In a recent study published in the journal Progress in Cardiovascular Diseases, researchers explore whether exercise could be used to treat anxiety.
Study: Is exercise a viable therapy for anxiety? Systematic review of recent literature and critical analysis. Image Credit: GP PIXSTOCK / Shutterstock.com
The mental health benefits of exercise
Lifestyle psychiatry acknowledges the impact of various health behaviors, such as nutrition, sleep, smoking, and physical activity on mental health.
Physical exercise is a well-known health behavior that provides both physical and psychological benefits. In fact, exercise is now recommended as the primary treatment for mild to moderate depression and as an adjunctive treatment for severe mental illness. However, the impact of exercise on anxiety has not been studied as extensively as its effect on depression.
About the study
The current review included studies that evaluated the impact of long-term exercise on anxiety outcomes in people with anxiety disorders or high levels of anxiety symptoms. To this end, a systematic search was conducted in April 2022 on MEDLINE, EMBASE, CINAHL, and PsycINFO for peer-reviewed studies in English. The selected studies obtained measurements from participants for anxiety-related disorder symptoms or elevated symptoms of anxiety.
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Only randomized clinical trials (RCTs) that fulfilled specified criteria were included in the review. These included articles published in English in a peer-reviewed journal, articles published between January 2014 and December 2021, eligible participants were at least 18 years old, at least 30 participants were included in the study, exercise interventions included more than one round of resistance training or aerobic exercise, the primary outcome measure was anxiety, and elevated anxiety symptoms were estimated using a validated assessment instrument or diagnosed using an established procedure like a psychiatric interview.
In addition to the inclusion criteria, any selected study provided information on the control condition, exercise intervention, participant demographics, percent attrition, primary outcome, anxiety measures, and anxiety-related results, including an objective to determine if exercise contributed to reduced anxiety.
Unclear impact of exercise on anxiety
A total of 7,240 records were identified during the electronic database search; however, after removing 1,952 duplicate entries, 5,288 unique articles remained.
Of these, 98.7% were excluded after the title and abstract were reviewed. Finally, the review examined 70 studies and 25 RCTs that met the eligibility criteria.
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Nineteen of these studies relied on self-report questionnaires to assess anxiety levels before the intervention. These questionnaires included the Spielberger State-Trait Anxiety Scale (STAI), Beck Anxiety Inventory (BAI), anxiety subscale of the Hospital Anxiety and Depression Scale (HADS), Anxiety Sensitivity Index (ASI), Psychiatric Diagnostic Screening Questionnaire (PDSQ), and Posttraumatic Stress Disorder (PTSD) Checklist (PCL).
Baseline anxiety was evaluated in four studies using structured interviews such as the Clinician-Administered PTSD Scale (CAPS), Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM), and Hamilton Anxiety Rating Scale (HAM-A).
Seven provided conclusive evidence that exercise intervention groups experienced improvements in their disorder status or anxiety symptoms as compared to controls. In two of the 13 studies conducted on anxious individuals, no clear reductions in anxiety levels were observed for the exercise cohort as compared to controls.
Six studies reported insignificant or no variations in anxiety levels between those who exercised and those who did not. In 12 studies, including eight trials involving anxious individuals, the findings were considered inconclusive or equivocal. Most of the studies yielded mixed results, as a reduction in anxiety was observed for certain measures or assessment periods.
Three studies reported positive findings; however, due to significant methodological limitations, it was difficult to determine whether exercise equivocally reduced anxiety. Moreover, four studies analyzed potential mediators or moderators of the anxiety-exercise correlation.
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Three studies found that the level of anxiety reduction due to exercise was influenced by the number of exercise sessions attended or the initial level of anxiety. Specifically, attending more exercise sessions was related to greater anxiety reduction, while higher baseline anxiety levels were also related to greater anxiety reduction.
Two studies examined potential mediators, including participants’ daily steps and increased aerobic fitness levels; however, these analyses did not produce a significant outcome.
Conclusions
The limited number of reliable studies and absence of positive results in over half of the reviewed studies limit the ability to draw definite conclusions about the effectiveness of exercise as a treatment for anxiety in patients.
Further research is needed to determine the advantages of exercise for people with anxiety. Clinicians who recommend exercise as therapy for anxiety must prioritize patient safety, establish clear and achievable exercise goals, and closely monitor symptoms.
Journal reference:
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Stonerock, G. L., Gupta, R. P., & Blumenthal, J. A. (2023). Is exercise a viable therapy for anxiety? Systematic review of recent literature and critical analysis. Progress in Cardiovascular Diseases. doi:10.1016/j.pcad.2023.05.006
To make study participants feel most comfortable, McCullough focused on the data that the dancing produced, not the dancers themselves. Credit: Aston K. McCullough
Forget sneakers or cleats and put on those boogie shoes, as new research from Northeastern University finds that dancing can have the same health benefits as running and other forms of exercise.
“You don’t necessarily need to have music, you don’t need to have any training or a teacher, anyone—ostensibly—can dance right where they are and get a health-enhancing dose of physical activity,” says Aston McCullough, assistant professor of physical therapy, human movement and rehabilitation sciences at Northeastern.
McCullough’s research on this topic appears in the journal PLOS ONE.
Scientists have long known that dancing has many benefits, improving everything from heart health and balance to flexibility and psychological well-being.
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But McCullough notes that prior studies have not measured the “dose” of free-form dance given—leading to questions about how intensely people move when dancing however they wish, and whether free-form dance is enough to reach a moderate or vigorous intensity.
Prior studies have also focused primarily on specific types of dance—for instance, ballet or hip-hop.
McCullough wanted to take a different approach—focusing not on trained dancers practicing an established style, but the everyday person who just likes to boogie down.
“We wanted to do a study that could give us the most bang for the buck, if you will,” McCullough says. “We said that anyone who comes in can do whatever they want—just dance however you want to dance. In that way, it automatically increases the public health relevance of the study.”
So McCullough gathered roughly 50 participants ranging in age from 18 to 83 years old and had zero to 56 years of dance training experience. Then he let them cut a rug for five-minute intervals at self-determined moderate and vigorous levels, both with and without self-selected music.
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Meanwhile, McCullough measured their heart rates, perceived exertion and oxygen levels. He found that whether in a club, on your own or even in the dark, getting down can get your heart rate up.
McCullough found that dancing—even without music—expended enough energy to reach the recommended moderate to vigorous physical activity intensities. Being trained in dance had no effect on the energy expended, and the music led participants to dance more intensely.
McCullough says the research is exciting because it means that dancing—wherever, whenever, however—counts toward the Office of Disease Prevention and Health Promotion’s recommendation that adult Americans get at least 150 minutes of moderate physical activity, or at least 75 minutes of vigorous activity, or some combination of the two, a week.
“People can dance without leaving their homes, people can dance without leaving a chair,” McCullough says. “So, in that way, we’re really excited about the benefits of dance for all people. Whatever may be your preferred way to dance, just make sure you have enough space around you to dance safely.”
Alas, dance may not be the perfect exercise.
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The Office of Disease Prevention and Health Promotion also recommends that adults do muscle-strengthening activities such as resistance training or weight training two days a week.
“Some dance forms may include bodyweight resistance training, like breakdancing,” McCullough says. “But more research is needed on bodyweight resistance training and dance.”
More information:
Aston K. McCullough et al, Absolute and relative intensities of solo, free-form dancing in adults: A pilot study, PLOS ONE (2024). DOI: 10.1371/journal.pone.0313144
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6 Best Exercise Bikes for Seniors, According to Fitness Experts
Hopping on a stationary bike is a great workout that’s accessible to people of all ages and fitness levels. A low-impact cardio exercise that’s easy on joints makes it ideal for those over 65, or those with joint pain and mobility issues. The best exercise bikes for seniors take all of this into account, allowing everyone to reap the many benefits of indoor cycling.
“Exercise bikes are great for cardiovascular health for seniors. They are non-weight-bearing which allows repetitive motion in the hip and knee joints without the added stress of gravity, joint impact forces, and joint compression,” says Karena Wu, P.T., D.P.T., physical therapist and owner of ActiveCare Physical Therapy. “The movement of the legs can help mobilize the joint fluids which helps to nourish the joints. This can create increased joint mobility and reduced stiffness. Pushing against resistance will work the muscles, keeping or making them strong.”
Meet the Experts: Karena Wu, P.T., D.P.T., physical therapist and owner of ActiveCare Physical Therapy; and Jim White, R.D.N., A.C.S.M. Ex-P, owner of Jim White Fitness and Nutrition Studios
Experts generally recommend recumbent exercise bikes for seniors, which feature a reclined seat and a backrest for support. “Recumbent exercise bikes are best for seniors especially dealing with joint pain, back issues, or balance concerns. This is due to the reclined seat that lessens stress on the lower back, lower pedal position which puts less stress on the knees and hips, and step-through design that makes it easier to get on and off,” explains Jim White, R.D.N., A.C.S.M. Ex-P, owner of Jim White Fitness and Nutrition Studios.
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Ahead, we rounded up the best exercise bikes for seniors, recommended by our fitness experts and highly rated by online reviewers. Shop top picks below that feature comfortable, ergonomic seats, a user-friendly design, and adjustable resistance levels for a customizable workout.
You know you should develop a regular exercise routine, but you lack motivation. Promises to yourself are quickly broken, and you never establish enough of the workout habit to experience any rewards.
Exercising as you age is important. It’s not only good for physical health to help prevent falls or enable you to do basic tasks — exercise is also superb for the mind.
“If you want to be cognitively active, it is so important to be physically active,” explained Dr. Amy Eyler, a professor of public health at Washington University in St. Louis. “There is a such a strong connection between these two behaviors.”
Why make exercise part of my routine?
First, regular exercise helps maintain bone density and muscle strength. It also lowers the risk of heart disease and certain types of cancer.
For older people, regular exercise helps maintain strength and balance and allows them to live independently. Research also suggests the immune system may get a bump from physical activity.
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There is also a psychological component. Successfully completing a daily exercise can improve one’s mood and sense of self-satisfaction.
Dr. Grover Smith, left, works out with exercise scientist Dr. Irv Rubenstein, right, at STEPS Fitness, Wednesday, Feb. 12, 2025, in Nashville, Tenn. (AP Photo/George Walker IV)
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Dr. Grover Smith, left, works out with exercise scientist Dr. Irv Rubenstein, right, at STEPS Fitness, Wednesday, Feb. 12, 2025, in Nashville, Tenn. (AP Photo/George Walker IV)
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This article is part of AP’s Be Well coverage, focusing on wellness, fitness, diet and mental health. Read more Be Well.
How to get started
Getting into the habit of doing regular physical activity can be difficult for some. The motivation to get moving is different for everyone.
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Initially you’ll need external motivation — I want to be able to play with my grandkids or keep driving the car — until you see results and the motivation shifts to internal, Eyler said.
“When you set a goal, you should ask yourself on a scale of 1 to 100, how confident am I that I can do this?” Eyler explained. “It has to be over the 90% level of confidence or you’re not going to do it. Lots of people set these goal too high and then fail.”
Build to your goals.
“Just walk whenever you can,” Eyler said. “You can walk for 10 minutes pretty much anywhere — indoors, at work, at home.”
And, if you’re trying to encourage others, look for positive reasons rather than nagging.
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“Telling someone they will be more independent if they take their blood pressure medicine is better than — take your blood pressure medicine,” she said.
Here are some tips about how to start — and how to stay with it — from three gym rats between the ages of 77 and 86. All got started late and have stayed with it. All three work out with Dr. Irv Rubenstein, an exercise scientist who runs STEPS Fitness in Nashville, Tennessee.
Dr. Grover Smith lifts a dumbbell at STEPS Fitness, Wednesday, Feb. 12, 2025, in Nashville, Tenn. (AP Photo/George Walker IV)
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Dr. Grover Smith lifts a dumbbell at STEPS Fitness, Wednesday, Feb. 12, 2025, in Nashville, Tenn. (AP Photo/George Walker IV)
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I always hated gym class
Kathryn Dettwiller, 77, got pushed into exercising 34 years ago by her husband.
“I always hated gym class,” she said. “I always hated getting down on the floor.”
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She works out in a gym twice a week with a trainer, which she said gives her added discipline and motivation.
“The external has become internal because I realize I need it,” she said. She cautioned beginners to expect some setbacks — minor injuries — and not to be discouraged.
“Try it as soon as your body starts playing out on you,” she said. “It’s like a game of Whack-A-Mole. One time your leg hurts, the next time it’s your back.”
Dr. Grover Smith, left, works out with exercise scientist Dr. Irv Rubenstein, right, at STEPS Fitness, Wednesday, Feb. 12, 2025, in Nashville, Tenn. (AP Photo/George Walker IV)
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Dr. Grover Smith, left, works out with exercise scientist Dr. Irv Rubenstein, right, at STEPS Fitness, Wednesday, Feb. 12, 2025, in Nashville, Tenn. (AP Photo/George Walker IV)
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It added structure to his life
Rick Bolsom, 82, enjoys the structure of having a trainer. In his case, his wife got him started almost two decades ago and he’s into a three-times-a-week routine.
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“I kept doing it because I had a sense of feeling better,” he said. “The key to me was probably doing it with a trainer. The structure really helped me to continue with it. Now it’s just become part of my life.”
“I couldn’t imagine quitting it,” he added. “I work out as vigorously as I did 15, 18 years ago. It turned out to be the smart thing to do.”
Bolsom also added in the social aspect to training in a gym or studio.
“I retired a few years ago. You do miss the connectivity with people.”
Flattery will get you everywhere
Dr. Grover Smith, a retired radiologist, is 86 and still going strong. He attributes this partly to training regularly in a gym three times a week, a habit he didn’t start until he was 74 and well into retirement. He was coaxed to go after several visits to his cardiologist.
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He said he went after the fourth time his cardiologist suggested it, although he was not having any specific heart problems. His plan was to go once to appease the cardiologist and that would be it. That was more than a decade ago.
Dr. Grover Smith works out at STEPS Fitness, Wednesday, Feb. 12, 2025, in Nashville, Tenn. (AP Photo/George Walker IV)
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Dr. Grover Smith works out at STEPS Fitness, Wednesday, Feb. 12, 2025, in Nashville, Tenn. (AP Photo/George Walker IV)
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“Medicine was basically my life and it was very time consuming,” Smith said. “It was sometimes seven days a week and I didn’t have time for a lot of other things.”
He’s not only fit, but now he also gets flattered.
He tells the story about a recent visit to a doctor who, after looking at his charts, told him: “Dr. Smith, you look 15 years younger than your age.”
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Smith laughed as he added the punchline.
“I would have told her to get her eyes examined — except she’s an ophthalmologist,” he quipped.