Exercise Therapy to Reduce Anxiety (ExTRA) in mid-life and later-life adults: pilot feasibility study

Anxiety is the most prevalent mental health condition, causing significant distress, disability and cost.

This pilot study assessed the feasibility and acceptability of an eight-week self-directed online exercise intervention, supported by wearable activity monitors (WAMs), for mid-life and later-life adults with clinically significant anxiety, and provided preliminary estimates of effectiveness.

The Exercise Therapy to Reduce Anxiety (ExTRA) project recruited 21 participants aged 40-77 years with Depression, Anxiety and Stress Scales (DASS-21) anxiety scores >7. The ExTRA online platform integrated with the WAMs, and provided information about anxiety, exercise programmes and strategies to help meet national physical activity guidelines, overcome barriers and set goals.

ExTRA was feasible, with a 63% recruitment rate and 100% retention rate. Overall, evaluation questionnaire responses demonstrated high acceptability. At week 8, WAM average steps/day increased by 1358 (p = 0.036, Hedge's g = -0.47), and fairly/very active minutes (3/6 metabolic equivalents) increased by 81.2 min/week (p = 0.024, g = -0.51), with moderate effect sizes. There was no statistically significant change on the self-report Global Physical Activity Questionnaire. The DASS-21 anxiety score reduction of 2.3 (p = 0.060, g = 0.42) from baseline to week 8 approached statistical significance. DASS-21 stress and depression scores were significantly reduced by 3.9 (p = 0.013, g = 0.57) and 3.7 (p = 0.02, g = 0.53), respectively, from baseline to week 8. There was no significant change in self-efficacy or dementia risk.

The ExTRA intervention is feasible and acceptable, with positive signals for increasing objectively measured physical activity and improving mental health. Findings support and inform the design of randomised controlled trials to assess efficacy of this potentially automated and scalable intervention.