# Exercise as it relates to Disease/Resistance training as a treatment for anxiety symptoms in young adults
## Background to Research

Living in the current society of ever present social media invasion and constant news attraction towards mental health, it is hard not to notice the increasing presence of anxiety in our young population. The COVID-19 pandemic has exacerbated this epidemic, increasing rates of anxiety and depression around the world. Treatment of anxiety after the onset of a disorder can involve many different aspects including pharmaceutical or psychiatric treatment. It has been shown in a 2010 meta-analysis that aerobic exercise can reduce anxiety symptoms, but little is known about the effect of resistance exercises. Any opportunity to help reduce anxiety and depression in our society should be explored thoroughly, especially in the time of a mental health crisis.
Prevention of disease can be the most important aspect of maintaining a person's wellbeing, and being able to prevent mental health issues before they begin could save over 3,000 Australian lives per year.

## Where is the research from?

This randomised control trial was conducted at the University of Limerick in Limerick, Ireland by Brett R. Gordon, Cillian P. McDowell, Mark Lyons & Matthew P. Herring and published in Scientific Reports in 2020. All of the authors have many published articles regarding to exercise and its relationship to health. The research was funded by the Irish Research Council through the Government of Ireland post graduate and post doctorate programmes.

## What kind of research is this?

This is a randomised control trial aimed to find a relationship between anxiety and resistance training exercise in young people who are not considered to have an anxiety disorder.

## What did the research involve?

This trial involved 44 young adults who were randomised into a wait-list (control) or a resistance training program. The program was designed in accordance to World Health Organisation and American College of Sports Medicine guidelines and lasted eight weeks after a three week familiarisation period. The program involved barbell squat, barbell bench press, hexagon bar deadlift, seated dumbbell shoulder lateral raise, barbell bent over rows, dumbbell lunges, seated dumbbell curls, and abdominal crunches and gradually increased in intensity. The research was designed not for individuals with pre-existing anxiety disorders, but for individuals at risk of developing anxiety disorders in the future. The median onset age for generalised anxiety disorder is 30 years, and as such the program recruited young adults.

## What were the basic results?

| Outcome | Group | Baseline | Week 1 | SMD | Hedges’ d | Week 4 | SMD | Hedges’ d | Week 8 | SMD | Hedges’ d |
| Anxiety Symptoms (STAI-Y2) | RET | 39.9 (7.9) | 36.3 (10.6) | − 0.45 | 0.51 (− 0.25 to 1.28) | 36.2 (10.5) | − 0.46 | − 0.35 (− 0.41 to 1.11) | 31.8 (8.0) | 1.03 | 0.85 (0.06 to 1.63) |
| Anxiety Symptoms (STAI-Y2) | WL | 36.7 (9.1) | 37.6 (8.6) | 0.10 | 0.51 (− 0.25 to 1.28) | 36.2 (9.8) | − 0.06 | − 0.35 (− 0.41 to 1.11) | 36.0 (9.5) | − 0.08 | |
As seen in the above table, the resistance exercise training group (RET) has a significant (Hedges' d 0.85) decrease in anxiety symptoms from week one to week eight. This result is not present for the wait list group (WL). Changes in strength were not significantly associated with changes in anxiety,

## What conclusions can we take from this research?

This study shows that resistance exercise training can be an effective way to reduce anxiety in people at risk of developing anxiety disorders later in life. The fact that strength changes were not associated with changes in anxiety levels suggest that sham exercises could produce a placebo effect that will still reduce anxiety. It is therefore the action of doing resistance training that reduces anxiety rather than the increase in muscular strength. Future studies should explore this effect in different population groups such as older individuals or in groups separated by sex to further develop knowledge of the capability of resistance training in the mind.

## Practical advice

People who have experienced childhood trauma are at a very high risk of developing anxiety disorders. It is imperative that when these individuals are identified, they are supported through a variety of ways to reduce their risk of developing anxiety disorders and a resistance training exercise program should be introduced to them. People at high stress due to work or other daily stresses are also considered high risk. This stress can be self diagnosed and therefore public health measures outlining the positive outcomes of resistance training should be introduced. Aerobic exercise has also been shown to reduce anxiety in the same population, however it produced a lesser change. Therefore, as is consistent with the WHO guidelines for physical activity, individuals' weekly exercise should include whole-body muscle strengthening exercises on two days of the week. Education in schools should also engage the students in resistance exercises that involve minimal equipment to allow the individuals to practice these exercises at home.

## Further information/resources

https://www.blackdoginstitute.org.au
https://www.betterhealth.vic.gov.au/health/healthyliving/resistance-training-health-benefits
https://www.nytimes.com/2020/11/04/well/mind/anxiety-stress-weight-training-lifting-resistance.html

## References

* ↑ Moghanibashi-Mansourieh A. Assessing the anxiety level of Iranian general population during COVID-19 outbreak. Asian Journal of Psychiatry [Internet]. 2020 [cited 14 September 2021];51:102076. Available from: https://www.sciencedirect.com/science/article/pii/S1876201820301878?via%3Dihub
* ↑ Treatments for Anxiety Disorders - Black Dog Institute [Internet]. Black Dog Website. 2021 [cited 16 September 2021]. Available from: https://www.blackdoginstitute.org.au/resources-support/anxiety/treatment/
* 1 2 6. Conn V. Anxiety Outcomes After Physical Activity Interventions. Nursing Research [Internet]. 2010 [cited 15 September 2021];59(3):224-231. Available from: https://pubmed.ncbi.nlm.nih.gov/20410849/
* ↑ 3. PARRY T. The effectiveness of early intervention: A critical review. Journal of Paediatrics and Child Health [Internet]. 1992 [cited 14 September 2021];28(5):343-346. Available from: https://pubmed.ncbi.nlm.nih.gov/1382490/
* ↑ Deaths by suicide over time - Australian Institute of Health and Welfare [Internet]. Australian Institute of Health and Welfare. 2021 [cited 15 September 2021]. Available from: https://www.aihw.gov.au/suicide-self-harm-monitoring/data/deaths-by-suicide-in-australia/suicide-deaths-over-time
* ↑ Gordon BR - Search Results - PubMed [Internet]. PubMed. 2021 [cited 16 September 2021]. Available from: https://pubmed.ncbi.nlm.nih.gov/?sort=date&term=Gordon+BR&cauthor_id=33067493
* ↑ Herring MP - Search Results - PubMed [Internet]. PubMed. 2021 [cited 16 September 2021]. Available from: https://pubmed.ncbi.nlm.nih.gov/?sort=date&term=Herring+MP&cauthor_id=33067493
* ↑ Lyons M - Search Results - PubMed [Internet]. PubMed. 2021 [cited 16 September 2021]. Available from: https://pubmed.ncbi.nlm.nih.gov/?sort=date&term=Lyons+M&cauthor_id=33067493
* ↑ McDowell CP - Search Results - PubMed [Internet]. PubMed. 2021 [cited 16 September 2021]. Available from: https://pubmed.ncbi.nlm.nih.gov/?sort=date&term=McDowell+CP&cauthor_id=33067493
* ↑ Epidemiology of anxiety disorders in the 21st century. Anxiety [Internet]. 2015 [cited 14 September 2021];17(3):327-335. Available from: https://pubmed.ncbi.nlm.nih.gov/26487813/
* 1 2 Anxiety disorders - Symptoms and causes [Internet]. Mayo Clinic. 2018 [cited 15 September 2021]. Available from: https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
* ↑ Physical activity [Internet]. Who.int. 2021 [cited 16 September 2021]. Available from: https://www.who.int/news-room/fact-sheets/detail/physical-activity