Sports Medicine

, Volume 47, Issue 12, pp 2521–2532 | Cite as

The Effects of Resistance Exercise Training on Anxiety: A Meta-Analysis and Meta-Regression Analysis of Randomized Controlled Trials

  • Brett R. Gordon
  • Cillian P. McDowell
  • Mark Lyons
  • Matthew P. Herring
Systematic Review

Abstract

Background

The salutary effects of resistance exercise training (RET) are well established, including increased strength and function; however, less is known regarding the effects of RET on mental health outcomes. Aerobic exercise has well-documented positive effects on anxiety, but a quantitative synthesis of RET effects on anxiety is needed.

Objectives

To estimate the population effect size for resistance exercise training (RET) effects on anxiety and to determine whether variables of logical, theoretical, and/or prior empirical relation to anxiety moderate the overall effect.

Methods

Thirty-one effects were derived from 16 articles published before February 2017, located using Google Scholar, MEDLINE, PsycINFO, PubMed, and Web of Science. Trials involved 922 participants (mean age = 43 ± 21 years, 68% female/32% male) and included both randomization to RET (n = 486) or a non-active control condition (n = 436), and a validated anxiety outcome measured at baseline, mid-, and/or post-intervention. Hedges’ d effect sizes were computed and random effects models were used for all analyses. Meta-regression quantified the extent to which participant and trial characteristics moderated the mean effect.

Results

RET significantly reduced anxiety symptoms (Δ = 0.31, 95% CI 0.17–0.44; z = 4.43; p < 0.001). Significant heterogeneity was not indicated (QT(30) = 40.5, p > 0.09; I2 = 28.3%, 95% CI 10.17–42.81); sampling error accounted for 77.7% of observed variance. Larger effects were found among healthy participants (Δ = 0.50, 95% CI 0.22–0.78) compared to participants with a physical or mental illness (Δ = 0.19, 95% CI 0.06–0.31, z = 2.16, p < 0.04). Effect sizes did not significantly vary according to sex (β = −0.31), age (β = −0.10), control condition (β = 0.08), program length (β = 0.07), session duration (β = 0.08), frequency (β = −0.10), intensity (β = −0.18), anxiety recall time frame (β = 0.21), or whether strength significantly improved (β = 0.19) (all p ≥ 0.06).

Conclusions

RET significantly improves anxiety symptoms among both healthy participants and participants with a physical or mental illness. Improvements were not moderated by sex, or based on features of RET. Future trials should compare RET to other empirically-supported therapies for anxiety.

Notes

Compliance with Ethical Standards

Funding

No sources of funding were used to assist in the conduct of this analysis or the preparation of this article.

Conflict of interest

Brett R. Gordon, Cillian P. McDowell, Mark Lyons, and Matthew P. Herring declare that they have no conflicts of interest relevant to the content of this analysis.

Supplementary material

40279_2017_769_MOESM1_ESM.docx (16 kb)
Electronic Supplementary Material Table S1 (DOCX 15 kb)
40279_2017_769_MOESM2_ESM.tif (50 kb)
Electronic Supplementary Material Table S2 (TIFF 49 kb)

References

  1. 1.
    Barlow DH. Anxiety and its disorders: the nature and treatment of anxiety and panic. 2nd ed. New York: Guilford press; 2004.Google Scholar
  2. 2.
    Strine TW, Mokdad AH, Balluz LS, et al. Depression and anxiety in the United States: findings from the 2006 behavioral risk factor surveillance system. Psychiatr Serv. 2015;12:67–74.Google Scholar
  3. 3.
    Stubbs B, Koyanagi A, Hallgren M, et al. Physical activity and anxiety: a perspective from the World Health Survey. J Affect Disord. 2017;208:545–52.CrossRefPubMedGoogle Scholar
  4. 4.
    Wittchen H-U, Zhao S, Kessler RC, et al. DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8–19.CrossRefPubMedGoogle Scholar
  5. 5.
    Baxter A, Vos T, Scott K, et al. The global burden of anxiety disorders in 2010. Psychol Med. 2014;44:2363–74.CrossRefPubMedGoogle Scholar
  6. 6.
    Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008;69:621–32.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    de Vries YA, de Jonge P, van den Heuvel E, et al. Influence of baseline severity on antidepressant efficacy for anxiety disorders: meta-analysis and meta-regression. Br J Psychiatry. 2016;208(6):515–21.CrossRefPubMedGoogle Scholar
  8. 8.
    Ensari I, Greenlee TA, Motl RW, et al. Meta-analysis of acute exercise effects on state anxiety: an update of randomized controlled trials over the past 25 years. Depression Anxiety. 2015;32(8):624–34.CrossRefPubMedGoogle Scholar
  9. 9.
    Conn VS. Anxiety outcomes after physical activity interventions: meta-analysis findings. Nurs Res. 2010;59(3):224–31.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Herring MP, Puetz TW, O’Connor PJ, et al. Effect of exercise training on depressive symptoms among patients with a chronic illness: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2012;172(2):101–11.CrossRefPubMedGoogle Scholar
  11. 11.
    Stonerock GL, Hoffman BM, Smith PJ, et al. Exercise as treatment for anxiety: systematic review and analysis. Ann Behav Med. 2015;49:542–56.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Stubbs B, Vancampfort D, Rosenbaum S, et al. An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: a meta-analysis. Psychiatr Res. 2017;249:102–8.CrossRefGoogle Scholar
  13. 13.
    O’Connor PJ, Herring MP, Caravalho A. Mental health benefits of strength training in adults. Am J Lifestyle Med. 2010;4(5):377–96.CrossRefGoogle Scholar
  14. 14.
    Physical Activity Guidelines Advisory Committee Report. 1st ed. Washington, DC: US Department of Health and Human Services; 2008.Google Scholar
  15. 15.
    Herring MP, Jacob ML, Suveg C, et al. Feasibility of exercise training for the short-term treatment of generalized anxiety disorder: a randomized controlled trial. Psychother Psychosom. 2012;81(1):21–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Schuch FB, Vancampfort D, Richards J, et al. Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J Psychiatr Res. 2016;77:42–51.CrossRefPubMedGoogle Scholar
  17. 17.
    Ekkekakis P. Honey, I shrunk the pooled SMD! Guide to critical appraisal of systematic reviews and meta-analyses using the Cochrane review on exercise for depression as example. Ment Health Phys Act. 2015;8:21–36.CrossRefGoogle Scholar
  18. 18.
    Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;6(7):1–6.Google Scholar
  19. 19.
    Herring MP, O’Connor PJ, Dishman RK. The effect of exercise training on anxiety symptoms among patients: a systematic review. Arch Intern Med. 2010;170(4):321–31.CrossRefPubMedGoogle Scholar
  20. 20.
    Jayakody K, Gunadasa S, Hosker C. Exercise for anxiety disorders: systematic review. Br J Sports Med. 2014;48(3):96–197.CrossRefGoogle Scholar
  21. 21.
    Wipfli BM, Rethorst CD, Landers DM. The anxiolytic effects of exercise: a meta-analysis of randomized trials and dose–response analysis. J Sport Exerc Psychol. 2008;30(4):392–410.CrossRefPubMedGoogle Scholar
  22. 22.
    Detsky AS, Naylor CD, O’Rourke K, et al. Incorporating variations in the quality of individual randomized trials into meta-analysis. J Clin Epidemiol. 1992;45(3):255–65.CrossRefPubMedGoogle Scholar
  23. 23.
    Jüni P, Witschi A, Bloch R, et al. The hazards of scoring the quality of clinical trials for meta-analysis. JAMA. 1999;282:1054–60.CrossRefPubMedGoogle Scholar
  24. 24.
    Hedges L, Olkin I. Statistical methods for meta-analysis. Orlando: Academic Press; 1985.Google Scholar
  25. 25.
    Nyberg A, Lindström B, Rickenlund A, Wadell K. Low-load/high-repetition elastic band resistance training in patients with COPD: a randomized, controlled, multicenter trial. Clin Respir J. 2015;9:278–88.CrossRefPubMedGoogle Scholar
  26. 26.
    O’Reilly SC, Muir KR, Doherty M. Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomised controlled trial. Ann Rheum Dis. 1999;58:15–9.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Lau PWC, Yu CW, Lee A, et al. The physiological and psychological effects of resistance training on Chinese obese adolescents. J Exerc Sci Fit. 2004;2:115–20.Google Scholar
  28. 28.
    Herring LY, Wagstaff C, Scott A. The efficacy of 12 weeks supervised exercise in obesity management. Clin Obes. 2014;4(4):220–7.PubMedGoogle Scholar
  29. 29.
    Lipsey MW, Wilson DB. Practical meta-analysis. 1st ed. Thousand Oaks: Sage Publications; 2001.Google Scholar
  30. 30.
    Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. 1st ed. West Sussex: The Cochrane Collaboration; 2011.Google Scholar
  31. 31.
    Egger M, Smith GD, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.CrossRefPubMedGoogle Scholar
  33. 33.
    Rosenberg MS. The file-drawer problem revisited: a general weighted method for calculating fail-safe numbers in meta-analysis. Evolution. 2005;59:464–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Aidar FJ, de Oliveira RJ, Silva AJ, et al. The influence of resistance exercise training on the levels of anxiety in ischemic stroke. Stroke Res Treat. 2012;2012:1–6, Article ID 298375.CrossRefGoogle Scholar
  35. 35.
    Goldfield GS, Kenny GP, Alberga AS, et al. Effects of aerobic training, resistance training, or both on psychological health in adolescents with obesity: the HEARTY randomized controlled trial. J Consult Clin Psychol. 2015;83(6):1123–35.CrossRefPubMedGoogle Scholar
  36. 36.
    Herring MP, Jacob ML, Suveg C, et al. Effects of short-term exercise training on signs and symptoms of generalized anxiety disorder. Ment Health Phys Act. 2011;4:71–7.CrossRefGoogle Scholar
  37. 37.
    Martins R, Coelho E, Silva M, et al. Effects of strength and aerobic-based training on functional fitness, mood and the relationship between fatness and mood in older adults. J Sports Med Phys Fit. 2011;51:489–96.Google Scholar
  38. 38.
    Norvell N, Belles D. Psychological and physical benefits of circuit weight training in law enforcement personnel. J Consult Clin Psychol. 1993;61:520–7.CrossRefPubMedGoogle Scholar
  39. 39.
    Rahmani-Nia F, Arazi H, Rahimi R, et al. Effects of an 8-week circuit strength training program on the body images and anxiety in untrained college students. Med Dello Sport. 2011;64:297–308.Google Scholar
  40. 40.
    Tsutsumi T, Don BM, Zaichkowsky LD, et al. Comparison of high and moderate intensity of strength training on mood and anxiety in older adults. Percept Mot Skills. 1998;87:1003–11.CrossRefPubMedGoogle Scholar
  41. 41.
    Vlachopoulou T, Tsalis G, Fokas K, et al. Efficacy of a weight training program as a treatment for chemically dependent adults. J Hum Mov Stud. 2005;49:373–88.Google Scholar
  42. 42.
    Zanuso S, Sieverdes JC, Smith N, et al. The effect of a strength training program on affect, mood, anxiety, and strength performance in older individuals. Int J Sport Psychol. 2012;43:53–66.Google Scholar
  43. 43.
    Courneya KS, Segal RJ, Mackey JR, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol. 2007;25(28):4396–404.CrossRefPubMedGoogle Scholar
  44. 44.
    Vizza L, Smith CA, Swaraj S, et al. The feasibility of progressive resistance training in women with polycystic ovary syndrome: a pilot randomized controlled trial. BMC Sports Sci Med Rehabil. 2016;8:1–14.CrossRefGoogle Scholar
  45. 45.
    Damush TM, Damush JG. The effects of strength training on strength and health-related quality of life in older adult women. Gerontologist. 1999;39:705–10.CrossRefPubMedGoogle Scholar
  46. 46.
    Spielberger CD, Gorsuch RL, Lushene R, et al. Manual for the state-trait anxiety inventory (form Y): self-evaluation questionnaire. 1st ed. Palo Alto: Consulting Psychologists Press; 1983.Google Scholar
  47. 47.
    Wipfli BM, Rethorst CD, Landers DM. The anxiolytic effects of exercise: a meta-analysis of randomized trials and dose–response analysis. J Sport Exerc Psychol. 2008;30:392–410.CrossRefPubMedGoogle Scholar
  48. 48.
    Hernández-Molina G, Reichenbach S, Zhang B, et al. Effect of therapeutic exercise for hip osteoarthritis pain: results of a meta-analysis. Arthritis Rheum. 2008;59(9):1221–8.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Puetz TW, O’Connor PJ, Dishman RK. Effects of chronic exercise on feelings of energy and fatigue: a quantitative synthesis. Psychol Bull. 2006;132(6):866–76.CrossRefPubMedGoogle Scholar
  50. 50.
    Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ. 1995;310:452.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Tohen M, Calabrese J, Vieta E, et al. Effect of comorbid anxiety on treatment response in bipolar depression. J Affect Disord. 2007;104(1):137–46.CrossRefPubMedGoogle Scholar
  52. 52.
    Laustsen S, Hjortdal VE, Petersen AK. Predictors for not completing exercise-based rehabilitation following cardiac surgery. Scand Cardiovasc J. 2013;47(6):344–51.CrossRefPubMedGoogle Scholar
  53. 53.
    Lindheimer JB, O’Connor PJ, Dishman RK. Quantifying the placebo effect in psychological outcomes of exercise training: a meta-analysis of randomized trials. Sports Med. 2015;45(5):693–711.CrossRefPubMedGoogle Scholar
  54. 54.
    Petruzzello SJ, Landers DM, Hatfield BD, et al. A meta-analysis on the anxiety-reducing effects of acute and chronic exercise. Sports Med. 1991;11(3):143–82.CrossRefPubMedGoogle Scholar
  55. 55.
    Ruscio AM, Chiu WT, Roy-Byrne P, et al. Broadening the definition of generalized anxiety disorder: effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication. J Anxiety Disord. 2007;21(5):662–76.CrossRefPubMedGoogle Scholar
  56. 56.
    Wolitzky-Taylor K, Dour H, Zinbarg R, et al. Experiencing core symptoms of anxiety and unipolar mood disorders in late adolescence predicts disorder onset in early adulthood. Depression Anxiety. 2014;31(3):207–13.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Physical Education and Sport SciencesUniversity of LimerickLimerickIreland
  2. 2.Health Research InstituteUniversity of LimerickLimerickIreland

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