Association between physical activity and risk of anxiety: a dose-response meta-analysis of 11 international cohorts
Bibliographic record
Abstract
Background: Anxiety disorders are the world's most common mental disorders and the risk of anxiety may be reduced by physical activity. However, the dose-response relationship between physical activity and the risk of anxiety remains uncertain. Methods: Following Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines, PubMed, Embase, Web of Science, and PsycINFO databases were searched for all prospective cohort studies on physical activity and the risk of anxiety up to 7 February 2025, with no language restrictions. We included prospective cohort studies reporting physical activity at three or more exposure levels and risk estimates for anxiety. Data extraction and article quality assessments were completed independently by two extractors. Data were synthesized using random-effects models, and nonlinear dose-response meta-analyses were performed using restricted cubic spline models. We used the Newcastle-Ottawa Scale (NOS) to assess the risk of bias for the included articles. Egger's test and Begg's test were used to evaluate the publication bias. Findings: = 0.9%; P = 0.32) found an inversed-line relationship between physical activity and anxiety risk. And physical activity levels less than 14.5 MET-h/week were not statistically significant in reducing anxiety risk [CI of relative risks (RR) included 1.00]. The NOS assessment showed low risk of bias for all 11 studies. Egger's test and Begg's test found no publication bias in the included studies (P = 0.73). Interpretation: Our research confirmed a dose-response relationship between physical activity and anxiety risk, and increasing physical activity within the range recommended by the World Health Organization (WHO) (10-20 MET-h/week) can significantly reduce anxiety risk. Subgroup analysis showed that this protective effect was most significant during the 5-year follow-up period, with a maximum anxiety risk reduction of 49%. Exceeding the recommended dose, there may be additional smaller benefits between doses 20-30 MET-h/week, and exceeding 50 MET-h/week may become a risk factor. In addition, the protective effect decreases with time and age, and the recommended dose by WHO (10-14.5 MET-h/week) has no statistically significant protection for the elderly, nor has the maximum beneficial dose been found, indicating the need for more relevant research on the elderly in the future. Funding: The National Traditional Chinese Medicine innovation team and talent support projects fund this study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.024 | 0.036 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.011 | 0.065 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".