Prev Med 28:75–85
Dimeo F, Bauer M, Vahram I, Proest G, Halter U (2001) Benefits from aerobic exercise in patients with major depression: a pilot study. Br J Sports Med 35:114–117
Dishman RK, Buckwort J (1996) Increasing physical activity: a quantitative synthesis. Med Sci Sports Exerc 28:706–719
Dishman RK, Renner KJ, Youngstedt SD et al (1997) Activity wheel running reduces escape latency and alters brain monoamine levels after footshock. Brain Res Bull 42:399–406
Doyne EJ, Ossip-Klein DJ, Bowman ED et al (1987) Running versus weight lifting in the treatment of depression. J Consult Clin Psychol 55:748–754
Dractu L (2001) Physical exercise: an adjunctive treatment for panic disorder? Eur Psychiatry 16:372–374
Droste SK, Gesing A, Ulbricht S et al (2003) Effects of long-term voluntary exercise on the mouse hypothalamic-pituary-adrenocortical axis. Endocrinology 114(7):3012–3023
Dunn AL, Garcia ME, Marcus BH et al (1998) Six month physical activity and fitness changes in project active, randomized trial. Med Sci Sports Exerc 30:1076–1083
Dunn AL, Madhukar H, Trivedi MD et al (2005) Exercise treatment for depression Efficacy and dose response. Am J Prev Med 28(1):1–8
Dunn AL, Trivedi MH, O’Neal HA (2001) Physical activity dose-response effects on outcome of depression and anxiety. Med Sci Sports Exerc 33:S587–S597
Esquivel G, Schruers K, Kuipers H, Griez E (2002) The effects of acute exercise and high lactate levels on 35% CO2 challenge in healthy volunteers. Acta Psychiatr Scand 106:394–397
Farmer ME, Locke BZ, Mosciki EK, Dannenberg AL, Larson DB, Radloff LS (1988) Physical activity and depressive symptoms: the NHANES I epidemiologic follow-up study. Am J Epidemiol 128:1340–1351
Fremont J, Craighead LW (1987) Aerobic exercise and cognitive therapy in the treatment of dysphoric moods. Cognit Ther Res 11:241–251
Goodwin RD (2003) Association between physical activity and mental disorders among adults in the United States. Prev Med 36:698–703
Greist JH, Klein MH, Eischens RR et al (1979) Running as treatment for depression. Compr Psychiatry 20:41–54
Guszkowska M (2004) Effects of exercise on anxiety, depression and mood. Psychiatr Pol 38(4):611–620
Haarasilta LM, Marttunen MJ, Kapiro JA, Aro HM (2004) Correlates of depression in a representative nationwide sample of adolescents (15–19 years) and young adults (20–24 years). Eur J Pub Health 14:280–285
King AC, Haskell WL, Taylor CB, Kraemer HC, DeBusk RF (1991) Group- vs. home-based exercise training in healthy older men and women: a community-based trial. JAMA 266:1535–1542
King AC, Taylor CB, Haskell WL (1993) Effects of differing intensities and formats of 12 months of exercise training on psychological outcomes in older adults. Health Psychol 12:292–300
Klein MH, Greist JH, Gurman AS, Neiberyer DP (1985) A comparative outcome study of group psychotherapy vs. exercise treatments for depression. Int J Mental Health 13:148–176
Knubben K, Reischies FM, Adli M et al (2007) A randomised, controlled study on the effects of a short-term endurance training programme in patients with major depression. Br J Sports Med 41(1):29–33. doi:10.1136/bjsm.2006.030130
Kodis J, Smith KM, Arthur HM, Daniels C, Suskin N, McKelvie RS (2001) Changes in exercise capacity and lipids after clinic versus home-based aerobic training in coronary artery bypass graft surgery patients. J Cardiopulm Rehabil 21:31–36
Lampinen P, Heikkinen RL, Ruoppila I (2000) Changes in intensity of physical exercise as predictors of depressive symptoms among older adults: an eight year follow-up study. Prev Med 12:113–180
Lawlor DA, Hopker SW (2001) The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials. BMJ 322:1–8
Long BC, van Stavel R (1995) Effects of exercise training on anxiety: a meta-analysis. J Appl Sport Psychol 7:167–189
Manger TA (2000) The effects of a community-based aerobic exercise program on posttraumatic stress disorder-related symptoms and concomitant anxiety and depression (dissertation). Hofstra University, Hempstead, NY
Manger TA, Motta RW (2005) The impact of an exercise program on posttraumatic stress disorder, anxiety, and depression. Int J Emerg Ment Health 7:49–57
Marcus BH, Forsyth LH (1998) Tailoring interventions to promote physically active lifestyles in women. Womens Health Issues 8:104–111
Marcus BH, Bock BC, Pinto BM et al (1998) Efficacy of an individualized, motivationally-tailored physical activity intervention. Ann Behav Med 20:174–180
Marks I (1999) Treatment of panic disorder. Am J Psychiatry 156:1129–1130
Martinsen EW, Medhus A, Sandvik L (1985) Effects of aerobic exercise on depression: a controlled study. BMJ 291:109
Martinsen EW, Hoffart A, Solberg O (1989) Comparing aerobic with nonaerobic forms of exercise in the treatment of clinical depression: a randomized trial. Compr Psychiatry 30(4):324–331
McEntee DJ, Halgin RP (1999) Cognitive group therapy and aerobic exercise in the treatment of anxiety. J Coll Stud Psychother 13(3):39–58
McNeil JK, LeBlanc EM, Joyner M (1991) The effect of exercise on depressive symptoms in the moderately depressed elderly. Psychol Aging 6:487–488
Merom D, Phongsavan P, Wagner R et al (2007) Promoting walking as an adjunct intervention to group cognitive behavioral therapy for anxiety disorders: a pilot group randomized trial. J Anxiety Disord 22(6):959–968. doi:101016/j.janxdis.2007.09.010
Meyer T, Broocks A (2000) Therapeutic impact of exercise on psychiatric diseases. Guidelines for exercise testing and prescription. Sports Med 30:269–279
Mobily KE, Rubinstein LM, Lemke JH, O’Hara MW, Wallace RB (1996) Walking and depression in a cohort of older adults: The Iowa 65+ Rural Health Study. JAPA 4:119–135
Morris M, Steinberg H, Sykes EA, Salmon P (1990) Effects of temporary withdrawal from regular running. J Psychosomat Res 33:47–61
Motl RW, Birnbaum AS, Kubik MY, Dishman RK (2004) Naturally occurring changes in physical activity are inversely related to depressive symptoms during early adolescence. Psychosom Med 66:336–342
Muller B, Armstrong HE (1975) A further note on the running treatment for anxiety. Psychother Theory Res Pract 12:385–387
North TC, McCullagh P, Tran ZV (1990) Effects of exercise on depression. Exerc Sport Sci Rev 18:379–415
Orwin A (1974) Treatment of situational phobia—a case for running. Br J Psychiatry 125:95–98
Otto MW, Church TS, Craft LL et al (2007) Exercise for mood and anxiety disorders. J Clin Psychiatry 9:287–294
Paffenbarger RS, Lee I-M, Leung R (1994) Physical activity and personal characteristics associated with depression and suicide in American college men. Acta Psychiatr Scan Suppl 377:16–22
Pate RR, Pratt M, Blair SN et al (1995) Physical activity and public health: a recommendation from the centers for disease control and prevention and the American college of sports medicine. JAMA 273:402–407
Petruzzello SJ, Landers AC, Hatfield BD, Kubitz KA, Salazar W (1991) A meta-analysis on the anxiety-reducing effect of acute and chronic exercise: outcomes and mechanisms. Sports Med 11:143–182
Ransford CP (1982) A role for amines in the antidepressant effect of exercise: a review. Med Sci Sports Exerc 14:1–10
Roth DL, Holmes DS (1987) Influence of aerobic exercise training and relaxation training on physical and psychological health following stressful life events. Psychosom Med 49:355–365
Ruuskanen JM, Ruoppila I (1995) Physical activity and psychological well-being among people aged 65–84 years. Age Ageing 24:292–296
Segar M, Hankon J, Jayaratne T et al (2002) Fitting fitness into women’s lives: effects of a gender-tailored physical activity intervention. Womens Health Issue 12:338–347
Sexton H, Maere Å, Dahl NH (1989) Exercise intensity and reduction in neurotic symptoms. Acta Psychiatr Scand 80:231–235
Singh NA, Clements KM, Fiattarone MA (1997) A randomized controlled trial of progressive resistance training in depressed elders. J Gerontol 52:M27–M35
Singh NA, Clements KM, Singh MA (2001) The efficacy of exercise as a long-term antidepressant in elderly subjects: a randomized, controlled trial. J Gerontol A Biol Sci Med Sci 56:M497–M504
Singh NA, Stavrinos TM, Scarbek Y, Galambos G, Liber C, Fiatarone Singh MA (2005) A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults. J Gerontol A Biol Sci Med Sci 60:768–776
Smith BJ, Bauman AE, Bull FC et al (2000) Promoting physical activity in general practice: a controlled trial of written advice and information materials. Br J Sports Med 34:262–267
Sothman MS, Ismail AH (1984) Relationship between urinary catecholamine metabolites, particularly MHPG, and selected personality and physical fitness characteristics in normal subjects. Psychosom Med 46:523
Sothmann MS, Ismail AH (1985) Factor analytic deprivation of the MHPG/NM ratio: implications for studying the link between physical fitness and depression. Biol Psychiatry 20:570–583
Stathopoulou G, Powers MB, Berry AC, Smits JAJ, Otto MW (2006) Exercise interventions for mental health: a quantitative and qualitative review. Clin Psychol Sci Pract 13:179–193
Stephens T (1988) Physical activity and mental health in the United States and Canada: evidence from four popular surveys. Prev Med 17:35–47
Steptoe A, Butler N (1996) Sports participation and emotional well-being in adolescents. Lancet 347:1789–1792
Steptoe A, Edwards S, Moses J, Mathews A (1989) The effects of exercise training on mood and perceived coping ability in anxious adults from the general population. J Psychosom Res 33:537–547
Steptoe A, Wardle J, Filler R et al (1997) Leisure-time physical exercise: prevalence, attitudinal correlates, and behavioral correlates among young Europeans from 21 countries. Prev Med 26:845–854
Stich FA (1998) A meta-analysis of physical exercise as a treatment for symptoms of anxiety adults from the general population. J Psychosom Res 33:537–547
Strawbridge WJ, Deleger S, Roberts RE et al (2002) Physical activity reduces the risk of subsequent depression for older adults. Am J Epidemiol 156:328–334
Strecher V, Wang C, Derry H (2002) Tailored interventions for multiple risk behaviours. Health Educ Res 17:619–626
Ströhle A, Feller C, Onken M et al (2005) The acute antipanic activity of aerobic exercise. Am J Psychiatry 162:2376–2378
Ströhle A, Feller C, Strasburger C, Heinz A, Dimeo F (2006) Anxiety modulation by the heart? Aerobic exercise and atrial natriuretic peptide. Psychoneuroendocrinology 31:1127–1130
Ströhle A, Höfler M, Pfister H et al (2007) Physical activity and prevalence and incidence of mental disorders in adolescents and young adults. Psychol Med 37(11):1657–1666
Ströhle A, Holsboer F (2003) Stress responsive neurohormones in depression and anxiety. Pharmacopsychiatry 36(suppl 3):207–214
Swinburn BA, Walter LG, Arroll B et al (1998) The green prescription study: a randomised controlled trial of written exercise advice provided by general practitioners. Am J Public Health 88:288–291
Thomas S, Reading I, Shephard RJ (1992) Revision of the Physical Activity Readiness Questionnaire (PAR-Q). Can J Sport Sci 17:338–345
Thirlaway K, Benton D (1992) Participation in physical activity and cardiovascular fitness have different effects on mental health and mood. J Psychosom Res 36:657–665
Veale D, Le Fevre K, Pantelis C et al (1992) Aerobic exercise in the adjunctive treatment of depression: a randomized controlled trial. J R Soc Med 85:541–544
Weyerer S (1992) Physical inactivity and depression in the community: evidence from the Upper Bavarian field study. Int J Sports Med 13:492–496
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Ströhle, A. Physical activity, exercise, depression and anxiety disorders. J Neural Transm 116, 777–784 (2009). https://doi.org/10.1007/s00702-008-0092-x
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DOI: https://doi.org/10.1007/s00702-008-0092-x