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

Purpose: 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.