Associations between physical activity intensity, frequency, and anxiety symptoms among South Korean adolescents: a...

Anxiety symptoms are an important public-health concern among South Korean adolescents. Although physical activity (PA) may support adolescent mental health, its associations with anxiety may differ according to activity type, intensity, frequency, and sociodemographic characteristics. Clarifying these differences could provide more inclusive school- and community-based health promotion. This study examined associations between PA types/intensities and frequencies and anxiety symptoms, and whether these associations differed by gender, school level, and socioeconomic status (SES).

Using data from 54,653 adolescents in the 20th Korea Youth Risk Behavior Web-Based Survey, this study conducted a single-group structural equation modeling analysis to reveal the overall associations between types/intensities and frequencies of PA and anxiety symptoms. This study also conducted multi-group structural equation modeling analyses to test whether these associations differed across sociodemographic factors.

In the single-group SEM, all types/intensities of PA for 3 days or more per week were generally associated with lower anxiety compared to PA for 0-2 days (βs ranging from -0.021 to -0.057, p < 0.01). These patterns, however, varied significantly across sociodemographic factors, such as gender, school level, and socioeconomic status in the multi-group SEM. Specifically, vigorous PA was most consistently associated with lower anxiety across multiple subgroups, whereas muscle-strengthening activities were significantly protective primarily at high frequency (≥ 5 days/week) among high school students and low-SES adolescents. In contrast, moderate-to-vigorous PA for ≥ 5 days/week was unexpectedly associated with higher anxiety levels among females (β = 0.055, p = 0.033) and high-SES adolescents (β = 0.111, p = 0.011).

More frequent PA appeared to be associated with fewer anxiety symptoms, although the associations were small and varied across sociodemographic groups. Because high-frequency Moderate-to-vigorous PA was positively linked to anxiety in certain subgroups, PA promotion should consider activity type, volume, and sociodemographic contexts rather than assuming uniform benefits. Education and public-health authorities should consider expanding equitable access to enjoyable, age-appropriate PA within comprehensive adolescent mental-health strategies, with program evaluation sensitive to gender, school level, and SES. Longitudinal and intervention studies are needed before anxiety-specific activity-frequency recommendations can be established.