Abstract
Physical activity may prevent anxiety, but the importance of exercise intensity, sex-specific mechanisms, and duration of the effects remains largely unknown. We used an observational study design to follow 395,369 individuals for up to 21 years to investigate if participation in an ultralong-distance cross-country ski race (Vasaloppet, up to 90 km) was associated with a lower risk of developing anxiety. Skiers in the race and matched non-skiers from the general population were studied after participation in the race using the Swedish population and patient registries. Skiers (n = 197,685, median age 36 years, 38% women) had a significantly lower risk of developing anxiety during the follow-up compared to non-skiers (adjusted hazard ratio, HR 0.42). However, among women, higher physical performance (measured as the finishing time to complete the race, a proxy for higher exercise dose) was associated with an increased risk of anxiety compared to slower skiing women (HR 2.00). For men, the finishing time of the race did not significantly impact the risk of anxiety. Our results support the recommendations of engaging in physical activity to decrease the risk of anxiety in both men and women. The impact of physical performance level on the risk of anxiety requires further investigations among women.
Highlights
Anxiety disorders are common mental health problems, estimated to currently affect up to 10% of the population globally [1] and twice as common among women compared to men [2, 3]
We could not detect any impact of the ski race finishing time on the risk of anxiety disorders among skiing men
We found that having a physically active lifestyle is associated with around 60% lower risk of developing anxiety disorders compared to matched individuals from the general population in an observational study following almost 400,000 individuals for up to 21 years
Summary
Anxiety disorders are common mental health problems, estimated to currently affect up to 10% of the population globally [1] and twice as common among women compared to men [2, 3]. The onset is typically early in life, during childhood, adolescence, or early adulthood. Several reports reveal poorer physical health and shorter life expectancy among patients with anxiety disorders [4, 5]. Up to half of the patients do not receive enough symptom relief when treated with first-line treatments, such as selective serotonin reuptake inhibitors (SSRI) or cognitive-behavioral therapy (CBT) [6]. Due to the high prevalence, early-onset, and frequency of treatment-resistance among individuals with anxiety disorders, Physical Activity and Incident Anxiety their contribution to years lived with disability and economic burden for society is substantial [7]
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