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Optimal Dose of Exercise for Generalized Anxiety Disorder (GAD) in Aging Adults (2024 Study)

Generalized Anxiety Disorder (GAD), a prevalent condition among older adults, may be significantly influenced by physical activity levels.

Recent research from The Irish Longitudinal Study on Ageing (TILDA) provides groundbreaking insights into how even minimal physical activity can reduce the risk of GAD.


  • Minimal Dose for Maximum Benefit: Even low levels of moderate-to-vigorous physical activity (MVPA) significantly lower the odds of GAD in older adults.
  • Dose-Response Relationship: Increased physical activity correlates with a progressively lower risk of GAD.
  • Beyond WHO Guidelines: Benefits are observed at activity levels lower than the World Health Organization’s recommended guidelines.
  • A Holistic Approach: The study underscores the importance of integrating physical activity into mental health strategies for older adults.

Source: Psychiatry Research (2024)

Physical Activity (Exercise) for Generalized Anxiety & Worry (Overview)

The relationship between exercise and its benefits for patients with Generalized Anxiety Disorder (GAD) and worry is a growing area of interest in mental health research.

Preliminary Data on Exercise and GAD/Worry

  • Reduction in Anxiety Symptoms: Studies, including the Irish Longitudinal Study on Ageing (TILDA), have shown that regular physical activity can lead to a reduction in symptoms of GAD and worry. This is observed across various intensities of exercise, from light to vigorous.
  • Improved Stress Response: Exercise has been found to improve the body’s ability to handle stress. Regular physical activity can modify the body’s stress response system, potentially making individuals more resilient to stressors that trigger anxiety.
  • Enhanced Mood & Emotional Well-being: Physical activity can lead to the release of endorphins, known as ‘feel-good’ hormones, which can elevate mood and bring about a sense of well-being, counteracting feelings of anxiety and worry.

Mechanisms of Anxiolytic Action

The beneficial effects of exercise on anxiety are multifaceted, involving complex neurochemical, neurophysiological, and cognitive mechanisms.

Neurochemical Changes

  • Serotonin & Dopamine Release: Exercise boosts levels of serotonin and dopamine, neurotransmitters that are often implicated in mood disorders like anxiety and depression. Serotonin, known for its role in mood stabilization, can alleviate anxiety symptoms, while dopamine, associated with reward and motivation, can improve overall mood and well-being.
  • Endorphins & Endocannabinoids: Exercise leads to the release of endorphins, natural painkillers produced by the body, which create a sense of euphoria often referred to as the “runner’s high.” Similarly, it can increase the levels of endocannabinoids, which are compounds that can reduce pain and increase feelings of calm and well-being.

Neurogenesis & Brain Health

  • Hippocampal Neurogenesis: Regular physical activity is associated with the growth of new neurons in the hippocampus, a brain region vital for emotional regulation and response to stress. This neurogenesis is crucial as the hippocampus is often smaller in individuals with anxiety.
  • Brain-Derived Neurotrophic Factor (BDNF): Exercise increases the production of BDNF, a protein that supports the survival of existing neurons and encourages the growth of new neurons and synapses, crucial for learning, memory, and higher thinking.

Cognitive Benefits

  • Enhancement of Executive Functions: Physical activity has been shown to improve executive functions like attention, problem-solving, and decision-making. This enhancement can empower individuals with anxiety to better regulate their emotions and cope with stressors.
  • Memory Improvement: Exercise can enhance memory function, which is often affected by anxiety disorders. Improved memory can help in the retention and application of coping strategies learned in therapy.

Reduction in Muscle Tension

  • Muscular Relaxation: Exercise, especially activities like yoga and stretching, can directly reduce muscle tension, a physical symptom of anxiety. This relaxation of the muscles can convey a message to the brain to relax, triggering a body-wide relaxation response.
  • Improved Sleep Quality: Regular exercise can also contribute to better sleep, which is often disrupted in individuals with anxiety. Better sleep can lead to reduced muscle tension and overall stress levels.

Hormonal Regulation

  • Cortisol Levels: Exercise can regulate cortisol, the body’s stress hormone. While acute exercise can increase cortisol temporarily, regular physical activity can lead to better regulation and balance of cortisol throughout the day, reducing the overall stress load on the body.
  • Insulin Sensitivity: Improved insulin sensitivity through regular exercise can also have mood-regulating effects. Since insulin regulates blood sugar levels, its efficiency can affect mood and energy levels, which are critical in managing anxiety.

Irish Longitudinal Study on Aging: Physical Activity Dose for Generalized Anxiety Disorder & Worry (2024)

Herring et al. sought to determine the lowest dose of moderate-to-vigorous physical activity (MVPA) that could effectively reduce the incidence and odds of Generalized Anxiety Disorder (GAD) and worry symptoms in older adults.

The study sought to quantify the association between various doses of weekly accumulated MVPA and GAD/worry over a decade.

A secondary aim was to examine the potential dose-response relationship between physical activity levels exceeding minimal sufficiency and currently recommended guidelines for GAD and worry protection.


Design & Population

  • TILDA involved older adults (≥50 years) in Ireland, utilizing data from five waves (2009–2018).
  • Physical activity was measured using the International Physical Activity Questionnaire.
  • GAD and worry were assessed using the Penn State Worry Questionnaire-Abbreviated and the Composite International Diagnostic Interview.

Physical Activity Assessment

  • Activities were quantified in MET minutes per week (MET.min.week−1), with categorization into three traditional and five expanded doses.
  • The analysis included continuous MVPA doses and the categorized doses for precise evaluation.

Statistical Analysis

  • Utilized mixed-effects regression models with negative binomial link function for worry and random effect logistic regression models for GAD.
  • Adjustments were made for relevant covariates like age, sex, education, smoking status, and alcohol issues.


Associations between Physical Activity & GAD

  • Lower odds of GAD were observed with increasing physical activity doses, with significant reductions even below WHO recommended levels.
  • Doses of 1-<600, 600-<1,200, and ≥2,400 MET.min.week−1 were associated with 18%, 22%, and 31% lower odds of GAD, respectively.
  • Notably, a dose of 1-<200 MET.min.week−1 showed a 47% lower odds of GAD compared to inactivity.

Impact on Participants with Chronic Diseases: Among participants with chronic diseases, physical activity above recommended levels showed a more pronounced protective effect against GAD.

Associations with Worry Symptoms: High doses of physical activity were associated with a lower rate of worry symptoms.


  • Self-Reported Data: The reliance on self-reported physical activity and worry/GAD measures may lead to reporting biases.
  • Lack of Diversity: The study predominantly involved older adults in Ireland, which may limit the generalizability of the findings to other populations or age groups.
  • Longitudinal Design Challenges: The longitudinal nature of the study could introduce attrition biases and the possibility of changes in participants’ health status over time that might not be fully accounted for.
  • Causal Inferences: While the study reveals associations between physical activity and GAD/worry, causality cannot be definitively established due to the observational design.

What are METs & MET Minutes in Exercise?

When it comes to exercise, understanding terms like METs and MET minutes can help you better gauge your activity levels and achieve your fitness goals.

These terms are often used in health and fitness studies but can be perplexing for those not familiar with them.

What are METs?

MET stands for Metabolic Equivalent of Task. It’s a unit that measures the energy expenditure of a specific physical activity.

One MET is the rate of energy expenditure while at rest.

It’s roughly equivalent to the energy you spend sitting quietly, equivalent to about 1 calorie per kilogram of body weight per hour.

Different activities have different MET values. For example, sleeping has a MET value of 0.9, walking at a moderate pace has a MET value of 3-4, and running might be 7 or higher.

MET Values Scale (1 to 10)

  • 1 MET: Resting State: Sitting quietly, lying down, watching television.
  • 2 METs: Very Light Activity: Standing, light household tasks (dusting, folding clothes).
  • 3 METs: Light Activity: Walking at a slow pace, light gardening (weeding), playing a musical instrument.
  • 4 METs: Moderate Activity: Brisk walking, water aerobics, casual cycling, dancing.
  • 5 METs: Moderate to Somewhat Vigorous Activity: Hiking, low-impact aerobics, power yoga.
  • 6 METs: Vigorous Activity: Fast walking or jogging at 6 mph, biking at a moderate speed, skiing.
  • 7 METs: More Vigorous Activity: Jogging, swimming laps at a moderate pace, playing tennis singles.
  • 8 METs: High-Intensity Activity: Running at a moderate pace, circuit training, soccer.
  • 9 METs: Very High-Intensity Activity: Running at a brisk pace, high-intensity interval training (HIIT), jump rope.
  • 10 METs & Above: Extremely High-Intensity Activity: Sprinting, competitive cycling, uphill running, fast swimming.

What are MET Minutes?

MET minutes combine the MET value of an activity with the time you spend doing it.

For instance, if you engage in an activity that is 3 METs (like moderate walking) for 30 minutes, you would calculate the MET minutes as: 3 METs x 30 minutes = 90 MET minutes.

This calculation helps quantify the total amount of energy expended during an activity.

What is MET.min.week? (Weekly Physical Activity Measurement)

MET.min.week refers to the total MET minutes accumulated over a week.

Say you do that same 3 MET activity (moderate walking) for 30 minutes, three times a week.

Your weekly MET minutes would be: 90 MET minutes x 3 days = 270 MET.min.week.

This measure gives an overview of your weekly physical activity level.

Practical Application: How to Use These Metrics

Setting Goals: Understanding METs can help you set realistic and specific exercise goals. For example, aiming for a certain number of MET minutes per week can guide your activity levels.

Mixing Activities: You can mix different activities with various MET values to reach your weekly MET minute goal. This adds variety and can make exercise more enjoyable.

Tracking Progress: By calculating your MET minutes, you can track your progress over time. This can be especially motivating if you’re working towards increasing your activity levels.

Real-World Example

Suppose you want to achieve 200 MET minutes per week.

You could do brisk walking (4 METs) for 30 minutes on five days of the week: 4 METs x 30 minutes x 5 days = 600 MET minutes per week.

Alternatively, you could combine activities like brisk walking, gardening, and yoga within a week to reach the desired MET minutes.

Details of Results from TILDA Study & Exercise for Anxiety in Adults (2024)

The TILDA study’s findings provide a nuanced understanding of how moderate-to-vigorous physical activity (MVPA) influences the risk of Generalized Anxiety Disorder (GAD) and worry among older adults.

1. Dose-Response Relationship Between MVPA & GAD

The study observed a clear dose-response relationship, indicating that higher doses of physical activity were associated with progressively lower odds of developing GAD.

Lower Doses (<600 MET.min.week−1)

  • Compared to no MVPA, engaging in low doses of physical activity (1-<600 MET.min.week−1) was associated with an 18% reduction in the odds of GAD.
  • This finding is particularly significant as it suggests that even activity levels below the commonly recommended thresholds can confer mental health benefits.

Moderate Doses (600-<1,200 MET.min.week−1): At moderate activity levels, which align more closely with WHO guidelines, there was a 22% reduction in the odds of GAD compared to inactivity.

High Doses (≥2,400 MET.min.week−1): Engaging in high doses of physical activity was linked to a 31% reduction in the odds of GAD, indicating a substantial protective effect.

2. Minimal Effective Dose for Reducing GAD Risk

The most striking finding was the identification of a minimal effective dose of physical activity for reducing GAD risk:

Minimal Dose (1-<200 MET.min.week−1)

  • The study found that even minimal doses of physical activity, as low as 1-<200 MET.min.week−1, were associated with a significant 47% reduction in the odds of GAD compared to no activity.
  • This level of activity is equivalent to about 10 minutes per day of moderate-intensity activity like brisk walking, five days a week.

3. Specific Findings for Participants with Chronic Diseases

  • Among those with chronic diseases, higher doses of physical activity were particularly effective in reducing GAD odds.
  • This suggests that physical activity may be an especially vital component of managing mental health in older adults with chronic conditions.

4. Impact of Physical Activity on Worry Symptoms

  • The high physical activity group (≥2,400 MET.min.week−1) showed significantly lower rates of worry symptoms compared to the low physical activity group, supporting the broader mental health benefits of physical activity.

What are some major takeaways from the results?

  • Incremental Benefits: The findings suggest incremental benefits with increased physical activity levels. Even small increases in physical activity can yield significant mental health improvements.
  • Relative Impact: The relative impact of physical activity was more pronounced in reducing GAD odds compared to worry symptoms, indicating a potentially stronger effect on more clinically significant anxiety presentations.
  • Comparison with WHO Guidelines: The results challenge current WHO physical activity guidelines for older adults by demonstrating significant benefits at lower activity levels, suggesting a potential need for guideline reevaluation.
  • Methodological Rigor: The longitudinal design and comprehensive statistical analysis enhance the reliability of these findings, although the observational nature limits causal inferences.

Physical Activity Recommendations for Aging Adults for Generalized Anxiety (Based on TILDA Study)

Based on the compelling findings of The Irish Longitudinal Study on Ageing (TILDA), specific recommendations can be formulated for physical activity in aging adults to address Generalized Anxiety Disorder (GAD) and worry.

These recommendations aim to provide a structured and practical approach for older individuals seeking to incorporate exercise into their daily routine for mental health benefits.

  • Start with Minimal Effective Dose: Older adults, especially those new to exercise or with limited physical capability, should start with the minimal effective dose identified in the study. This includes engaging in moderate-intensity activities equivalent to 1-<200 MET.min.week−1.
  • Gradual Increment in Activity Levels: Initially, aim for about 10 minutes per day of moderate-intensity activity, such as brisk walking, for five days a week. Gradually increase the duration and frequency as comfort and fitness levels improve.
  • Diversify Activities: Include a variety of activities to maintain engagement and cater to individual preferences. Options like swimming, cycling, light aerobics, and gentle yoga can be effective and enjoyable.
  • Incorporate Strength Training: Alongside aerobic activities, incorporate strength training exercises at least twice a week. This can include bodyweight exercises, resistance bands, or light weightlifting, focusing on major muscle groups.
  • Warm-Up & Cool-Down: Begin each session with a 5-10 minute warm-up (e.g., gentle walking, stretching) and end with a cool-down period to prevent injuries.
  • Monitor Intensity: Use the ‘talk test’ to gauge exercise intensity. One should be able to talk but not sing during moderate-intensity activities. Alternatively, aim for 50-70% of the maximum heart rate.
  • Stay Consistent & Patient: Consistency is key. Encourage regular activity each week and be patient with progress. Remember, the goal is to improve mental health, not just physical fitness.
  • Safety First: Older adults, especially those with chronic conditions, should consult healthcare providers before starting any new exercise regimen.
  • Social & Fun Activities: Incorporate social elements, like group exercises or walking with friends, to enhance enjoyment and adherence.
  • Track Progress & Adjust: Maintain a simple log of physical activities to track progress. Adjust the type, intensity, and duration of exercises based on health changes and fitness improvements.

Correlation vs. Causation in TILDA Study: Anxiety & Exercise

The findings from studies like the one exploring the relationship between MET (Metabolic Equivalent of Task) levels of physical activity and Generalized Anxiety Disorder (GAD) in aging adults are insightful.

However, it’s important to understand that exercise may not necessarily be causing lower GAD/worry – it could be just a correlation (e.g. people without GAD/worry aren’t afraid of being judged at the gym or something).

Correlation in the MET Study

  • Observational Nature: The MET study, like many others in the field, is observational. It identifies patterns and relationships between variables – in this case, physical activity levels (measured in METs) and the incidence or severity of GAD.
  • Established Link: The study successfully establishes a correlation, indicating that higher levels of physical activity (higher MET values) are associated with lower instances or severity of GAD in older adults.

Why Correlation is Not Causation

  • Lack of Controlled Variables: Unlike experimental studies, observational studies do not control for all potential confounding variables. This means other factors might influence both physical activity levels and GAD symptoms.
  • Directionality Issue: Correlational studies cannot definitively determine the direction of the relationship. While it may seem that increased physical activity reduces GAD symptoms, it’s also possible that individuals with lower GAD symptoms are more inclined to engage in physical activity.
  • Third-Party Variables: There might be external factors influencing both the independent variable (physical activity) and the dependent variable (GAD symptoms). For example, overall health status or lifestyle choices could affect both.

Implications for Interpretation and Application

  • Cautious Interpretation: While the correlation is significant and informative, clinicians, researchers, and individuals should interpret the findings with caution. They indicate a trend or relationship but do not prove that one variable causes changes in the other.
  • Guide for Further Research: These findings should be a stepping stone for further research. Controlled, experimental studies are needed to establish a cause-and-effect relationship definitively.

Takeaway: Dose of Physical Activity for Generalized Anxiety in Aging Adults

The Irish Longitudinal Study on Ageing (TILDA) presents groundbreaking insights into the relationship between physical activity and Generalized Anxiety Disorder (GAD) in older adults.

It highlights a dose-response relationship, revealing even minimal physical activity levels, specifically those below standard guidelines, can significantly reduce the odds of GAD.

Notably, activities equivalent to 1-<200 MET.min.week−1, a relatively low intensity, were linked to a considerable decrease in GAD risk.

The study’s findings advocate for a reevaluation of current physical activity recommendations, especially for the aging population.

By illustrating the mental health benefits of achievable levels of physical activity, TILDA offers a promising perspective for integrating exercise into preventive and therapeutic strategies for GAD.

It underscores the importance of personalized and moderate exercise regimens for enhancing mental well-being in older adults.


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