What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Depression and Anxiety (n=21298). Intervention: Resistance exercise vs. No aerobic or resistance exercise. Primary outcome: Moderate-to-severe depression (PHQ-9 ≥ 10) (OR 0.46, 95% CI 0.31-0.68, p=<0.001).

What question did this study set out to answer?

The study aims to compare the effectiveness of aerobic and resistance exercise on depression and anxiety in a large sample of Korean adults.

March 25, 2026Open Access

Comparative Associations of Aerobic Exercise and Resistance Exercise With Depression and Anxiety in Korean Adults: A Nationwide Propensity Score Matching Analysis

Q: What are the key findings of this study?

Resistance exercise was significantly associated with a 54% lower odds of moderate-to-severe depression (OR 0.46) compared to no aerobic or resistance exercise in Korean adults.

Q: What question did this study set out to answer?

The study aims to compare the effectiveness of aerobic and resistance exercise on depression and anxiety in a large sample of Korean adults.

Key Result

Resistance exercise was significantly associated with a 54% lower odds of moderate-to-severe depression (OR 0.46) compared to no aerobic or resistance exercise in Korean adults.

Key Points

The study aims to compare the effectiveness of aerobic and resistance exercise on depression and anxiety in a large sample of Korean adults.
Utilized data from the Korean National Health and Nutrition Examination Survey (KNHANES) with 21,298 participants for depression and 8,707 for anxiety.
Participants were categorized into four groups: total exercise, aerobic exercise, resistance exercise, non-exercise.
Applied propensity score matching to control for confounders like age and sex.
Conducted multivariate linear and logistic regression analyses to evaluate exercise effects on mental health outcomes.
Resistance exercise (RE) was associated with the lowest depression and anxiety scores compared to non-exercise participants.
Total exercise (TE) also showed positive effects on depression but was less effective than RE.
Aerobic exercise (AE) did not significantly affect depression or anxiety levels.
Stronger positive effects of RE were noted in women and older adults.

Study Design

Type

Cross-Sectional (n=21,298)

Structured PICO

Does resistance exercise, aerobic exercise, or their combination improve depression and anxiety scores in Korean adults compared to no exercise?

Population

21,298 Korean adults aged ≥ 19 years for depression analysis and 8,707 for anxiety analysis from the Korean National Health and Nutrition Examination Survey (KNHANES).

Intervention

Resistance exercise (RE) defined as moderate-to-high-intensity muscle-strengthening activities ≥2 days/week, aerobic exercise (AE) defined as ≥600 MET-min/week, and total exercise (TE) combining both.

Comparator

Non-AE-RE group (met neither aerobic nor resistance exercise criteria).

Outcome

Depression measured by Patient Health Questionnaire-9 (PHQ-9) and anxiety measured by Generalized Anxiety Disorder-7 (GAD-7).patient reported

Resistance exercise is more strongly associated with lower depression and anxiety levels than aerobic exercise in Korean adults, highlighting its potential value in mental health interventions.

Main Result

Effect estimate: OR 0.46 (95% CI 0.31-0.68)

Absolute Event Rate: 2.6% vs 6.1%

p-value: p=<0.001

Limitations

Cross-sectional design precludes any causal inference
Self-reported physical activity data introduces potential recall bias and misclassification
Unable to control for current or past treatment for depression or anxiety, including pharmacological interventions
Findings are specific to a single ethnic group, limiting generalizability to other populations

Abstract

Background: Depression and anxiety are psychiatric disorders that significantly affect patients' well-being, morbidity, and mortality.Aerobic exercise (AE) and resistance exercise (RE) have been proposed as interventions to alleviate depressive and anxiety symptoms; however, their comparative effectiveness remains unclear.This study compared the associations of AE, RE, and their combination (total exercise; TE) with depression and anxiety in a large representative sample of the Korean population.Methods: Data from the Korean National Health and Nutrition Examination Survey (KNHANES) were used to analyze 21,298 participants for depression (measured using the Patient Health Questionnaire-9) and 8,707 participants for anxiety (measured using the Generalized Anxiety Disorder-7).The participants were divided into four exercise groups: TE, AE, RE, and non-AE-RE.Propensity score based exact matching was applied using a 1:1:1:1 ratio across the four exercise groups to control for confounding factors such as age and sex.Multivariate linear and logistic regression analyses were conducted to evaluate the effects of each exercise type on depression and anxiety.Results: After propensity score matching, the RE group had the lowest depression ( = -0.534;95% CI, -0.765 to -0.303; P < 0.001) and anxiety ( = -0.459;95% CI, -0.808 to -0.110; P = 0.010) scores compared with the non-AE-RE group.The TE group also showed favorable associations with depression ( = -0.473;95% CI, -0.706 to -0.241; P < 0.001), although to a lesser extent than the RE group.AE was not significantly associated with either of the outcomes.Subgroup analyses indicated stronger associations of RE in women and older adults.Conclusion: RE was more strongly associated with lower depression and anxiety levels than AE, particularly in women and older adults.This study underscores the importance of incorporating resistance training into exercise prescriptions and public health interventions to enhance mental health outcomes.

Bookmark

View Full Paper