Gender-specific associations between leisure-time physical activity and symptoms of anxiety: the HUNT study

  • Audun Brunes
  • Sigridur Lara Gudmundsdottir
  • Liv Berit AugestadEmail author
Original Paper



The underlying goal of the study was to examine gender-specific effects of leisure-time physical activity on the development of symptoms of anxiety.


The second wave of a prospective cohort survey (HUNT 2) was conducted during 1995–1997 in the county of Nord-Trøndelag, Norway, with a follow-up in 2006–2008 (HUNT 3). The sample consisted of 12,796 women and 11,195 men with an age range of 19–85 years. A binomial model with a log-link function and generalized linear model analysis with gamma distribution was used to assess the association between physical activity and anxiety symptoms (Hospital Anxiety and Depression Scale anxiety subscale, HADS-A).


A total of 1,211 (9.5 %) women and 650 (5.8 %) men developed HADS-defined anxiety (≥8 on the HADS-A scale). Men who scored in the middle tertile of the calculated physical activity index developed significantly fewer cases of HADS-defined anxiety compared with men in the lowest tertile (p < 0.05). In the gamma regression analysis for women, having higher scores on the moderate-high physical activity was associated with fewer symptoms of anxiety (p < 0.01).


Women developed almost twice as many cases of HADS-defined anxiety compared to men. Significant associations were found between general leisure-time physical activity and anxiety symptoms among women and men, but the true effect is likely to be different from the observed associations due to several threats to the internal validity in the study.


Anxiety Epidemiology Physical activity Prospective study design 


Conflict of interest

None declared.


  1. 1.
    Alonso J, Angermeyer MC, Bernert S et al (2004) Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 109(240):21–27Google Scholar
  2. 2.
    Kessler RC, Chiu WT, Demler O, Merkingas KR, Walters EE (2005) Prevalence, severity, and comorbidity of 12-Month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):617–627PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    The Norwegian Institute of Public Health (2009) Psykiske lidelser i Norge: Et folkehelseperspektiv. [Mental disorders in Norway: a public health perspective]. The Norwegian Institute of Public Health, Oslo. Accessed 13 Jan 2012
  4. 4.
    Biddle SJH, Mutrie N (2008) Psychology of physical activity: determinants, well-being and interventions, 2nd edn. Routledge, New YorkGoogle Scholar
  5. 5.
    Gustavsson A, Svensson M, Jacobi F et al (2011) Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21(10):718–779PubMedCrossRefGoogle Scholar
  6. 6.
    Andlin-Sobocki P, Wittchen HU (2005) Cost of anxiety disorders in Europe. Eur J Neurol 12:39–44PubMedCrossRefGoogle Scholar
  7. 7.
    Jacobi F, Wittchen HU, Hôllting C (2004) Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med 34(4):597–611PubMedCrossRefGoogle Scholar
  8. 8.
    Bienvenu OJ, Gould NF, Mason ST, Fauerbach JA (2009) Anxiety disorders prevention: overview and focus on post-traumatic stress disorder. Minerva Psichiatr 50(3):265–275Google Scholar
  9. 9.
    McLean CP, Asnaani A, Litz BT, Hofmann SG (2011) Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res 45(8):1027–1035PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Bekker MH, van Mens-Verhulst J (2007) Anxiety disorders: sex differences in prevalence, degree, and background, but gender-neutral treatment. Gend Med 4:178–193CrossRefGoogle Scholar
  11. 11.
    Martinsen EW (2008) Physical activity in the prevention and treatment of anxiety and depression. Nord J Psychiatry 62(47):25–29PubMedCrossRefGoogle Scholar
  12. 12.
    McDonald DG, Hodgdon JA (1991) The psychological effects of aerobic fitness training research and theory. Springer, New YorkCrossRefGoogle Scholar
  13. 13.
    Petruzzello SJ, Landers DM, Hatfield BD, Kubitz KA, Salazar W (1991) A meta-analysis on the anxiety-reducing effects of acute and chronic exercise: outcomes and mechanisms. J Sports Med 11(3):143–182CrossRefGoogle Scholar
  14. 14.
    Byrne A, Byrne D (1993) The effect of exercise on depression, anxiety and other mood states: a review. J Psychosom Res 37(6):565–574PubMedCrossRefGoogle Scholar
  15. 15.
    Long BC, Vanstavel R (1995) Effects of exercise training on anxiety: a meta-analysis. J Appl Sport Psychol 7(2):167–189CrossRefGoogle Scholar
  16. 16.
    Wipfli BM, Rethorst CD, Landers DM (2008) The anxiolytic effects of exercise: a meta-analysis of randomized trials and dose-response analysis. J Sport Exerc Psychol 30:392–410PubMedGoogle Scholar
  17. 17.
    Asmundson GJG, Fetzner MG, DeBoer LB, Powers MB, Otto MW, Smits JAJ (2013) Let’s get physical: a contemporary review of the anxiolytic effects of exercise for anxiety and its disorders. Depress Anxiety 30(4):362–373PubMedCrossRefGoogle Scholar
  18. 18.
    Jayakody K, Gunadasa S, Hosker C (2014) Exercise for anxiety disorders: systematic review. Br J Sports Med 48:187–196PubMedCrossRefGoogle Scholar
  19. 19.
    Stephens T (1988) Physical activity and mental health in the United States and Canada: evidence from four population surveys. J Prev Med 17(1):35–47CrossRefGoogle Scholar
  20. 20.
    Goodwin RD (2003) Association between physical activity and mental disorders among adults in the United States. Prev Med 36(6):698–703PubMedCrossRefGoogle Scholar
  21. 21.
    Thorsen L, Nystad W, Stigum H, Dahl O, Klepp O, Bremnes RM, Wist E, Fosså SD (2005) The association between self-reported physical activity and prevalence of depression and anxiety disorder in long-term survivors of testicular cancer and men in a general population sample. Support Care Cancer 13(8):637–646PubMedCrossRefGoogle Scholar
  22. 22.
    Brunes A, Augestad LB, Gudmundsdottir SL (2013) Personality, physical activity, and symptoms of anxiety and depression: the HUNT study. Soc Psychiatry Psychiatr Epidemiol 48:745–756PubMedCrossRefGoogle Scholar
  23. 23.
    de Moor MHM, Beem AL, Stubbe JH, Boomsma DI, de Geus EJC (2006) Regular exercise, anxiety, depression and personality: a population-based study. Prev Med 42(4):273–279PubMedCrossRefGoogle Scholar
  24. 24.
    Mutrie N, Hannah MK (2007) The importance of both setting and intensity of physical activity in relation to non-clinical anxiety and depression. Int J Health Promot Educ 45(1):24–32CrossRefGoogle Scholar
  25. 25.
    Harvey SB, Hotopf M, Overland S, Mykletun A (2010) Physical activity and common mental disorders. Br J Psychiatry 197(5):357–364PubMedCrossRefGoogle Scholar
  26. 26.
    Jonsdottir IH, Rödjer L, Hadzibajramovic E, Börjesson M, Ahlborg GA Jr (2010) Prospective study of leisure-time physical activity and mental health in Swedish health care workers and social insurance officers. Prev Med 51(5):373–377PubMedCrossRefGoogle Scholar
  27. 27.
    Azevedo Da Silva M, Singh-Manoux A, Brunner E, Kaffashian S, Shipley M, Kivimäki M, Nabi H (2012) Bidirectional association between physical activity and symptoms of anxiety and depression: the Whitehall II study. Eur J Epidemiol 27(7):537–546PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    ten Have M, de Graaf R, Monshouwer K (2011) Physical exercise in adults and mental health status: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). J Psychosom Res 71(5):342–348PubMedCrossRefGoogle Scholar
  29. 29.
    de Moor MHM, Beem AL, Stubbe JH, Boomsma DI, de Geus EJC (2008) Testing causality in the association between regular exercise and symptoms of anxiety and depression. Arch Gen Psychiatry 65(8):897–905PubMedCrossRefGoogle Scholar
  30. 30.
    Holmen J, Midthjell K, Krüger Ø (2003) The Nord-Trøndelag Health Study 1995-97 (HUNT2): objectives, contents, methods and participation. Norsk Epidemiologi 13:19–32Google Scholar
  31. 31.
    Kurtze N, Rangul V, Hustvedt B, Flanders DW (2007) Reliability and validity of self-reported physical activity in the Nord-Trøndelag Health Study (HUNT 2). Eur J Epidemiol 22(6):379–387PubMedCrossRefGoogle Scholar
  32. 32.
    Augestad LB, Schei B, Forsmo S, Langhammer A, Flanders WD (2004) The association between physical activity and forearm bone mineral density in healthy premenopausal women. J Women’s Health 13:301–313CrossRefGoogle Scholar
  33. 33.
    Gudmundsdottir SL, Flanders WD, Augestad LB (2011) Physical activity and age at menopause: the Nord-Trøndelag population-based health study. Climacteric 16(1):78–87CrossRefGoogle Scholar
  34. 34.
    Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67(6):361–370PubMedCrossRefGoogle Scholar
  35. 35.
    Herrmann C (1997) International experiences with the Hospital Anxiety and Depression Scale: a review of validation data and clinical results. J Psychosom Res 42(1):17–41PubMedCrossRefGoogle Scholar
  36. 36.
    Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res 52:69–77PubMedCrossRefGoogle Scholar
  37. 37.
    Whitelaw S, Teuton J, Swift J, Scobie G (2010) The physical activity—mental wellbeing association in young people: a case study in dealing with a complex public health topic using a ‘realistic evaluation’ framework. Mental Health Phys Activity 3(2):61–66CrossRefGoogle Scholar
  38. 38.
    Salmon P (2001) Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clin Psychol Rev 21(1):33–61PubMedCrossRefGoogle Scholar
  39. 39.
    Lox CL, Kathleen AM, Petruzzello SJ (2010) The psychology of exercise: integrating theory and practice, 3rd edn. Holcomb Hathaway Publishers, ScottsdaleGoogle Scholar
  40. 40.
    Petruzzello SJ, Landers DM, Hatfield BD, Kubitz KA, Salazar W (1991) A meta-analysis on the anxiety-reducing effects of acute and chronic exercise. Sports Med 11(3):143–182PubMedCrossRefGoogle Scholar
  41. 41.
    Martinsen EW, Moser T, Borge L, Moe T, Johannesen B, Kaggestad J (2004) Kropp og sinn: fysisk aktivitet og psykisk helse (Body and mind: physical activity and psychological health). Fagbokforlaget, BergenGoogle Scholar
  42. 42.
    Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84(2):191–215PubMedCrossRefGoogle Scholar
  43. 43.
    Dishman RK, Renner KJ, Youngstedt SD, Reigle TG, Bunnell BN, Burke KA, Yoo HS, Mougey EH, Meyerhoff JL (1997) Activity wheel running reduces escape latency and alters brain monoamine levels after footshock. Brain Res Bull 42:399–406PubMedCrossRefGoogle Scholar
  44. 44.
    Moylan S, Eyre HA, Maes M, Baune BT, Jacka FN, Berk M (2013) Exercising the worry away: how inflammation, oxidative and nitrogen stress mediates the beneficial effect of physical activity on anxiety disorder symptoms and behaviours. Neurosci Biobehav Rev 37(4):573–584PubMedCrossRefGoogle Scholar
  45. 45.
    Wittchen HU, Jacobi F (2005) Size and burden of mental disorders in Europe—a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 15(4):357–376PubMedCrossRefGoogle Scholar
  46. 46.
    McLean CP, Anderson ER (2009) Brave men and timid women? A review of the gender differences in fear and anxiety. Clin Psychol Rev 29(6):496–505PubMedCrossRefGoogle Scholar
  47. 47.
    Feingold A (1994) Gender differences in personality: a meta-analysis. Psychol Bull 116(3):429–456PubMedCrossRefGoogle Scholar
  48. 48.
    Altemus M (2006) Sex differences in depression and anxiety disorders: potential biological determinants. Horm Behav 50(4):534–538PubMedCrossRefGoogle Scholar
  49. 49.
    Asztalos M, Wijndaele K, De Bourdeaudhuij I, Philippaerts R, Matton L, Duvigneaud N, Thomis M, Lefevre J, Cardon G (2012) Sport participation and stress among women and men. Psychol Sport Exerc 13(4):466–483CrossRefGoogle Scholar
  50. 50.
    Tudor K (2013) Mental health promotion: paradigms and practice. Routledge, New YorkGoogle Scholar
  51. 51.
    Vanhees L, Lefevre J, Philippaerts R (2005) How to assess physical fitness? Eur J Cardiovasc Prev Rehabil 12:102–114PubMedCrossRefGoogle Scholar
  52. 52.
    Rothman KJ, Greenland S, Lash TL (eds) (2008) Modern epidemiology, 3rd edn. Wolters Kluwer Health, PhiladelphiaGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Audun Brunes
    • 1
  • Sigridur Lara Gudmundsdottir
    • 2
  • Liv Berit Augestad
    • 1
    Email author
  1. 1.Department of Neuroscience, The Faculty of MedicineNorwegian University of Science and Technology (NTNU)TrondheimNorway
  2. 2.Center for Sport and Health SciencesUniversity of IcelandReykjavikIceland

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