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

  • S. A. Hiles (a1), F. Lamers (a1), Y. Milaneschi (a1) and B. W. J. H. Penninx (a1)

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.

Corresponding author
*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:
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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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
Eyre, HA, Baune, BT (2012). Neuroimmunological effects of physical exercise in depression. Brain, Behavior, and Immunity 26, 251266.
Goodwin, RD (2003). Association between physical activity and mental disorders among adults in the United States. Preventive Medicine 36, 698703.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Patten, SB, Williams, JVA, Lavorato, DH, Eliasziw, M (2009). A longitudinal community study of major depression and physical activity. General Hospital Psychiatry 31, 571575.
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.
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.
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.
Rush, AJ, Gullion, CM, Basco, MR, Jarrett, RB, Trivedi, MH (1996). The inventory of depressive symptomatology (IDS): Psychometric properties. Psychological Medicine 26, 477486.
Salmon, P (2001). Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clinical Psychology Review 21, 3361.
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.
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.
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.
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.
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.
Ströhle, A (2009). Physical activity, exercise, depression and anxiety disorders. Journal of Neural Transmission 116, 777784.
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.
Ten Have, M, de Graaf, R, Monshouwer, K (2011). Physical exercise in adults and mental health status. Journal of Psychosomatic Research 71, 342348.
Teychenne, M, Ball, K, Salmon, J (2008). Physical activity and likelihood of depression in adults: a review. Preventive Medicine 46, 397411.
Teychenne, M, Ball, K, Salmon, J (2010). Sedentary behavior and depression among adults: a review. International Journal of Behavioral Medicine 17, 246254.
Teychenne, M, Costigan, SA, Parker, K (2015). The association between sedentary behaviour and risk of anxiety: a systematic review. BMC Public Health 15, 513.
Touloumis, A (2015). Package multgee: a generalized estimating equations solver for multinomial responses. Journal of Statistical Software 64, 114.
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.
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.
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.
Warburton, DER, Nicol, CW, Bredin, SSD (2006). Health benefits of physical activity: the evidence. Canadian Medical Association Journal 174, 801809.
WHO (2009). Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. World Health Organization: Geneva.
Wilson, KE, Dishman, RK (2015). Personality and physical activity: a systematic review and meta-analysis. Personality and Individual Differences 72, 230242.
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.
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.
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