Physical activity and anxiety: A perspective from the World Health Survey.
Despite the known benefits of physical activity (PA) among people with anxiety, little is known about PA levels in people with anxiety at the population level. This study explored the global prevalence of anxiety and its association with PA.



Cross-sectional, community-based data from the World Health Survey was analyzed. Prevalence of anxiety was estimated for 237,964 individuals (47 countries). PA was categorized as low, moderate, and high based on the International Physical Activity Questionnaire (short form). The association between PA and anxiety was assessed by multivariable logistic regression.



The overall global prevalence of anxiety was 11.4% (47 countries). Across 38 countries with available data on PA, 62.5%, 20.2%, and 17.3% of the sample engaged in high, moderate, and low levels of PA respectively. The prevalence of low physical activity in those with and without anxiety was 22.9% vs. 16.6% (p<0.001) (38 countries, n=184,920). In the pooled model adjusted for socio-demographics, depression, and country, individuals engaging in low PA (vs. high PA) had 1.32 (95% CI=1.17-1.47) times higher odds for anxiety than those with high PA. Female sex, older age, lower education and wealth, and depression were also associated with low PA. At the individual country level, there was a significant positive association between low PA and anxiety in 17 of the 38 countries.



Low PA levels are associated with increased prevalence of anxiety. There is a need for longitudinal research to establish the directionality of the relationships observed.
Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom. Electronic address: brendon.stubbs@kcl.ac.uk.
Brendon
B
Stubbs
Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain.
Ai
A
Koyanagi
Division of Epidemiology and Public Health Intervention Research (EPHIR), Department of Public Health Sciences, Karolinska Institutet, Solna 171 77, Sweden.
Mats
M
Hallgren
Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom.
Joseph
J
Firth
School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.
Justin
J
Richards
Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Pós Graduação em Ciências Médicas Unilassale, Canoas, Brazil.
Felipe
F
Schuch
Department of Exercise Physiology, School of Medical Sciences, University of New South Wales, Sydney, Australia.
Simon
S
Rosenbaum
Kyambogo University, Kampala, Uganda; Butabika National Referral and Mental Health Hospital, Kampala, Uganda.
James
J
Mugisha
Geriatrics Division, Department of Medicine-DIMED, University of Padova, Italy; Institute of clinical Research and Education in Medicine (IREM), Padova, Italy.
Nicola
N
Veronese
Department of Public Health, University of Helsinki, Helsinki, Finland.
Jouni
J
Lahti
KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium.
Davy
D
Vancampfort
D000328:Adult; D001007:Anxiety / Q000453:epidemiology* / Q000503:physiopathology; D001008:Anxiety Disorders / Q000453:epidemiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D015444:Exercise / Q000523:psychology*; D005260:Female; D014943:Global Health; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011795:Surveys and Questionnaires
Anxiety; Community-based; Exercise; Multi-country study; Physical activity; Psychiatry