Comparative Efficacy of Exercise Interventions for Anxiety Disorders: A Bayesian Network Meta-Analysis

Jiahui Liu,1,* Hengchang Wang,2,* Yi Lan,1 Dian Yuan,1,3 Bin Du,4 Yifan Zhou,1 Weihao Zhang,1 Xiong-Wen Ke,1,5 Qingqing Jiang,2,6 Furong Wang,6,7 Shiyi Cao,2 Jian Sun1,3 1Wushu College, Wuhan Sports University, Wuhan, Hubei, People’s Republic of China; 2School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 3Northeast China Ethnic Traditional Sports Research Center, Wuhan Sports University, Wuhan, Hubei, People’s Republic of China; 4The School of Physical Education, Central China Normal University, Wuhan, Hubei, People’s Republic of China; 5Rochester Institute of Technology, Rochester, NY, USA; 6School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 7Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jian Sun, Wushu College, Wuhan Sports University, 461 Luoyu Road, Hongshan District, Wuhan, Hubei, People’s Republic of China, Email [email protected] Shiyi Cao, Email [email protected]: The objective of this study is to conduct a Bayesian multilevel network meta-analysis to compare the effectiveness of various exercise modalities on anxiety symptoms and to assess how exercise and individual characteristics moderate these effects.Methods: A comprehensive search of Web of Science, PubMed, Embase, and Cochrane databases identified randomized controlled trials (RCTs) on exercise and anxiety. Literature screening, data extraction, and analysis were conducted independently by two researchers. A Bayesian-based network meta-analysis was applied, and the Confidence in Network Meta-Analysis (CINeMA) tool assessed evidence quality.Results: Forty-five studies (97 groups, 2643 participants) were included. Compared to control groups, meditation (Hedges’ g = − 0.72, 95% CI: − 1.20 to − 0.24), yoga (Hedges’ g = − 0.59, 95% CI: − 0.93 to − 0.27), and tai chi/qigong (Hedges’ g = − 0.52, 95% CI: − 0.88 to − 0.17) had the strongest effects. Resistance training (Hedges’ g = − 0.40), aerobic exercise (Hedges’ g = − 0.40), and walking/jogging (Hedges’ g = − 0.39) were also effective. However, mixed aerobic exercise did not achieve statistical significance.Conclusion: Static, breath-focused exercises (eg, meditation, yoga, tai chi/qigong) and dynamic exercises (eg, resistance training, walking/jogging) may be effective interventions for anxiety reduction, with broad applicability across populations.Keywords: anxiety disorders, exercise, meta-analysis