Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies


Objective: The objective of this selective EBM review is to determine whether or not “Does exercise decrease the level of anxiety in adults?”

Study Design: A systematic review of three randomized controlled trials (RCTs) that were peer reviewed and published between 2016 and 2020.

Data Sources: All articles were published in peer-reviewed journals. Two of the RCTs were researched using Pubmed and one RCT was found using Academic Search Premier, AMED. All studies were selected based on applicability to the clinical question presented in the objective, and if the researched outcomes were patient oriented.

Outcome Measured: A reduction in anxiety level was the outcome measured in all three studies. The outcomes were measured using three different scales: Hamilton Inventories for Anxiety (Ham-A), Anxiety-DASS-21 subscale, and Chinese Mandarin Version of the State-Trait Anxiety Inventory Form (CMSTAI-Y) scores.

Results: In the RCT lead by Plag et al., high intensity interval training (HIIT) and low intensity training (LIT) were statistically significant for anxiety reduction (p<0.01) when comparing the mean (standard deviation) Ham-A scores from baseline to post-test to follow-up. The effect size was large (F=65.56) and about double in HIIT compared to LIT. De Manincor et al. produced results that were not clinically significant in reducing anxiety when yoga was implemented for exercise. The study was found to have a p-value of .16, an adjusted mean difference (AMD) of - 1.91, and a confidence interval (CI) of -4.58 to .76. Ma et al. had a significant reduction in state anxiety (F=9.35, p=.000) and trait anxiety (F= 6.18, p= .003).

Conclusion: The evidence of this systematic review is inconclusive. Plag et al. and Ma et al. both yielded significant data (p-value <.01) supporting that their exercise interventions, six 20-minute HIIT sessions and a 6 week home-based exercise program respectively, helped reduce anxiety in adults. De Manincor et al. did not have significant data (p=.16) to prove that their exercise intervention, yoga, reduced anxiety levels. Future studies should be conducted to investigate other exercise alternatives and repeat studies with a larger treatment population.