A new study looked into athletes as they participated in a Swedish ultra-long cross-country skiing competition and their link to reduced risk of anxiety. Although former research has studied the association between depression and mental health with exercise, those studies did not specifically focus on anxiety disorders.
In this new study, researchers found that both male and female skiers experienced less risk of future anxiety disorders over time, as compared to the control group. In fact, what they saw was that the high-performing skiers were ‘more likely to develop anxiety disorders’ than the slower performing female skiers.
Notably, for the former studies – despite covering a larger group of people – often excluded women from the studies, while also not substantially exploring the long-term mental health effects that people gain from exercising. This new study looks at the way that intense exercise corresponds to lessening anxiety in both women and men over a longer period of time.
The Swedish study, which was published in Frontiers in Psychiatry, took data from at least 400,000 participants, both men and female, while following them for up to 21 years as they looked into how exercise has managed to benefit them in preventing anxiety disorders through time.
Cross-Country Race
In order to study a large group of participants that are considered to have ‘active lifestyles,’ the research team looked into participants of the world’s largest long-distance cross-country ski race called Vassaloppet, which is in Sweden through the years 1989 and 2010.
The 90-kilometer course, which is approximately 55.9-miles, is what the research team used as a basis of an active lifestyle.
When lead author of the study, Martina Svensson, spoke with Medical News Today (MNT), she explained “Previous studies have shown that this group of skiers are significantly more active in their leisure time and have a higher fitness level compared to the matched general population we use as control population.”
As for the control population, the study used participants who were considered ‘similar to the skiers in their region of residency and their age group and sex.’ But they did not include in the study those diagnosed with dementia or other types of severe diseases like heart disease or cancer. The research group also made sure that none of the study participants had psychiatric disorders, including those with anxiety disorders.
Although she was not a part of the study, Kristin Szuhany, Ph.D. from the Anxiety, Stress, and Prolonged Grief Programalso spoke about the study with MNT.
Her concerns were about to what degree the ‘participation in the race could serve as a proxy for an active lifestyle.’ She pointed out that “physical activity is not measured more broadly, which makes it difficult to say more generally that a physically active lifestyle contributed to the reduction in onset of anxiety disorders.”
She continued, “Additionally, there is no measure of the actual amount of physical activity the individuals participated in; therefore, it is challenging to make broader conclusions.”
How to Avoid Reverse Causation
In the study, the skiers were found to have a nearly 60% lower chance of developing anxiety disorder during the 21-year follow up period than those individuals that were part of the control group.
The researchers made sure to exclude participants that developed anxiety within the first 5 years of the race. Study author Svensson shared with MNT that they did this to “reduce the risk of bias due to reverse causation,” because certain individuals may have already had anxiety symptoms that kept them from doing physical activities like the ski race. She added, “Many other studies do not control for this.”
Finding a Connection Between Speed and Anxiety in Women
Interestingly, the research group did find a surprising correspondence between skiing speed and anxiety in women, but it was not the same for the men.
Svensson went on to say, “What surprised us the most was to discover how the physical performance in the ski race (finishing time among the skiers) impacted the risk of future anxiety differently in physically active men and women. We were surprised to see that physically high-performing women had almost a doubled risk of developing anxiety compared to lower-performing women.”
“However, the total risk of getting anxiety among these high-performing women was still lower compared to the more physically inactive women in the general population,” Svennson added.
She also shared, “So, it seems like both sexes benefit from being physically active, even though the optimal level may differ between men and women.”
Although for Dr. Szuhany, she shared her concerns over the validity of ‘using speed as a proxy for exercise intensity,’ saying “given that [it is] likely skiers are exerting effort in the moderate-to-vigorous intensity range regardless of their finishing time in this type of race.”
Needing Further Research
Svensson admitted to MNT that “Our results suggest that the relation between symptoms of anxiety and exercise behavior may not be linear.”
She also went on to say, “Exercise behaviors and anxiety symptoms are likely to be affected by genetics, psychological factors, and personality traits — confounders that were not possible to investigate in our cohort. Studies investigating the driving factors behind these differences between men and women when it comes to extreme exercise behaviors and how it affects the development of anxiety are needed.”
MNT also asked Dr. Szuhany – since she is a member of the Anxiety & Depression Association of America – if the organization actually makes recommendations to their patients when it comes to exercise and their anxiety disorder.
She told them, “At this point, there are no existing guidelines for the specific dose of exercise required to improve mental health symptoms. This is a very important topic for rigorous investigation. Meta-analyses and population-based studies have suggested a moderate effect overall of exercise on reducing anxiety symptoms.”
On the contrary though, Dr. Szuhany commented on the study’s concerns when it came to the female skiers, saying,“Some individual studies suggest that exercising at high intensity levels may be most beneficial [for] improving anxiety symptoms. One hypothesis is that exercise at higher intensity mimics sensations that are feared in those with anxiety (e.g., heart racing, shortness of breath, sweating) and may act as an exposure to get more comfortable in the context of these sensations.”
But on the other hand, Dr. Szuhany did agree with the study authors that, “many individuals who have anxiety will avoid exercise to avoid these physical sensations. Therefore, it may be important to study interventions to increase exercise engagement among individuals who are fearful of exercise-induced physical sensations.”
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