Association Between Physical Activity and Anxiety in A Rural Chinese Middle-Aged and Older Cohort

Background: As China’s population ages, the burden of anxiety is increasing. Physical activity (PA) is a cost-effective lifestyle factor, but its associations with mental health differ by domain and volume. Methods: This cross-sectional study included 4394 rural middle-aged and older adults (mean age 56.67± 8.73 years) from the Yangzhou Upper Gastrointestinal Disease Screening Cohort. PA was assessed using a questionnaire based on the International Physical Activity Questionnaire (IPAQ), and anxiety was measured with the 7-item Generalized Anxiety Disorder Scale (GAD-7). Logistic regression and restricted cubic spline (RCS) models were used to examine associations and nonlinear patterns. Sensitivity analyses assessed robustness. Results: Domain-specific associations with anxiety were observed. After confounder adjustment, each 1-SD increase in total physical activity (TPA) and occupational physical activity (OPA) was associated with 22% higher odds of anxiety (both OR=1.22, 95% CI: 1.11– 1.34, P< 0.001). Household physical activity (HPA) showed a marginally positive association (OR=1.10, 95% CI: 1.00– 1.21, P=0.050), whereas leisure-time physical activity (LTPA) was inversely associated (OR=0.88, 95% CI: 0.80– 0.96, P=0.004). RCS analysis further revealed reverse L-shaped dose-response relationships for TPA and OPA, with inflection points at 7098.72 and 4200.11 MET-min/week, respectively. Conclusion: We found that the relationship between PA and anxiety was domain-specific. OPA was positively associated with anxiety above a certain threshold, whereas LTPA was inversely associated. HPA showed only a weak positive association. Public health strategies should distinguish between activity domains and population characteristics, and implement targeted interventions for anxiety.