Elsevier

Journal of Affective Disorders

Volume 208, 15 January 2017, Pages 545-552
Journal of Affective Disorders

Physical activity and anxiety: A perspective from the World Health Survey

https://doi.org/10.1016/j.jad.2016.10.028Get rights and content

Highlights

  • The global relationship between anxiety and physical activity is not known.

  • Across 47 countries, 11.4% people had anxiety.

  • The prevalence of low PA was 22.9% vs 16.6% (p<0.001) in people with and without anxiety.

  • A meta-analysis adjusted for age & sex demonstrated that anxiety was associated with low PA (OR 1.43).

Abstract

Background

Despite the known benefits of physical activity (PA) among people with anxiety, little is known about PA levels in people with anxiety at the population level. This study explored the global prevalence of anxiety and its association with PA.

Methods

Cross-sectional, community-based data from the World Health Survey was analyzed. Prevalence of anxiety was estimated for 237,964 individuals (47 countries). PA was categorized as low, moderate, and high based on the International Physical Activity Questionnaire (short form). The association between PA and anxiety was assessed by multivariable logistic regression.

Results

The overall global prevalence of anxiety was 11.4% (47 countries). Across 38 countries with available data on PA, 62.5%, 20.2%, and 17.3% of the sample engaged in high, moderate, and low levels of PA respectively. The prevalence of low physical activity in those with and without anxiety was 22.9% vs. 16.6% (p<0.001) (38 countries, n=184,920). In the pooled model adjusted for socio-demographics, depression, and country, individuals engaging in low PA (vs. high PA) had 1.32 (95% CI=1.17–1.47) times higher odds for anxiety than those with high PA. Female sex, older age, lower education and wealth, and depression were also associated with low PA. At the individual country level, there was a significant positive association between low PA and anxiety in 17 of the 38 countries.

Conclusion

Low PA levels are associated with increased prevalence of anxiety. There is a need for longitudinal research to establish the directionality of the relationships observed.

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

References (50)

  • D.S. Baldwin et al.

    Pharmacological treatment of generalized anxiety disorder

    Curr. Top. Behav. Neurosci.

    (2010)
  • D.S. Baldwin et al.

    Evidence-based pharmacological treatment of generalized anxiety disorder

    Int. J. Neuropsychopharmacol.

    (2011)
  • N.M. Batelaan et al.

    Anxiety and new onset of cardiovascular disease: critical review and meta-analysis

    Br. J. Psychiatry

    (2016)
  • A.J. Baxter et al.

    Global prevalence of anxiety disorders: a systematic review and meta-regression

    Psychol. Med.

    (2013)
  • A.J. Baxter et al.

    HThe global burden of anxiety disorders in 2010

    Psychol. Med.

    (2014)
  • Clift, E., 2001. Information education and communication: lessons from the past; perspectives for the...
  • V.S. Conn

    Anxiety outcomes after physical activity interventions: meta-analysis findings

    Nurs. Res.

    (2010)
  • C. Craig et al.

    International physical activity questionnaire: 12-country reliability and validity

    Med. Sci. Sports Exerc.

    (2003)
  • C.L. Craig et al.

    International physical activity questionnaire: 12-country reliability and validity including commentary by Bassett DR Jr

    Med. Sci. Sports Exerc.

    (2003)
  • M.A. Da Silva et al.

    Bidirectional association between physical activity and symptoms of anxiety and depression: the Whitehall II study

    Eur. J. Epidemiol.

    (2012)
  • A. De Herdt et al.

    Social anxiety in physical activity participation in patients with mental illness: a cross-sectional multicenter study

    Depress Anxiety

    (2013)
  • M. Dworak et al.

    Impact of singular excessive computer game and television exposure on sleep patterns and memory performance of school-aged children

    Pediatrics

    (2007)
  • R. Endrighi et al.

    The effect of experimentally induced sedentariness on mood and psychobiological responses to mental stress

    Br. J. Psychiatry.: J. Ment. Sci.

    (2015)
  • H. Haller et al.

    The prevalence and burden of subthreshold generalized anxiety disorder: a systematic review

    BMC Psychiatry

    (2014)
  • B. Helgadóttir et al.

    Physical activity patterns of people affected by depressive and anxiety disorders as measured by accelerometers: a cross-sectional study

    PloS One

    (2015)
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