1Department of Family Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
2Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Korea
3Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
4Department of Medical Education, Pusan National University School of Medicine, Yangsan, Korea
5Family Medicine Clinic, Obesity, Metabolism and Nutrition Center and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
*Corresponding Author: Gyu Lee Kim Tel: +82-51-240-7834, Fax: +82-51-240-7843, E-mail: happygaru@pnuh.co.kr
• Received: August 30, 2024 • Revised: January 9, 2025 • Accepted: February 21, 2025
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Physical inactivity and sedentary behavior influence the prevalence of anxiety disorders. However, there is a lack of research on how these factors affect Korean adults. Therefore, we conducted a large-scale cohort study to investigate the association of physical activity and sedentary behavior with the development of anxiety disorders.
Methods
This cross-sectional study included 5,615 Korean adults aged 19 years and over. This study analyzed data from the Korea National Health and Nutrition Examination Survey VIII (2021). Participants were divided into three groups based on sedentary time (minute per day), and anxiety levels were compared using the Generalized Anxiety Disorder Scale.
Results
The odds ratio (OR) for severe generalized anxiety disorder was higher in the longer sedentary time group (≥480 & <660 minutes and ≥660 minutes) than in the lowest sedentary time group (<480 minutes) (≥480 & <660 minutes: OR, 1.004; 95% confidence interval [CI], 0.463–2.178; ≥660 minutes: OR, 2.233; 95% CI, 1.385–3.599; P=0.001). After adjusting for confounding factors, these correlations remained consistent and statistically significant. Furthermore, subgroup analysis revealed that middle-aged adults, women, high school graduates, individuals living with housemates, and employed individuals had a stronger association with severe anxiety as sitting time increased.
Conclusion
Sitting for more than 11 hours a day is a significant risk factor for the development of severe anxiety. Incorporating regular walking into daily routines and reducing sedentary behaviors could alleviate anxiety in Korean adults.
Anxiety disorders are a group of mental illnesses characterized by abnormal and pathological anxiety that interferes with activities of daily living. Anxiety has been defined as normal response. However, when it exceeds a certain threshold, it leads to mental distress and physical symptoms. The sympathetic nervous system becomes excited, causing somatization symptoms, such as headaches, increased heart and respiratory rates, gastrointestinal issues, and difficulty in performing daily activities at home, work, and school [1].
The prevalence of anxiety disorders varies according to country, with higher lifetime prevalence rates in high-income countries than in middle- or low-income countries [2]. In South Korea, a country that has experienced rapid socioeconomic development, the prevalence of anxiety disorders has gradually increased [3]. According to a study conducted in 2021, approximately 1.7% of South Korean adults reported experiencing generalized anxiety disorders (GAD) [4]. Anxiety disorders encompass a range of conditions; GAD is specifically characterized by persistent, uncontrollable worry and anxiety lasting for more than 6 months [5].
Anxiety disorders are the most common mental illnesses globally and contribute significantly to the global burden of disease [6]. They are commonly treated with benzodiazepines, antidepressants such as selective serotonin reuptake inhibitors, and selective serotonin norepinephrine reuptake inhibitors, either alone or in combination with cognitive behavioral therapy (CBT) [7]. Additionally, exercise has been proven effective for anxiety disorders, either as a primary treatment or in conjunction with CBT or medication [8].
Extensive evidence has indicated that a sedentary lifestyle is associated with an increased risk of anxiety [9]. Increased sedentary time may contribute to higher anxiety levels, which in turn are also known to result in greater sedentary behavior [10]. Studies have emphasized the importance of reducing sedentary time, as excessive sedentary behavior is associated with adverse mental health outcomes independent of decreased physical activity [11]. These studies suggest a complex and interactive relationship between physical inactivity and anxiety disorders.
Although several studies have examined the link between sedentary behavior and anxiety disorders in adolescents [12-16], there is a relative lack of research on this topic in adults. Therefore, this study aimed to examine the effects of sedentary behavior and physical activity on anxiety in adults, using data from the 2021 Korea National Health and Nutrition Examination Survey (KNHANES). The findings of this study are expected to contribute to the development of effective interventions for the management and prevention of anxiety disorders in Korean adults.
Methods
Study design and data collection
This cross-sectional study investigated the relationship between sedentary time and GAD among Korean adults. Data were collected from the KNHANES VIII (2021). The study protocol was reviewed and approved by the Institutional Review Board (IRB) of Pusan National University Hospital (IRB no., 2509-010-154). The participants were 5,615 Korean adults who consented to participate in the survey. The included participants were adults aged 19 years and older who completed the questionnaire and provided necessary health information.
Data were collected using a structured questionnaire with sections on demographic information, sedentary time, physical activity, and anxiety levels. The demographic section collected data regarding age, sex, education level, socioeconomic factors, smoking and drinking status, existing psychological issues, underlying medical conditions, and physical activity levels.
Independent variables
The independent variables were physical activities and sedentary time. Physical activities included activities during work, leisure time, and walking [17]. Physical activity was assessed based on participants’ responses to the activities they engaged in during a typical week. High-intensity activity refers to vigorous exercise that causes significant breathlessness or a very high heart rate. Moderate-intensity activity refers to activities that cause slight breathlessness or mildly increased heart rate. High-intensity work activities include lifting or carrying heavy objects, ground digging, labor at construction sites, and carrying heavy items upstairs. Moderate-intensity work activities included walking fast, carrying light objects, cleaning, and childcare activities. High-intensity leisure activities included running, rope jumping, biking, basketball, swimming, and badminton. Moderate-intensity leisure activities included fast walking, jogging, weight training, golf, dancing, and Pilates. Walking time was calculated based on the number of days in the past week when the participant walked for at least 10 minutes at a time multiplied by the total walking time on those days.
Sedentary time refers to time spent sitting or lying down, excluding sleep. It includes activities such as sitting at a desk; sitting with friends; traveling by car, bus, or train; reading; writing; playing cards; watching TV; playing games; using the Internet; and listening to music. The participants reported the average daily hours spent on these activities. Sedentary time per day was categorized into three groups: <8 hours, 8–11 hours, and >11 hours [18,19].
Dependent variable
The dependent variable was likelihood of developing GAD. This was measured using the Generalized Anxiety Disorder Scale (GAD-7), a validated self-report questionnaire [20]. Participants rated the frequency of each of the seven anxiety symptoms over the past 2 weeks on a scale from 0 (not at all) to 3 (nearly every day). The total score ranged from 0 to 21. Anxiety levels were categorized as follows: mild anxiety is defined as a score of 5 to 9 points, moderate anxiety as a score of 10 to 14 points, and severe anxiety as a score of 15 to 21 points.
Confounding variables
Potential confounding variables were identified and controlled in the analysis. Participants with preexisting mental health issues [21], such as depression, stress levels, suicidal thoughts, and sleep problems, as well as underlying diseases including type two diabetes [22], dyslipidemia [23], hypertension [24], and coronary artery disease [25], were included.
Individuals currently undergoing treatment for depression were considered to have depressive symptoms. Perceived stress levels were assessed via survey using the categories: “very much,” “often,” “a little,” and “not at all.” Participants were asked whether they had experienced suicidal thoughts in the past year with a binary “yes” or “no” response. Sleep quality was evaluated based on difficulties experienced over the past week and categorized as “not at all,” “slightly,” “moderately,” or “severely.” Underlying health conditions were identified based on the participants’ history of treatment for chronic diseases.
Statistical analysis
To enhance the representativeness of the sample and the accuracy of the estimates, a complex sampling design was adopted. Weighting, stratification, and clustering techniques were used for analysis.
In the general characteristics section, chi-square test was conducted to present the population number and percentages for each category. A general linear model was used to examine the association between physical activity and GAD-7 scores. Data were presented as mean values with standard error (SE). Finally, logistic regression analysis was performed to evaluate the association between anxiety levels and sitting time, while controlling for confounding variables. A subgroup analysis was also conducted. Odds ratios (OR) with 95% confidence intervals (95% CI) were presented as the effect size. All statistical analyses were performed using the IBM SPSS ver. 25.0 (IBM Corp.). P-values were calculated using Pearson test. For all analyses, the level of significance was set at a P-value of less than 0.05.
Results
Characteristics of the participants
Table 1 lists various characteristics of the general population and their associations with anxiety levels. The distribution of number and percentages for each category based on GAD-7 scores is presented. For the physical activity category, the average time was presented along with the SE.
For individuals with normal GAD-7 scores, the mean age was 45.17 years, which gradually increased with the severity of anxiety (P<0.001). Similarly, the proportion of women increased progressively as the severity of GAD increased (P<0.001). The groups defined according to anxiety levels showed significant differences in proportions based on educational attainment (P=0.009). The highest proportions of individuals were observed in the following order: university graduates or above, high school graduates, elementary school education or less, and middle school graduates. The proportion of individuals living alone increased with GAD severity (P=0.023), whereas employment rates showed a marked decline (P=0.002).
All mental health factors showed statistically significant associations (P<0.001). The prevalence of depression increases sharply with the increasing severity of GAD. Among those with severe GAD, a significant majority (85.6%) reported experiencing stress, compared to only 29.7% in the normal group. Similarly, suicidal ideation increased sharply across the groups, and sleep disturbances became more prevalent with higher anxiety levels.
With regard to physical activity, moderate-intensity exercise showed no significant differences across anxiety levels. High-intensity physical activity showed a significant difference across the anxiety level groups (P<0.001), and no individuals engaged in high-intensity physical activity in the mild and severe GAD groups. Additionally, walking time was not significantly associated with GAD levels, whereas sedentary time showed a marked association (P=0.005).
Associations between physical activities and anxiety
Table 2 shows the associations between various types of physical activities, such as work-related activities, leisure activities, walking, and sitting times, and GAD-7 scores. The GAD-7 scores exhibited a significant difference based on the intensity of work-related physical activity (mean±SE: no activity, 2.042±0.673; moderate intensity, 2.611±0.719; high intensity, 2.361±0.674; P=0.033), whereas no significant difference was observed in leisure-related physical activity.
GAD-7 scores varied depending on the duration of time spent walking (mean±SE: <45 min/d, 2.254±0.161; ≥45 & <100 min/d, 1.883±0.162; ≥100 min/d, 2.069±0.149; P=0.009), with the lowest GAD-7 scores observed in those who walked for ≥45 & <100 minutes per day. Thus, there was a significant association between the walking time and anxiety scores, although the results did not demonstrate a linear decrease in anxiety as the walking time increased.
Lastly, GAD-7 scores showed a significant difference based on sitting time (mean±SE: <480 min/d, 1.916±0.113; ≥480 & <660 min/d, 2.089±0.139; ≥660 min/d, 2.322±0.105; P=0.002). The analysis revealed a pattern of increased GAD-7 scores with longer sitting time.
In Figure 1, the proportion of participants engaging in physical activity is compared between those with normal-to-moderate anxiety levels and those with severe anxiety levels. As shown in Figure 1A and B, the proportion of participants according to the intensity of work-related and leisure physical activity did not differ significantly between the severe anxiety group and the normal-to-moderate anxiety group. In Figure 1C, comparisons based on walking time also revealed no statistically significant differences. However, as shown in Figure 1D, a significant difference in percentages was observed based on sedentary time (P=0.009). The group with normal-to-moderate anxiety showed a distribution of 34.5% sitting for less than 8 hours, 34.6% for ≥8 & <11 hours, and 30.9% sitting for more than 11 hours per day. The severe anxiety group showed distributions of 26.7%, 25.1%, and 48.2%, respectively. Approximately 48% of individuals in the severe anxiety group reported sitting for more than 11 hours per day, indicating a notably high proportion.
Associations between sedentary time and level of anxiety
Table 3 shows the association between sitting time and anxiety levels. The analysis was conducted using four models, each adjusted for varying levels of potential confounders. Using sitting for less than 480 minutes per day as a reference, the ORs for mild or higher, moderate or higher, and severe anxiety were evaluated. The ORs for mild or higher (P=0.184) and moderate or higher (P=0.270) anxiety were not statistically significant. However, for severe anxiety, the OR increased with longer sitting time when no other variables were adjusted. In particular, sitting for more than 660 minutes per day resulted in a significantly higher risk of severe anxiety (OR, 2.233; 95% CI, 1.385–3.599; P=0.001). Even after adjusting for psychiatric factors (OR, 1.899; 95% CI, 1.045–3.451; P=0.040), underlying diseases (OR, 2.189; 95% CI, 1.364–3.511; P=0.001), and physical activity (OR, 2.162; 95% CI, 1.329–3.517; P=0.002), sitting for more than 660 minutes per day was significantly associated with severe anxiety across all models.
A subgroup analysis of severe anxiety based on sedentary time is presented in Table 4. The subgroups were defined according to age, sex, educational level, living alone or with others, and employment status. Age groups were classified as 19 to 34, 35 to 49, 50 to 64, and 65 years and above. Among these groups, the risk of severe anxiety increased significantly with longer sedentary time, especially when sitting for more than 660 minutes per day in adults aged 35–49 years (OR, 7.306; 95% CI, 2.243–23.796; P=0.002). In contrast, the OR for severe anxiety was not significantly different among other age groups. Additionally, when subgroup analysis was conducted according to sex, significant results were observed in women (OR, 2.408; 95% CI, 1.331–4.358; P=0.009), whereas no statistically significant results were found in men. Regarding education level, individuals with a high school diploma showed significant results (OR, 19.320; 95% CI, 4.488–83.171; P<0.001), whereas those with less or more education than high school did not show statistically significant results. Individuals living with other family members showed significant results (OR, 1.960; 95% CI, 1.140–3.368; P=0.023), whereas those living alone did not show statistically significant results. This indicates that the risk of severe anxiety increases with longer sedentary time for individuals living with others than for those living alone. The risk was also higher for those who were employed than for those who were unemployed (OR, 4.311; 95% CI, 1.705–10.896; P=0.005).
Discussion
Key findings and comparison with existing literature
This study demonstrates a strong and consistent association between prolonged sitting time and elevated anxiety levels, particularly severe anxiety. The progressive increase in the OR with longer sitting duration across all models underscores the potential role of sedentary behavior as a modifiable risk factor for anxiety. The persistence of significant associations even after adjusting for a wide range of mental, clinical, and physical health confounders suggests that the relationship between prolonged sitting and anxiety is not solely attributable to preexisting conditions, but may be independently influenced by sedentary behavior itself. In addition, these findings align with those of previous studies that reported a link between sedentary behavior and poor mental health outcomes, including an increased risk of anxiety and depression [26].
Several hypotheses have been proposed to explore the mechanisms through which a sedentary lifestyle affects mental health, especially the occurrence of anxiety. Prolonged sedentary behavior amplifies the activation of the body’s stress response system through elevated levels of cortisol and interleukin-6, both of which are strongly associated with anxiety. Furthermore, prolonged sitting can disrupt the balance of the autonomic nervous system, leading to excessive sympathetic nervous system activity, which manifests as physical symptoms such as increased heart rate and blood pressure. These physiological changes, coupled with potential structural and functional alterations in brain regions involved in emotion regulation, contribute to the development of anxiety and other mood disorders [27].
Relationship between physical activity and anxiety
Interestingly, although physical activity is widely recognized for its mental health benefits, this study found that its impact varied depending on the type of activity. Moderate-intensity work-related physical activity was found to be associated with elevated anxiety levels. These observations are consistent with the current literature, suggesting that occupational physical activity may be associated with adverse health outcomes, potentially due to the stressors and demands associated with work [28,29]. Conversely, engaging in high-intensity physical activity during leisure time was associated with lower GAD-7 scores compared to that when not engaging in physical activity or performing moderate-intensity activity, suggesting potential mental health benefits. However, these differences were not statistically significant. This result was expected because leisure-time physical activity is often voluntary and self-paced and is known to foster positive psychological outcomes [30]. Voluntary and enjoyable physical activity is more likely to reduce anxiety and improve overall mental health. In summary, the type of physical activity performed may influence mental health. These findings highlight the importance of distinguishing between occupational and leisure-time physical activities when evaluating their effect on mental health.
Additionally, the results revealed a complex relationship between walking duration and anxiety levels. Participants who walked for less than 45 minutes per day had a mean GAD-7 score of 2.245, which decreased to 1.883 for those who walked between 45 and 100 minutes per day. Nevertheless, for those walking >100 minutes per day, the mean GAD-7 score increased slightly to 2.069. Despite being statistically significant, this nonlinear association suggests that moderate walking may be beneficial for reducing anxiety, whereas very low and very high walking durations may not provide the same mental health benefits. This finding corresponds to the relationship often observed in physical activity research in which moderate levels of activity are associated with the greatest mental health benefits, whereas excessively low or high levels may not confer additional advantages. This highlights the importance of moderate-intensity physical activities, such as walking, as a key factor in reducing anxiety among people in modern society. In addition, encouraging small achievable exercise goals can help individuals improve their mental health. Furthermore, the slight increase in anxiety scores among those walking for more than 100 minutes could be indicative of underlying health conditions or stressors that compel individuals to engage in more prolonged walking, potentially as a means of managing these issues. Individuals who exercise more due to existing health issues or stress factors may experience anxiety levels that could offset or minimize the positive effects of physical activity.
Relationship between demographic factors and anxiety
Finally, we conducted a subgroup analysis to examine the association between sedentary behavior and severe anxiety, stratified according to demographic characteristics. Our findings highlight that prolonged sedentary time, exceeding 660 minutes per day, significantly exacerbates the risk of severe anxiety in specific subgroups. Middle-aged adults (35–49 years) are particularly susceptible to the anxiety-inducing effects of extended sedentary time. This age group experiences peak socioeconomic activity and is more likely to hold jobs involving prolonged sitting, which contributes to elevated stress levels. Consequently, they may be more susceptible to psychological fluctuations related to sedentary time than other age groups. High school graduates were more susceptible to the mental effects of prolonged sitting than individuals with other educational backgrounds. High school graduates often occupy middle management or field roles and balance responsibilities at work and home. This dual burden may increase anxiety levels during prolonged sitting. In contrast, individuals with higher education levels may benefit from greater job autonomy and access to stress management resources, whereas those with lower education levels may face fewer occupational pressures, making them less prone to anxiety. Furthermore, it can be observed that individuals living with other family members are more severely affected by prolonged sitting than those who live alone. For those living with others, interpersonal conflict, caregiving responsibilities, and financial burdens may increase stress during prolonged sedentary periods. Similarly, employed individuals may experience physical strain and fatigue in sedentary job environments, potentially triggering anxiety. Non-economically active individuals may encounter fewer workplace stressors, thus mitigating the negative impacts of prolonged sitting time.
Considering this, sitting for more than 11 hours per day significantly increased the risk of severe anxiety in certain groups. Thus, managing sedentary behaviors may help reduce anxiety levels in these groups. Further analysis is required to identify the factors that contribute to these outcomes.
Strengths and limitations
A major strength of this study is the large sample size of the Korean population, which enhances the generalizability of the findings. Additionally, this study analyzes anxiety in relation to sedentary behavior and various forms of physical activity, distinguishing it from previous studies on anxiety among Koreans. Moreover, a subgroup analysis was conducted to identify specific factors within the general characteristics that significantly increased the risk of severe anxiety with increased sedentary time.
However, this study had some limitations. The cross-sectional design limited causal inferences. While these associations are robust, it remains unclear whether prolonged sitting leads to anxiety or whether individuals with higher anxiety levels are more likely to engage in sedentary behavior. Therefore, a longitudinal study is necessary to assess the changes in anxiety levels after interventions targeting reduced sedentary time. In addition, the reliance on self-reported measures for both sedentary behavior and anxiety may introduce reporting bias. Objective measurements of physical activity and sedentary behavior using tools, such as accelerometers, are essential to validate these findings.
Conclusion
This study suggests that prolonged sitting significantly increases the risk of severe anxiety among Korean adults. Further research is required to assess whether interventions aimed at reducing sedentary time can effectively reduce anxiety. Additionally, for the subgroups showing a strong association between prolonged sitting and severe anxiety, further investigation into the contributing factors could aid in the management of anxiety in these populations.
Notes
Conflict of interest
No potential conflict of interest relevant to this article was reported.
Funding
None.
Data availability
The datasets generated and analyzed in the current study are available from the Korea National Health and Nutrition Examination Survey repository, accessible at https://knhanes.kdca.go.kr/.
Distribution of participants based on the anxiety levels. Values are presented as % on the bar chart. The chi-square test was used for the analysis. (A) Physical activity at work. (B) Physical activity during leisure. (C) Walking time. (D) Sedentary time.
Values are presented as number (%) or mean±standard error. Chi-square test and general linear model was used for the analysis. Dash indicates that no valid data were available.
CHD, coronary heart disease.
*P<0.05.
a)Annual family income (Korean won) was classified into three categories: low (2 million or less), intermediate (2 million–180 million), and high (180 million or more).
b)Drinking alcohol was classified into three groups: rare (not drinking at all in the past year or drinking less than once a month), sometimes (drinking 2–4 times/mo or 2–3 times/wk), and often (drinking ≥4/wk).
c)If someone is receiving treatment for depression, they are considered to have depressive symptoms.
d)People who regularly experience stress in their daily lives were included.
e)It was defined as experiencing difficulty sleeping during the past 1 week.
f)Intensity of physical activity refers to the level of physical activity performed both at work and during leisure time.
Table 2.
Associations between physical activities and the GAD-7 score
GAD-7 score is presented as mean±standard error. Associations were calculated using general linear model. Physical activity during work and leisure time over the past 1 week was indicated as either “yes” or “no.”
GAD-7, Generalized Anxiety Disorder Scale.
*P<0.05.
Table 3.
Associations between level of anxiety and sitting time
Values are presented as odds ratio (95% confidence interval). Associations were calculated using a logistic regression analysis. Model 1 was adjusted for no covariate. Model 2 was adjusted for psychiatric factors, including depression, stress level, suicidal thoughts, and sleeping problems. Model 3 was adjusted for underlying diseases such as diabetes, dyslipidemia, hypertension, and coronary artery disease. Model 4 was adjusted for the physical activity during work or leisure time and walking. Physical activity and walking were both calculated in minutes per day. Covariates were not added as the models advanced, and each model was analyzed independently.
Ref, reference.
*P<0.05.
Table 4.
Subgroup analysis of odds ratios for severe anxiety based on sedentary time
Values are presented as odds ratio (95% confidence interval). Associations were calculated using a logistic regression analysis.
Ref, reference.
*P<0.05.
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Association between sedentary time and anxiety in Korean adults: insights from the 2021 Korea National Health and Nutrition Examination Survey
Figure. 1. Distribution of participants based on the anxiety levels. Values are presented as % on the bar chart. The chi-square test was used for the analysis. (A) Physical activity at work. (B) Physical activity during leisure. (C) Walking time. (D) Sedentary time.
Graphical abstract
Figure. 1.
Graphical abstract
Association between sedentary time and anxiety in Korean adults: insights from the 2021 Korea National Health and Nutrition Examination Survey
Characteristic
GAD-7 score
P-value
Normal (n=4,749)
Mild (n=612)
Moderate (n=152)
Severe (n=102)
Demographic
Age (y)
45.17±0.48
43.06±0.78
44.92±1.37
50.61±2.13
<0.001
Sex
<0.001
Male
2,567 (48.1)
216 (41.2)
51 (38.0)
26 (24.5)
Female
2,182 (51.9)
396 (58.8)
101 (62.0)
76 (75.5)
Educational level
0.009*
≤Elementary school
868 (12.3)
84 (8.2)
27 (10.7)
31 (19.5)
Middle school
462 (7.8)
47 (7.9)
10 (6.0)
16 (14.5)
High school
1,514 (37.4)
196 (34.1)
55 (37.9)
23 (27.6)
≥University
1,648 (42.5)
249 (49.7)
53 (45.4)
26 (38.4)
Annual family incomea)
0.301
Low
20 (0.4)
3 (0.4)
1 (1.0)
3 (2.0)
Intermediate
4,319 (97.5)
550 (97.4)
133 (94.3)
91 (95.7)
High
82 (2.2)
13 (2.2)
6 (4.6)
1 (2.3)
Living alone
773 (13.1)
93 (12.4)
36 (19.7)
30 (23.7)
0.023*
Employed
2,992 (66.1)
371 (62.3)
89 (59.2)
46 (45.1)
0.002*
Lifestyle factor
Smoking
0.120
Never
2,845 (56.2)
386 (60.2)
90 (54.6)
60 (59.5)
Former
1,172 (25.6)
124 (21.2)
26 (18.9)
21 (21.9)
Current
732 (18.1)
102 (18.6)
36 (26.5)
20 (18.6)
Alcoholb)
0.293
Rare
2,341 (53.4)
277 (48.9)
72 (46.2)
46 (56.3)
Sometimes
1,562 (40.4)
222 (43.4)
48 (44.4)
28 (36.1)
Often
263 (6.2)
47 (7.7)
14 (9.4)
6 (7.5)
Prevalent mental health
Depressionc)
48 (0.9)
32 (6.2)
16 (9.8)
21 (24.2)
<0.001
Stressd)
827 (18.4)
384 (63.2)
126 (85.0)
84 (85.6)
<0.001
Suicide ideation
99 (1.9)
73 (12.2)
39 (24.9)
40 (41.7)
<0.001
Sleep disturbancee)
417 (7.8)
163 (23.4)
68 (38.7)
65 (56.2)
<0.001
Underlying disease
Diabetes
547 (9.5)
53 (6.9)
21 (11.1)
17 (11.3)
0.212
Dyslipidemia
910 (15.5)
94 (11.4)
28 (14.1)
24 (17.4)
0.069
Hypertension
1,283 (20.7)
107 (13.3)
29 (13.4)
34 (23.8)
<0.001
CHD
123 (1.8)
14 (1.8)
1 (0.6)
7 (5.4)
0.072
Physical activity (min/d)
Moderate intensityf)
114.50±9.35
123.25±14.07
90.98±6.41
167.77±0.00
0.611
High intensityf)
82.99±0.00
-
217.90±0.00
-
<0.001
Walking
47.52±1.27
45.58±1.98
43.65±3.95
41.20±4.56
0.199
Sitting
541.56±7.14
544.55±9.41
536.18±20.36
606.33±19.87
0.005*
Physical activity
GAD-7
P-value
Work
0.033*
No
2.042±0.673
Moderate intensity
2.611±0.719
High intensity
2.361±0.674
Leisure
0.254
No
2.073±0.251
Moderate intensity
2.085±0.255
High intensity
1.671±0.229
Walking (min/d)
0.009*
<45
2.245±0.161
≥45 & <100
1.883±0.162
≥100
2.069±0.149
Sitting (min/d)
0.002*
<480
1.916±0.113
≥480 & <660
2.089±0.139
≥660
2.322±0.105
Model
Level of anxiety
Sitting (min/d)
P-value
<480
≥480 & <660
≥660
1
Mild or more
1 (Ref)
1.077 (0.854–1.357)
1.210 (0.985–1.486)
0.184
Moderate or more
1 (Ref)
1.027 (0.675–1.564)
1.287 (0.915–1.810)
0.270
Severe
1 (Ref)
1.004 (0.463–2.178)
2.233 (1.385–3.599)
0.001*
2
Mild or more
1 (Ref)
1.053 (0.809–1.369)
1.079 (0.841–1.384)
0.831
Moderate or more
1 (Ref)
0.970 (0.623–1.512)
1.093 (0.740–1.613)
0.830
Severe
1 (Ref)
0.922 (0.397–2.142)
1.899 (1.045–3.451)
0.040*
3
Mild or more
1 (Ref)
1.086 (0.862–1.369)
1.216 (0.990–1.493)
0.173
Moderate or more
1 (Ref)
1.025 (0.674–1.559)
1.281 (0.911–1.803)
0.279
Severe
1 (Ref)
0.986 (0.456–2.134)
2.189 (1.364–3.511)
0.001*
4
Mild or more
1 (Ref)
1.088 (0.864–1.370)
1.222 (0.992–1.506)
0.167
Moderate or more
1 (Ref)
1.060 (0.694–1.620)
1.327 (0.939–1.875)
0.226
Severe
1 (Ref)
1.013 (0.465–2.207)
2.162 (1.329–3.517)
0.002*
Variable
Sitting (min/d)
P-value
<480
≥480 & <660
≥660
Age (y)
19–34
1 (Ref)
0.772 (0.115–5.197)
1.226 (0.240–6.249)
0.798
35–49
1 (Ref)
2.153 (0.440–10.536)
7.306 (2.243–23.796)
0.002*
50–64
1 (Ref)
0.798 (0.239–2.661)
1.176 (0.318–4.351)
0.880
≥65
1 (Ref)
0.773 (0.271–2.204)
1.653 (0.657–4.157)
0.247
Sex
Male
1 (Ref)
0.471 (0.120–1.852)
1.941 (0.713–5.286)
0.083
Female
1 (Ref)
1.287 (0.526–3.148)
2.408 (1.331–4.358)
0.009*
Educational level
≤Elementary school
1 (Ref)
0.815 (0.276–2.407)
0.970 (0.379–2.481)
0.923
Middle school
1 (Ref)
0.764 (0.186–3.135)
2.714 (0.734–10.041)
0.180
High school
1 (Ref)
5.153 (0.844–31.460)
19.320 (4.488–83.171)
<0.001
≥University
1 (Ref)
0.839 (0.231–3.047)
1.413 (0.719–2.775)
0.432
Living
Alone
1 (Ref)
1.418 (0.377–5.330)
2.977 (1.032–8.585)
0.085
With others
1 (Ref)
0.916 (0.384–2.183)
1.960 (1.140–3.368)
0.023*
Employment
Employed
1 (Ref)
1.566 (0.511–4.803)
4.311 (1.705–10.896)
0.005*
Unemployed
1 (Ref)
0.669 (0.255–1.754)
1.144 (0.520–2.516)
0.489
Table 1. General characteristics of the study participants
Values are presented as number (%) or mean±standard error. Chi-square test and general linear model was used for the analysis. Dash indicates that no valid data were available.
CHD, coronary heart disease.
P<0.05.
Annual family income (Korean won) was classified into three categories: low (2 million or less), intermediate (2 million–180 million), and high (180 million or more).
Drinking alcohol was classified into three groups: rare (not drinking at all in the past year or drinking less than once a month), sometimes (drinking 2–4 times/mo or 2–3 times/wk), and often (drinking ≥4/wk).
If someone is receiving treatment for depression, they are considered to have depressive symptoms.
People who regularly experience stress in their daily lives were included.
It was defined as experiencing difficulty sleeping during the past 1 week.
Intensity of physical activity refers to the level of physical activity performed both at work and during leisure time.
Table 2. Associations between physical activities and the GAD-7 score
GAD-7 score is presented as mean±standard error. Associations were calculated using general linear model. Physical activity during work and leisure time over the past 1 week was indicated as either “yes” or “no.”
GAD-7, Generalized Anxiety Disorder Scale.
P<0.05.
Table 3. Associations between level of anxiety and sitting time
Values are presented as odds ratio (95% confidence interval). Associations were calculated using a logistic regression analysis. Model 1 was adjusted for no covariate. Model 2 was adjusted for psychiatric factors, including depression, stress level, suicidal thoughts, and sleeping problems. Model 3 was adjusted for underlying diseases such as diabetes, dyslipidemia, hypertension, and coronary artery disease. Model 4 was adjusted for the physical activity during work or leisure time and walking. Physical activity and walking were both calculated in minutes per day. Covariates were not added as the models advanced, and each model was analyzed independently.
Ref, reference.
P<0.05.
Table 4. Subgroup analysis of odds ratios for severe anxiety based on sedentary time
Values are presented as odds ratio (95% confidence interval). Associations were calculated using a logistic regression analysis.
, Gyu Lee Kim1*
