Sports Medicine

, Volume 36, Issue 9, pp 767–780 | Cite as

Physical Activity and Feelings of Energy and Fatigue

Epidemiological Evidence
  • Timothy W. PuetzEmail author
Review Article


Approximately 20% of adults worldwide report persistent fatigue. Physical activity is a healthful behaviour that has promise for combating feelings of fatigue and low energy. This article summarises the epidemiological literature that examined the association between physical activity and feelings of energy and fatigue. Twelve population-based studies conducted between January 1945 and February 2005 that concurrently measured physical activity and feelings of energy and fatigue were located. All of the studies suggested that there was an association between physical activity and a reduced risk of experiencing feelings of low energy and fatigue when active adults were compared with sedentary peers (odds ratio = 0.61; 95% CI 0.52, 0.72). The effect was heterogeneous and varied according to study design and the energy/fatigue measure used in the study. Because epidemiological comparisons cannot establish direction of causality, standard criteria for evaluating strength of evidence in epidemiological studies (i.e. strength of association, temporal sequence, consistency, dose response and biological plausibility) were used to judge whether the observed association between physical activity and feelings of energy and fatigue suggest causality in the absence of adequate experimental evidence. There was agreement among the studies suggesting a strong, consistent, temporally appropriate dose-response relationship between physical activity and feelings of energy and fatigue. No compelling evidence has confirmed any plausible biological mechanisms that explain the apparent protective effect of physical activity against feelings of low energy and fatigue. Nonetheless, the epidemiological evidence is sufficiently strong to justify better controlled prospective cohort studies and randomised controlled trials.


Physical Activity Physical Inactivity Leisure Time Physical Activity Temporal Sequence Biological Plausibility 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The author would like to thank Derek Hales, Patrick O’Connor and Rod Dishman for their assistance in preparing this manuscript.

No sources of funding were used to assist in the preparation of this review. The author has no conflicts of interest that are directly relevant to the content of this review.


  1. 1.
    O’Connor PJ, Puetz TW. Chronic physical activity and feelings of energy and fatigue. Med Sci Sports Exerc 2005; 37 (2): 299–305PubMedCrossRefGoogle Scholar
  2. 2.
    Wessely S, Hotopf M, Sharpe M. Chronic fatigue and its syndromes. Oxford: Oxford University Press, 1998Google Scholar
  3. 3.
    Chen MK. The epidemiology of self-perceived fatigue among adults. Prev Med 1986; 15 (1): 74–81PubMedCrossRefGoogle Scholar
  4. 4.
    Kroenke K, Price RK. Symptoms in the community: prevalence, classification, and psychiatric comorbidity. Arch Intern Med 1993; 153 (21): 2474–80PubMedCrossRefGoogle Scholar
  5. 5.
    Addington AM, Gallo JJ, Ford DE, et al. Epidemiology of unexplained fatigue and major depression in the community: The Baltimore ECA follow-up, 1981-1994. Psychol Med 2001; 31 (6): 1037–44PubMedCrossRefGoogle Scholar
  6. 6.
    Darbishire L, Ridsdale L, Seed PT. Distinguishing patients with chronic fatigue from those with chronic fatigue syndrome: a diagnostic study in UK primary care. Br J Gen Pract 2003; 53 (491): 441–5PubMedGoogle Scholar
  7. 7.
    Ream E, Richardson A. Fatigue: a concept analysis. Int J Nurs Stud 1996; 33 (5): 519–29PubMedCrossRefGoogle Scholar
  8. 8.
    O’Connor PJ. Evaluation of four highly cited energy and fatigue mood measures. J Psychosom Res 2004; 57 (5): 435–41PubMedCrossRefGoogle Scholar
  9. 9.
    Fuhrer R, Wessely S. The epidemiology of fatigue and depression: a French primary-care study. Psychol Med 1995; 25 (5): 895–905PubMedCrossRefGoogle Scholar
  10. 10.
    Ware J. SF-36 Health Survey manual and interpretation guide. Lincoln (RI): Quality Metric, 2000Google Scholar
  11. 11.
    McHorney CA, Ware JE, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36) II: psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993; 31 (3): 247–63PubMedCrossRefGoogle Scholar
  12. 12.
    McHorney CA, Ware JE, Lu JF, et al. The MOS 36-Item Short-Form Health Survey (SF-36) III: tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 1994; 32 (1): 40–66PubMedCrossRefGoogle Scholar
  13. 13.
    Wagner AK, Gandek B, Aaronson NK, et al. Cross-cultural comparisons of the content of SF-36 translations across 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 1998; 51 (11): 925–32Google Scholar
  14. 14.
    Kuenstner S, Langelotz C, Budach V, et al. The comparability of quality of life scores: a multitrait multimethod analysis of the EORTC QLQ-C30, SF-36 and FLIC questionnaires. Eur J Cancer 2002; 38 (3): 339–48PubMedCrossRefGoogle Scholar
  15. 15.
    Appels A, Hoppener P, Mulder P. A questionnaire to assess premonitory symptoms of myocardial infarction. Int J Cardiol 1987; 17 (1): 15–24PubMedCrossRefGoogle Scholar
  16. 16.
    Kimura T, Ogushi Y, Takahashi M, et al. Association of health-related quality of life with health examination including organic functions and lifestyles in Japanese employees. Qual Life Res 2004; 13 (2): 519–29PubMedCrossRefGoogle Scholar
  17. 17.
    Lee C, Russell A. Effects of physical activity on emotional well-being among older Australian women: cross-sectional and longitudinal analyses. J Psychosom Res 2003; 54 (2): 155–60PubMedCrossRefGoogle Scholar
  18. 18.
    Stewart AL, Hays RD, Wells KB, et al. Long-term functioning and well-being outcomes associated with physical-activity and exercise in patients with chronic conditions in the medical outcomes study. J Clin Epidemiol 1994; 47 (7): 719–30PubMedCrossRefGoogle Scholar
  19. 19.
    Coakley EH, Kawachi I, Manson JE, et al. Lower levels of physical functioning are associated with higher body weight among middle-aged and older women. Int J Obes 1998; 22 (10): 958–65CrossRefGoogle Scholar
  20. 20.
    Brown WJ, Mishra G, Lee C, et al. Leisure time physical activity in Australian women: relationship with well being and symptoms. Res Q Exerc Sport 2000; 71 (3): 206–16PubMedGoogle Scholar
  21. 21.
    Lallukka T, Sarlio-Lahteenkorva S, Roos E, et al. Working conditions and health behaviours among employed women and men: the Helsinki Health Study. Prev Med 2004; 38 (1): 48–56PubMedCrossRefGoogle Scholar
  22. 22.
    Kristal-Boneh E, Froom P, Harari G, et al. Fatigue among Israeli industrial employees. J Occup Environ Med 1996; 38 (11): 1145–50PubMedCrossRefGoogle Scholar
  23. 23.
    Laforge RG, Rossi JS, Prochaska JO, et al. Stage of regular exercise and health-related quality of life. Prev Med 1999; 28 (4): 349–60PubMedCrossRefGoogle Scholar
  24. 24.
    Bultmann U, Kant I, Kasi SV, et al. Lifestyle factors as risk factors for fatigue and psychological distress in the working population: prospective results from the Maastricht Cohort Study. J Occup Environ Med 2002; 44 (2): 116–24PubMedCrossRefGoogle Scholar
  25. 25.
    Eriksen W, Bruusgaard D. Do physical leisure time activities prevent fatigue? A 15 month prospective study of nurses’ aides. Br J Sports Med 2004; 38 (3): 331–6Google Scholar
  26. 26.
    Wendel-Vos GCW, Schuit AJ, Tijhuis MAR, et al. Leisure time physical activity and health-related quality of life: crosssectional and longitudinal associations. Qual Life Res 2004; 13 (3): 667–77PubMedCrossRefGoogle Scholar
  27. 27.
    Lipsey MW, Wilson DB. Practical meta-analysis. Thousand Oaks (CA): Sage Publications, 2001Google Scholar
  28. 28.
    Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273 (5): 402–7PubMedCrossRefGoogle Scholar
  29. 29.
    US Department of Health and Human Services. Physical activity and health: a report of the Surgeon General. Washington, DC: USDHHS, 1996Google Scholar
  30. 30.
    Hasselblad V, Hedges LV. Meta-analysis of screening and diagnostic tests. Psychol Bull 1995; 117 (1): 167–78PubMedCrossRefGoogle Scholar
  31. 31.
    Hedges LV, Olkin I. Statistical methods for meta-analysis. New York: Academic Press, 1985Google Scholar
  32. 32.
    Rosenberg MS. The file-drawer problem revisited: a general weighted method for calculating fail-safe numbers in metaanalysis. Evolution Int J Org Evolution 2005 Feb; 59 (2): 464–8Google Scholar
  33. 33.
    Hedges LV, Pigott TD. The power of statistical tests in meta-analysis. Psychol Methods 2001; 6 (3): 203–17PubMedCrossRefGoogle Scholar
  34. 34.
    Hedges LV, Pigott TD. The power of statistical tests for moderators in meta-analysis. Psychol Methods 2004; 9 (4): 426–45PubMedCrossRefGoogle Scholar
  35. 35.
    Hill AB. The environment and disease: association or causation. Proc R Soc Med 1965; 58: 295–300PubMedGoogle Scholar
  36. 36.
    Grimes DA, Schulz KF. An overview of clinical research: the lay of the land. Lancet 2002; 359 (9300): 57–61PubMedCrossRefGoogle Scholar
  37. 37.
    LaPorte RE, Montoye HL, Caspersen CJ. Assessment of physical activity in epidemiological research: problems and prospects. Public Health Rep 1985; 100: 131–46Google Scholar
  38. 38.
    Dittner AJ, Wessely SC, Brown RG. The assessment of fatigue: a practical guide for clinicians and researchers. J Psychosom Res 2004; 56: 157–70PubMedCrossRefGoogle Scholar
  39. 39.
    Demyttenaere K, De Fruyt J, Stahl SM. The many faces of fatigue in major depressive disorder. Int J Neuropsychopharm 2005; 8 (1): 93–105Google Scholar
  40. 40.
    Stahl SM. The psychopharmacology of energy and fatigue. J Clin Psychiatry 2002; 63 (1): 7–8PubMedCrossRefGoogle Scholar
  41. 41.
    Stahl SM, Zhang LS, Damatarca C, et al. Brain-circuits determine destiny in depression: a novel approach to the psychopharmacology of wakefulness, fatigue, and executive dysfunction in major depressive disorder. J Clin Psychiatry 2003; 64: 6–17CrossRefGoogle Scholar
  42. 42.
    Dishman RK, Washburn RA, Heath GW. Physical activity epidemiology. Champaign (IL): Human Kinetics, 2004Google Scholar

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  1. 1.Department of KinesiologyUniversity of GeorgiaAthensUSA

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