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Sit, step, sweat: longitudinal associations between physical activity patterns, anxiety and depression

Published online by Cambridge University Press:  31 January 2017

S. A. Hiles*
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
F. Lamers
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
Y. Milaneschi
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
B. W. J. H. Penninx
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
*Address for correspondence: S. A. Hiles, Ph.D., Department of Psychiatry, VU University Medical Center, A.J. Ernststraat 1187, 1081 HL, Amsterdam, The Netherlands. (Email:



Physical inactivity has been identified as a risk factor for depression and, less often, as a long-term consequence of depression. Underexplored is whether similar bi-directional longitudinal relationships are observed for anxiety disorders, particularly in relation to three distinct indicators of activity levels – sports participation, general physical activity and sedentary behavior.


Participants were from the Netherlands Study of Depression and Anxiety (NESDA; N = 2932, 18–65 years old; 57% current anxiety or depressive disorder, 21% remitted disorder, 22% healthy controls). At baseline, 2, 4, and 6 years, participants completed a diagnostic interview and self-report questionnaires assessing psychopathology symptom severity, physical activity indicators, and sociodemographic and health covariates.


Consistently across assessment waves, people with anxiety and/or depressive disorders had lower sports participation and general physical activity compared to healthy controls. Greater anxiety or depressive symptoms were associated with lower activity according to all three indicators. Over time, a diagnosis or greater symptom severity at one assessment was associated with poorer sports participation and general physical activity 2 years later. In the opposite direction, only low sports participation was associated with greater symptom severity and increased odds of disorder onset 2 years later. Stronger effects were observed for chronicity, with lower activity according to all indicators increasing the odds of disorder chronicity after 2 years.


Over time, there seems to a mutually reinforcing, bidirectional relationship between psychopathology and lower physical activity, particularly low sports participation. People with anxiety are as adversely affected as those with depression.

Original Articles
Copyright © Cambridge University Press 2017 

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Ainsworth, BE, Bassett, DR, Strath, SJ, Swartz, AM, O'Brien, WL, Thompson, RW, Jones, DA, Macera, CA, Kimsey, CD (2000). Comparison of three methods for measuring the time spent in physical activity. Medicine and Science in Sports and Exercise 32, S457S464.CrossRefGoogle ScholarPubMed
Azevedo Da Silva, M, Singh-Manoux, A, Brunner, EJ, Kaffashian, S, Shipley, MJ, Kivimäki, M, Nabi, H (2012). Bidirectional association between physical activity and symptoms of anxiety and depression: the Whitehall II study. European Journal of Epidemiology 27, 537546.CrossRefGoogle ScholarPubMed
Beck, AT, Epstein, N, Brown, G, Steer, RA (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 56, 893897.CrossRefGoogle ScholarPubMed
Brunes, A, Gudmundsdottir, SL, Augestad, LB (2014). Gender-specific associations between leisure-time physical activity and symptoms of anxiety: the HUNT study. Social Psychiatry and Psychiatric Epidemiology 50, 419427.Google Scholar
Cairney, J, Faulkner, G, Veldhuizen, S, Wade, TJ (2009). Changes over time in physical activity and psychological distress among older adults. Canadian Journal of Psychiatry 54, 160169.Google Scholar
Carey, VJ (2015). gee: Generalized esimation equation solver. Ported to R by Thomas Lumley (versions 3.13 and 4.4) and Brian Ripley (version 4.13).Google Scholar
Cooney, GM, Dwan, K, Greig, CA, Lawlor, DA, Rimer, J, Waugh, FR, McMurdo, M, Mead, GE (2013). Exercise for depression. Cochrane Database of Systematic Reviews 9, CD004366.Google Scholar
Craig, CL, Marshall, AL, Sjöström, M, Bauman, AE, Booth, ML, Ainsworth, BE, Pratt, M, Ekelund, U, Yngve, A, Sallis, JF, Oja, P (2003). International physical activity questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise 35, 13811395.Google Scholar
Daumit, GL, Goldberg, RW, Anthony, C, Dickerson, F, Brown, CH, Kreyenbuhl, J, Wohlheiter, K, Dixon, LB (2005). Physical activity patterns in adults with severe mental illness. Journal of Nervous and Mental Disease 193, 641646.CrossRefGoogle ScholarPubMed
De Moor, MHM, Boomsma, DI, Stubbe, JH, Willemsen, G, de Geus, EJC (2008). Testing causality in the association between regular exercise and symptoms of anxiety and depression. Archives of General Psychiatry 65, 897905.Google Scholar
De Wit, LM, van Straten, A, Lamers, F, Cuijpers, P, Penninx, B (2011). Are sedentary television watching and computer use behaviors associated with anxiety and depressive disorders? Psychiatry Research 186, 239243.Google Scholar
Duivis, HE, Vogelzangs, N, Kupper, N, De Jonge, P, Penninx, BWJH (2013). Differential association of somatic and cognitive symptoms of depression and anxiety with inflammation: findings from the netherlands study of depression and anxiety (NESDA). Psychoneuroendocrinology 38, 15731585.Google Scholar
Ebstrup, JF, Aadahl, M, Eplov, LF, Pisinger, C, Jørgensen, T (2013). Cross-sectional associations between the five factor personality traits and leisure-time sitting-time: the effect of general self-efficacy. Journal of Physical Activity and Health 10, 572580.Google Scholar
Everson-Hock, ES, Green, MA, Goyder, EC, Copeland, RJ, Till, SH, Heller, B, Hart, O (2016). Reducing the impact of physical inactivity: evidence to support the case for targeting people with chronic mental and physical conditions. Journal of Public Health 38, 343351.Google Scholar
Eyre, HA, Baune, BT (2012). Neuroimmunological effects of physical exercise in depression. Brain, Behavior, and Immunity 26, 251266.Google Scholar
Goodwin, RD (2003). Association between physical activity and mental disorders among adults in the United States. Preventive Medicine 36, 698703.CrossRefGoogle ScholarPubMed
Gudmundsson, P, Lindwall, M, Gustafson, DR, Östling, S, Hällström, T, Waern, M, Skoog, I (2015). Longitudinal associations between physical activity and depression scores in Swedish women followed 32 years. Acta Psychiatrica Scandinavica 132, 451458.Google Scholar
Hamer, M, Molloy, GJ, de Oliveira, C, Demakakos, P (2009). Persistent depressive symptomatology and inflammation: to what extent do health behaviours and weight control mediate this relationship? Brain, Behavior, and Immunity 23, 413418.Google Scholar
Harris, AHS, Cronkite, R, Moos, R (2006). Physical activity, exercise coping, and depression in a 10-year cohort study of depressed patients. Journal of Affective Disorders 93, 7985.Google Scholar
Healy, GN, Dunstan, DW, Salmon, J, Cerin, E, Shaw, JE, Zimmet, PZ, Owen, N (2008). Breaks in sedentary time: beneficial associations with metabolic risk. Diabetes Care 31, 661666.CrossRefGoogle ScholarPubMed
Herring, MP, Jacob, ML, Suveg, C, Dishman, RK, O'Connor, PJ (2012). Feasibility of exercise training for the short-term treatment of generalized anxiety disorder: a randomized controlled trial. Psychotherapy and Psychosomatics 81, 2128.Google Scholar
Hiles, SA, Baker, AL, de Malmanche, T, McEvoy, M, Boyle, M, Attia, J (2015). Unhealthy lifestyle may increase later depression via inflammation in older women but not men. Journal of Psychiatric Research 63, 6574.CrossRefGoogle Scholar
Kang, H-J, Bae, K-Y, Kim, S-W, Shin, I-S, Yoon, J-S, Kim, J-M (2016). Anxiety symptoms in Korean elderly individuals: a two-year longitudinal community study. International Psychogeriatrics 28, 423433.CrossRefGoogle ScholarPubMed
Kotov, R, Gamez, W, Schmidt, F, Watson, D (2010). Linking ‘big’ personality traits to anxiety, depressive, and substance use disorders: a meta-analysis. Psychological Bulletin 136, 768821.Google Scholar
Krämer, LV, Helmes, AW, Seelig, H, Fuchs, R, Bengel, J (2014). Correlates of reduced exercise behaviour in depression: the role of motivational and volitional deficits. Psychology and Health 29, 12061225.Google Scholar
Lee, I-M, Shiroma, EJ, Lobelo, F, Puska, P, Blair, SN, Katzmarzyk, PT (2012). Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 380, 219229.CrossRefGoogle ScholarPubMed
Liao, Y, Shibata, A, Ishii, K, Oka, K (2015). Independent and combined associations of physical activity and sedentary behavior with depressive symptoms among japanese adults. International Journal of Behavioral Medicine 23, 402409.Google Scholar
Lindwall, M, Larsman, P, Hagger, MS (2011). The reciprocal relationship between physical activity and depression in older European adults: a prospective cross-lagged panel design using SHARE data. Health Psychology 30, 453462.Google Scholar
Lopresti, AL, Hood, SD, Drummond, PD (2013). A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep and exercise. Journal of Affective Disorders 148, 1227.Google Scholar
Mammen, G, Faulkner, G (2013). Physical activity and the prevention of depression: a systematic review of prospective studies. American Journal of Preventive Medicine 45, 649657.Google Scholar
Medina, JL, Jacquart, J, Smits, JAJ (2015). Optimizing the exercise prescription for depression: the search for biomarkers of response. Current Opinion in Psychology 4, 4347.CrossRefGoogle ScholarPubMed
Moylan, S, Eyre, HA, Maes, M, Baune, BT, Jacka, FN, Berk, M (2013). Exercising the worry away: how inflammation, oxidative and nitrogen stress mediates the beneficial effect of physical activity on anxiety disorder symptoms and behaviours. Neuroscience and Biobehavioral Reviews 37, 573584.CrossRefGoogle ScholarPubMed
Opdenacker, J, Boen, F (2008). Effectiveness of face-to-face versus telephone support in increasing physical activity and mental health among university employees. Journal of Physical Activity and Health 5, 830843.Google Scholar
Owen, N, Healy, GN, Matthews, CE, Dunstan, DW (2010). Too much sitting: the population health science of sedentary behavior. Exercise and Sport Sciences Reviews 38, 105113.Google Scholar
Panagiotakos, DB, Pitsavos, C, Lentzas, Y, Skoumas, Y, Papadimitriou, L, Zeimbekis, A, Stefanadis, C (2008). Determinants of physical inactivity among men and women From Greece: a 5-year follow-up of the ATTICA study. Annals of Epidemiology 18, 387394.Google Scholar
Patten, SB, Williams, JVA, Lavorato, DH, Bulloch, AGM (2013). Recreational physical activity ameliorates some of the negative impact of major depression on health-related quality of life. Frontiers in Psychiatry 4, 15.CrossRefGoogle ScholarPubMed
Patten, SB, Williams, JVA, Lavorato, DH, Eliasziw, M (2009). A longitudinal community study of major depression and physical activity. General Hospital Psychiatry 31, 571575.Google Scholar
Penedo, FJ, Dahn, JR (2005). Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Current Opinion in Psychiatry 18, 189193.Google Scholar
Penninx, BWJH, Beekman, ATF, Smit, JH, Zitman, FG, Nolen, WA, Spinhoven, P, Cuijpers, P, De Jong, PJ, Van Marwijk, HWJ, Assendelft, WJJ, van der Meer, K, Verhaak, P, Wensing, M, de Graaf, R, Hoogendijk, WJ, Ormel, J, van Dyck, R (2008). The Netherlands study of depression and anxiety (NESDA): rationale, objectives and methods. International Journal of Methods in Psychiatric Research 17, 121140.CrossRefGoogle ScholarPubMed
Rush, AJ, Giles, DE, Schlesser, MA, Fulton, CL, Weissenburger, J, Burns, C (1986). The inventory for depressive symptomatology (IDS): preliminary findings. Psychiatry Research 18, 6587.Google Scholar
Rush, AJ, Gullion, CM, Basco, MR, Jarrett, RB, Trivedi, MH (1996). The inventory of depressive symptomatology (IDS): Psychometric properties. Psychological Medicine 26, 477486.CrossRefGoogle ScholarPubMed
Salmon, P (2001). Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clinical Psychology Review 21, 3361.Google Scholar
Sanchez-Villegas, A, Ara, I, Guillén-Grima, F, Bes-Rastrollo, M, Varo-Cenarruzabeitia, JJ, Martínez-González, MA (2008). Physical activity, sedentary index, and mental disorders in the SUN cohort study. Medicine and Science in Sports and Exercise 40, 827834.Google Scholar
Saunders, JB, Aasland, OG, Babor, TF, de la Fuente, JR, Grant, M (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction 88, 791804.Google Scholar
Scarapicchia, TMF, Sabiston, CM, O'Loughlin, E, Brunet, J, Chaiton, M, O'Loughlin, JL (2014). Physical activity motivation mediates the association between depression symptoms and moderate-to-vigorous physical activity. Preventive Medicine 66, 4548.Google Scholar
Schuch, FB, Deslandes, AC, Stubbs, B, Gosmann, NP, Silva, CTB da, Fleck, MP de A (2016 a). Neurobiological effects of exercise on major depressive disorder: a systematic review. Neuroscience and Biobehavioral Reviews 61, 111.CrossRefGoogle ScholarPubMed
Schuch, FB, Vancampfort, D, Richards, J, Rosenbaum, S, Ward, PB, Stubbs, B (2016b). Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. Journal of Psychiatric Research 77, 4251.Google Scholar
Ströhle, A (2009). Physical activity, exercise, depression and anxiety disorders. Journal of Neural Transmission 116, 777784.CrossRefGoogle ScholarPubMed
Sutin, AR, Stephan, Y, Luchetti, M, Artese, A, Oshio, A, Terracciano, A (2016). The five-factor model of personality and physical inactivity: a meta-analysis of 16 samples. Journal of Research in Personality 63, 2228.Google Scholar
Ten Have, M, de Graaf, R, Monshouwer, K (2011). Physical exercise in adults and mental health status. Journal of Psychosomatic Research 71, 342348.Google Scholar
Teychenne, M, Ball, K, Salmon, J (2008). Physical activity and likelihood of depression in adults: a review. Preventive Medicine 46, 397411.Google Scholar
Teychenne, M, Ball, K, Salmon, J (2010). Sedentary behavior and depression among adults: a review. International Journal of Behavioral Medicine 17, 246254.Google Scholar
Teychenne, M, Costigan, SA, Parker, K (2015). The association between sedentary behaviour and risk of anxiety: a systematic review. BMC Public Health 15, 513.Google Scholar
Touloumis, A (2015). Package multgee: a generalized estimating equations solver for multinomial responses. Journal of Statistical Software 64, 114.Google Scholar
Van Reedt Dortland, AKB, Vreeburg, SA, Giltay, EJ, Licht, CMM, Vogelzangs, N, Van Veen, T, De Geus, EJC, Penninx, BWJH, Zitman, FG (2013). The impact of stress systems and lifestyle on dyslipidemia and obesity in anxiety and depression. Psychoneuroendocrinology 38, 209218.Google Scholar
Van Rijsselt, RJT (1994). Societal participation. In Autonomy and Well-being in the Aging Population 1. Report from the Longitudinal Aging Study Amsterdam 1992–1993 (ed. Deeg, D. J. H. and Westendorp-de Serière, M.), pp. 97102. VU Uitgeverij: Amsterdam.Google Scholar
Van Uffelen, JGZ, Van Gellecum, YR, Burton, NW, Peeters, G, Heesch, KC, Brown, WJ (2013). Sitting-time, physical activity, and depressive symptoms in mid-aged women. American Journal of Preventive Medicine 45, 276281.Google Scholar
Warburton, DER, Nicol, CW, Bredin, SSD (2006). Health benefits of physical activity: the evidence. Canadian Medical Association Journal 174, 801809.Google Scholar
WHO (2009). Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. World Health Organization: Geneva.Google Scholar
Wilson, KE, Dishman, RK (2015). Personality and physical activity: a systematic review and meta-analysis. Personality and Individual Differences 72, 230242.Google Scholar
Wilson, PM, Sabiston, CM, Mack, DE, Blanchard, CM (2012). On the nature and function of scoring protocols used in exercise motivation research: an empirical study of the behavioral regulation in exercise questionnaire. Psychology of Sport and Exercise 13, 614622.Google Scholar
Wipfli, B, Landers, D, Nagoshi, C, Ringenbach, S (2011). An examination of serotonin and psychological variables in the relationship between exercise and mental health. Scandinavian Journal of Medicine and Science in Sports 21, 474481.CrossRefGoogle ScholarPubMed