Can Exercise Really Treat Anxiety? Here’s What the Evidence Shows
Anxiety is one of the most common reasons people visit their doctor, yet treatment options in general practice are often limited to medication or cognitive behavioral therapy (CBT). Many patients would prefer to avoid the side effects of medication and want practical, lifestyle-based alternatives. A 2018 systematic review and meta-analysis published in BMC Health Services Research asked a straightforward question: does exercise actually work as a treatment for anxiety, and how intense does it need to be?
Researchers analyzed 15 randomized controlled trials involving patients with either formally diagnosed anxiety disorders or clinically raised anxiety on validated rating scales — a broader, more realistic mix of patients than seen in earlier reviews, and one that better reflects who actually walks into a GP’s office.
The findings were encouraging. Compared with a waiting-list control group, aerobic exercise produced a meaningful reduction in anxiety symptoms. Programs involving running, walking, or treadmill training — done at least twice a week for two weeks or more — consistently outperformed doing nothing at all.
Even more interesting: when researchers compared high-intensity exercise (at least 60% of maximum heart rate) to low-intensity activities like gentle walking or stretching, the higher-intensity workouts won out, producing a significantly greater drop in anxiety levels. And this wasn’t a fleeting effect — follow-up data suggested improvements were sustained for several months after the exercise program ended.
Interestingly, patients with a formal anxiety diagnosis benefited just as much as those with elevated anxiety who hadn’t received an official diagnosis, suggesting exercise is broadly useful across the anxiety spectrum, not just for the most severe cases.
Of course, the review had limitations: the number of available trials was small, blinding participants to treatment allocation is naturally difficult with exercise (you know if you’re exercising), and higher-intensity programs saw somewhat higher dropout rates, since some participants found them too strenuous.
The takeaway? Exercise isn’t a replacement for professional mental health care, but it deserves a real seat at the table alongside medication and therapy. For general practitioners, “exercise on prescription” schemes — especially ones that build toward higher intensity over time — represent a low-cost, low-side-effect option that’s also, per economic analyses, cost-effective for health systems.
If you’re managing anxiety and haven’t considered a structured exercise routine, this research suggests it might be worth the conversation with your doctor.
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Source: Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis. BMC Health Services Research, 18, 559. https://doi.org/10.1186/s12913-018-3313-5
About the Author
Stephanie Schabel, PMHNP-BC, is a board-certified Psychiatric Mental Health Nurse Practitioner at SKS Psychiatry specializing in functional and integrative psychiatry. She holds nursing degrees from Texas State University and Gonzaga University, and is a member of Psychiatry Redefined, one of the nation’s leading training programs in functional and integrative psychiatry. Stephanie’s approach combines evidence-based psychiatric care with root-cause, whole-person treatment for depression, anxiety, ADHD, and related conditions.
A Note on Medical Advice
This article summarizes published research for general informational purposes only. It is not medical advice and should not be used to diagnose, treat, or manage any mental health condition. Ketogenic diets can affect medication levels (including mood stabilizers and antipsychotics), blood sugar, and other aspects of health, and are not appropriate for everyone. If you or someone you know is considering dietary changes to help manage a mental health condition, please consult a physician, psychiatrist, or registered dietitian before making any changes.
