Physical activity and anxiety: A perspective from the World Health Survey
Introduction
Anxiety is a common and burdensome mental health complaint (Haller et al., 2014) which can greatly impair an individual's functioning, quality of life and well-being (Mendlowicz and Stein, 2000, Olatunji et al., 2007). Symptoms of anxiety are personified by nervousness, pervasive thoughts of worry and pessimism, which if left untreated can develop into an anxiety disorder (Herring et al., 2010). The global prevalence of anxiety disorders ranges from 2.4–29.8% in the past year (Baxter et al., 2013), whilst high prevalence of subthreshold anxiety (Haller et al., 2014) and symptoms of anxiety are also common and problematic across the lifespan (Prina et al., 2011, Stubbs et al., 2016a, Baxter et al., 2014). Anxiety disorders are the sixth leading cause of disability, in terms of years lived with disability, in both high-income and low- and middle-income countries. Globally, anxiety disorders accounted for 390 disability-adjusted life years per 100,000 persons in 2010, with no discernible change observed over time (Baxter et al., 2014). The burden of anxiety is increased even more by the high risk of co-morbid cardiovascular diseases and associated premature mortality (Batelaan et al., 2016, Roest et al., 2012). Therefore, it is not a surprise that the global financial burden of anxiety is substantial, owing to lost work productivity and high medical resource use (Chisholm et al., 2016, Hoffman et al., 2008).
Antidepressants such as selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) or benzodiazepines (Baldwin et al., 2011, Baldwin et al., 2010) are the frontline treatment of anxiety symptoms among people with anxiety disorders (de Vries et al., 2016) while cognitive behavioral therapy is efficacious in reducing anxiety symptoms (Hofmann and Smits, 2008). More recently, evidence has been accumulating that self-help interventions may also be beneficial in people with anxiety disorders (Lewis et al., 2012). For example, physical activity has been proposed as such a self-management strategy (Pedersen and Saltin, 2015, Jayakody et al., 2013, Conn, 2010). Previous systematic reviews (Pedersen and Saltin, 2015, Jayakody et al., 2013, Conn, 2010) have suggested that physical activity is helpful in reducing anxiety symptoms, while its role in preventing cardio-metabolic risks is largely known (Stubbs et al., Rosenbaum). People with anxiety may be at increased risk of cardiovascular disease and poorer cardiorespiratory function (Caldirola et al., 2016) and physical activity may help improve these outcomes (Vancampfort et al., 2016a). Despite the established benefits of physical activity in people with anxiety, little is known about physical activity levels in this population. Studies that have considered the relationship between physical activity and anxiety have been of small sample sizes and limited to one country (Helgadóttir et al., 2015, da Silva et al., 2014, Da Silva et al., 2012, Park et al., 2011). In addition, at the population level, there is a paucity of information on factors that might influence physical activity and anxiety. Such information might prove useful for developing interventions.
Given the aforementioned, using multi-country data from the World Health Survey, the current paper set out with the following aims: (a) describe the concurrent global prevalence of physical activity and anxiety; and (b) explore the association between anxiety and physical activity.
Section snippets
The survey
Data from the current study derives from the World Health Survey (WHS). The WHS was a cross-sectional, community-based survey carried out in 70 countries between 2002 and 2004. Data were collected using single-stage random sampling in 10 countries, while stratified multi-stage random cluster sampling was employed in 60 countries. Survey details are available elsewhere (http://www.who.int/healthinfo/survey/en/). Briefly, individuals with a valid home address aged ≥18 years were eligible to
Results
The country sample size ranged from 929 (Latvia) to 38,746 (Mexico) (Table 1). The overall crude prevalence of anxiety in 47 countries was 11.4% (95%CI 11.1–11.8%). The age- and sex-adjusted prevalence of anxiety varied widely between countries and ranged from 1.1% (China, Vietnam) to 79.2% (Kazakhstan), with Sri Lanka (64.9%), Brazil (22.4%), and Bangladesh (20.9%) also having high rates of anxiety. The country-wise prevalence of anxiety is graphically displayed in Fig. 1. Most countries in
Discussion
Our paper reiterates the high prevalence and disease burden of anxiety globally. To the best of our knowledge, our analyses are the first to suggest on a global level that engaging in low physical activity levels (i.e. being physically inactive) is associated with anxiety. Specifically, after full-adjustment, compared to high physical activity, individuals engaging in low physical activity had 32% higher odds of experiencing anxiety, while there was no significant difference for moderate levels
Conflict of interest
BS, AK, SR, DV FS, JR have no conflicts of interest to declare.
Acknowledgments
BS receives funding from National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care Funding scheme. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.
AK's work was supported by Miguel Servet Contract financed by the CP13/ 00,150 and PI15/00862 projects, integrated into the National R + D + I and funded by ISCIII - General Branch
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