This review aims to explore the efficacy of exercise in the treatment of anxiety disorders and its underlying mechanisms, summarizing recent research advances and focusing on the potential biological and psychological pathways through which exercise exerts its anxiolytic effects.

To ensure comprehensive coverage of relevant studies, we conducted a systematic search in databases such as PubMed, Web of Science, and Embase, combining MeSH terms with free-text terms. Keywords included “exercise,” “physical activity,” and “anxiety disorder.”

Current research widely supports exercise as a safe and effective intervention for anxiety. Both aerobic exercise and resistance training have shown significant anxiety-reducing effects across various populations. The mechanisms of action can be categorized into three main types: cellular and molecular mechanisms, systemic immune effects, and behavioral and cognitive pathways. Different forms of exercise have distinct advantages: aerobic exercise is suitable for the general population, resistance training is beneficial for individuals with coexisting physical conditions, and low-intensity exercises such as yoga and Tai Chi are suitable for pregnant women, the elderly, or postoperative recovery patients. Given its good safety profile and broad applicability, moderate exercise should be considered a first-line treatment for mild anxiety and an adjunctive intervention for moderate to severe anxiety. Future research should further clarify the mechanistic differences between various exercise modalities and promote the development of individualized exercise prescriptions.