Despite the availability of effective treatment strategies, including pharmacotherapy, psychotherapy, and combination therapy, the prevalence of anxiety continues to increase, especially in low-income and conflict-ridden countries, Vincent Wing-Hei Wong, a PhD student at The Chinese University of Hong Kong, and colleagues wrote.
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Previous studies have shown that lifestyle factors including diet, sleep, and sedentary behavior are involved in the development of anxiety symptoms, but the impact of lifestyle medicine (LM) as a treatment for anxiety has not been well studied, they wrote.
In a meta-analysis published in the Journal of Affective Disorders, the researchers identified 53 randomized, controlled trials with a total of 18,894 participants. Anxiety symptoms were measured using self-report questionnaires including the Hospital Anxiety and Depression Scale, the Depression Anxiety and Stress Scale, and the General Anxiety Disorder–7. Random-effects models were used to assess the effect of the intervention at immediate post treatment, short-term follow-up (1-3 months post treatment), medium follow-up (4-6 months), and long-term follow-up (7 months or more).
The studies included various combinations of LM intervention involving exercise, stress management, and sleep management. The interventions ranged from 1 month to 4 years, with an average duration of 6.3 months.
Overall, patients randomized to multicomponent LM interventions showed significantly improved symptoms compared to controls immediately after treatment and at short-term follow-up (P < .001 for both).
However, no significant differences were noted between the multicomponent LM intervention and control groups at medium-term follow-up, the researchers said. Only one study included data on long-term effects, so these effects were not evaluated in a meta-analysis, and more research is needed.
In a subgroup analysis, the effect was greatest for individuals with moderate anxiety symptoms at baseline (P < .05). “Our results could perhaps be explained by the occurrence of floor effect; those with higher baseline anxiety symptoms have greater room for improvement relative to those with fewer symptoms,” the researchers wrote.
The study findings were limited by several factors including the risk of overall bias and publication bias for the selected studies, as well as the limited degree of improvement because most patients had minimal anxiety symptoms at baseline, the researchers noted. Other limitations included the small number of studies for subgroup comparisons and the use of self-reports.
However, the results were strengthened by the use of broad search terms to capture multiple lifestyle determinants, and the diverse study populations and backgrounds from individuals in 19 countries.
The results support findings from previous studies, and support the value of multicomponent LM interventions for patients with anxiety in the short-term and immediately after treatment, the researchers emphasized.
“The LM approach, which leverages a range of universal lifestyle measures to manage anxiety and other common mental disorders such as depression, may be a viable solution to address the huge mental health burden through empowering individuals to practice self-management,” they concluded.
However, the researchers acknowledged the need for more randomized, controlled trials targeting patients with higher baseline anxiety levels or anxiety disorders, and using technology to improve treatment adherence.
The study received no outside funding. The researchers had no financial conflicts to disclose.