The effect of meeting Canada's 24-hour movement guidelines on the severity of symptoms of generalized anxiety disorder: A target trial emulation from a longitudinal study.

BACKGROUND

While individual movement behaviours (i.e., physical activity (PA), sedentary behaviour (SB), and sleep) are linked to anxiety, the effect of adhering to integrated 24-h movement recommendations remains unclear. This study estimated the causal effect of meeting the Canadian 24-Hour Movement Guidelines on generalized anxiety symptoms among young adults.

METHODS

Data were drawn from 692 participants (mean age 34; 58% female) from a Canadian longitudinal observational study. Participants self-reported PA, SB, sleep, and completed the Generalized Anxiety Disorder-7 (GAD-7) scale (score range: 0-21). Guidelines were defined as: ≥150 min/week of moderate-to-vigorous PA; ≤7 h/day of self-reported sitting time including ≤3 h/day of leisure screen time; and 7-9 h of sleep/night. The target trial framework was used to emulate four hypothetical trials, and targeted maximum likelihood estimation was used to evaluate the effect of meeting PA, SB, sleep, and all three recommendations, on GAD-7 scores after 1.5 years of follow-up.

RESULTS

Meeting the SB recommendation reduced GAD-7 scores by 0.73 points (95% confidence interval: -1.41, -0.05). In contrast, meeting the PA recommendation resulted in a change in GAD-7 scores very close to zero with wide 95% confidence intervals, while meeting the sleep recommendation and all three recommendations did not demonstrate a statistically significant change.

CONCLUSION

The observed small decrease in GAD-7 scores associated with meeting the SB recommendation is meaningful at a population level. These findings may help refocus Canada's 24-Hour Movement Guidelines to inform population-level strategies to address anxiety in young adults.