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Paed MH – Physical activity can reduce symptoms of anxiety for children and adolescents

Evidence Summary
Twelve studies examined the relationship between physical activity, sporting activity and inactivity on symptoms of anxiety.

1.1 There is evidence from one meta-analysis (1)(which included 6 studies and 289 randomised participants) that physical activity can improve anxiety symptoms. Exercise interventions had a large effect on reducing anxiety sensitivity (six studies, g=0.72, p=0.001) compared to control.

1.2 There is evidence from one large controlled non-randomised study that physical activity can reduce symptoms of anxiety (2). It reported a 13.7% reduction in anxiety symptoms post intervention compared to control. One factorial RCT (participants were depressed adolescents), found that anxiety symptoms improved across all groups, but there was no significant differences between exercise and psychological therapy(3).

2.1 There is evidence from one interventional study that sport may result in greater state anxiety(4).2.2 There is evidence from two qualitative studies (one longitudinal, one cross-sectional two groups) that sport can reduce anxiety symptoms. The longitudinal study found a small effect size of participation in sport on anxiety symptoms (5). The two group cross-sectional study found that competing in sport may be beneficial to trait anxiety, but has no effect on state anxiety(6).

3.1 One longitudinal study found that increased sedentary time (greater use of computer/videogames) was associated with greater odds of generalised anxiety disorder(7)

Quality of Evidence
B. Mix of study designs contribute to the evidence, which includes meta-analysis, RCTs and longitudinal with cross-sectional analysis.
Strength of Recommendation

  1. There was robust evidence from most of the twelve studies that physical activity can cause a reduction in anxiety symptoms for children and adolescents
    There was robust evidence from most of the twelve studies that physical activity can cause a reduction in anxiety symptoms for children and adolescents, however one interventional study suggested that sport may result in greater state anxiety. Further, there was evidence that inactivity and sedentary behaviours can increase anxiety symptoms.

1) Jacquart J, Dutcher CD, Freeman SZ, et al. The effects of exercise on transdiagnostic treatment targets: A meta-analytic review. Behaviour research and therapy. 2019 Apr 1;115:19-37.

2) Bonhauser M, Fernandez G, Püschel K, et al. Improving physical fitness and emotional well-being in adolescents of low socioeconomic status in Chile: results of a school-based controlled trial. Health Promotion International. 2005 Jun 1;20(2):113-22.

3) Parker AG, Hetrick SE, Jorm AF, et al. The effectiveness of simple psychological and physical activity interventions for high prevalence mental health problems in young people: a factorial randomised controlled trial. Journal of affective disorders. 2016 May 15;196:200-9.

4) Karakaya I, Çoşkun A, Ağaoğlu B. Evaluation of depression, anxiety and self-esteem levels in swimmers. Anatolian Journal of Psychiatry. 2006;7(3):162-6.

5) Brière FN, Yale-Soulière G, Gonzalez-Sicilia D, et al. Prospective associations between sport participation and psychological adjustment in adolescents. J Epidemiol Community Health. 2018 Jul 1;72(7):575-81.

6) Brand S, Gerber M, Beck J, et al. High exercise levels are related to favorable sleep patterns and psychological functioning in adolescents: a comparison of athletes and controls. Journal of Adolescent Health. 2010 Feb 1;46(2):133-41.

7) Zink J, Belcher BR, Kechter A, et al. Reciprocal associations between screen time and emotional disorder symptoms during adolescence. Preventive medicine reports. 2019 Mar 1;13:281-8.