General Hospital Psychiatry 49 (2017) 11–18

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General Hospital Psychiatry

journal homepage: www.elsevier.com/locate/genhospsych

Review article

Mental health consequences of exercise withdrawal: A systematic review T

a,⁎ a b
Ali A. Weinstein , Christine Koehmstedt , Willem J. Kop
a
Center for the Study of Chronic Illness and Disability, George Mason University, 4400 University Drive, Fairfax, VA 22030, United States
b
Medical and Clinical Psychology, Tilburg University, Netherlands

A R T I C L E I N F O A B S T R A C T

Keywords: Objective: A sedentary lifestyle has been associated with mental health disorders. Many medical conditions result
Exercise cessation in the cessation of exercise, which may increase the risk of developing mental health problems. The purpose of
Depressive symptomatology this article is to systematically review the literature examining the effects of exercise withdrawal on mental
Anxiety health.
Physical activity
Method: Literature was searched using PubMed, PsycINFO, and SPORTdiscus for studies that experimentally
Activity restriction
manipulated the withdrawal of exercise and included mental health as outcome measure.
Results: A total of 19 studies met inclusion criteria (total N = 689 with 385 individuals participating in an
exercise withdrawal condition). Exercise withdrawal consistently resulted in increases in depressive symptoms
and anxiety. Other mental health outcomes were investigated infrequently. Severe mental health issues requiring
clinical intervention after experimentally controlled exercise withdrawal was rare. Heterogeneity in methods
and outcomes was observed, especially in terms of the duration of exercise withdrawal (range 1 to 42 days,
median = 7 days), with stronger effects if exercise withdrawal exceeded 2 weeks.
Conclusion: Experimentally controlled exercise withdrawal has adverse consequences for mental health. These
observations in healthy individuals may help to understand the onset of mental health problems in response to
acute and chronic medical conditions associated with reduced physical activity. Future research is needed to
investigate potential mechanisms explaining the adverse mental health consequences of cessation of exercise
that will provide new targets for clinical interventions.

1. Introduction hospital activity confinement. As stated above, depression is associated

The mental health consequences of a sedentary lifestyle have been
well documented [1] with a sedentary lifestyle being related to in-
creased negative mood and clinical mental health disorders [2,3]. In
addition, the mood enhancing properties of engaging in exercise have
been investigated, especially the potential treatment benefits of exercise
for those with depression and anxiety [4–6]. A bi-directional connec-
tion between mental health and usual physical activity levels has been
documented [7,8]. The effect of the removal of exercise (experimental
exercise withdrawal/exercise cessation) on mental health has not been
systematically reviewed. Findings from these studies may help to elu-
cidate the pathways connecting physical activity and mental health
[9–14].
There are various voluntary (i.e., loss of motivation, fear of falling/
injury) and involuntary (i.e., injury, sickness) reasons for the cessation
of exercise [15]. It is important to understand how these interruptions
in activity can affect one's mental health status. Many patients are put
on forced activity restrictions, such as injury-related restrictions and in-
with reduced activity [16], but research has also shown that reduced
activity may result in depressive symptomatology [17,18]. Clinicians
need to understand the potential mental health consequences of the
cessation of exercise since depressive symptoms and anxiety may
complicate the index clinical condition (e.g., post-myocardial infarction
recovery, heart failure, stroke, chronic obstructive pulmonary disease,
rheumatic arthritis) as well as the effectiveness of the treatment [19].
The primary purpose of this article is to systematically review the
literature examining the impact of exercise deprivation/withdrawal on
mental health. This systematic review includes only experimentally
controlled studies where participants abstained from exercise for a
predetermined length of time. Mental health was defined broadly to
include any measure of mood, affect, clinical mental health sympto-
matology, and/or quality of life. A full review of all the relevant lit-
erature was conducted with outcomes and quality-related character-
istics of all included studies documented. A synthesis of the literature is
provided along with recommendations for future research.

⁎
Corresponding author at: 4400 University Drive, MSN 5B7, George Mason University, Fairfax, VA 22030, United States.
E-mail address: aweinst2@gmu.edu (A.A. Weinstein).

http://dx.doi.org/10.1016/j.genhosppsych.2017.06.001
Received 13 February 2017; Received in revised form 1 June 2017; Accepted 5 June 2017
0163-8343/ © 2017 Elsevier Inc. All rights reserved.
A.A. Weinstein et al.
Fig. 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format diagram describing systematic review procedure.
2. Methods
The systematic review was conducted in accordance with the
guidelines of the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) (see supplemental table S1 for the PRISMA
checklist). Articles were identified through both computer and manual
searches. Investigators developed search terms using keywords: (a)
words describing exercise withdrawal and (b) words describing mood/
mental health (Fig. 1). Supplemental table S2 shows a complete list of
search terms and keywords that were used. To identify potential arti-
cles, search terms were then adapted and systematically searched in
three databases: PubMed, PsycINFO, and SPORTdiscus. Searches were
conducted in November 2016. No date limit was set for searches. After
relevant literature was selected by title/abstract review, manual sear-
ches were conducted by reviewing the reference section of each article.
Inclusion criteria for initial selection were that studies included: (a)
human participants, (b) experimentally manipulated exercise with-
drawal/cessation/deprivation, (c) mental health as an outcome (de-
fined as an assessment of the participants' condition with regard to their
12
General Hospital Psychiatry 49 (2017) 11–18
psychological and emotional well-being), and (d) English as the lan-
guage of the article. Conference abstracts and unpublished data were
included only if they appeared in electronic databases listed above or if
they were cited in the reference section of other identified articles. We
identified two unpublished dissertation and all identified conference
abstracts were later published as full articles and included in this re-
view. The following types of studies were excluded: (a) case reports; (b)
exercise withdrawal following non-experimentally controlled condi-
tions (e.g., injury, involuntary confinement). No limitations were set on
the nature of the study sample (e.g., athletes, clinical samples, students)
or the quality of the study design (e.g., presence of a control condition,
randomized, cross-over designs). We report relevant study character-
istics in Table 1. However, all included studies met inclusion criterion
(b) that requires experimental manipulation of exercise withdrawal. A
broad inclusion for “mental health” was used (see supplemental table
S2 for search terms), including depressive symptoms, self-esteem, fa-
tigue, anxiety, quality of life, and general mood symptoms and well-
being.
A total of 61 unique articles were identified and title/abstracts were
 Table 1
Characteristics of exercise withdrawal and mental health response studies ordered by length of exercise withdrawal period.
Authors Purpose
Bahrke, To examine effects of mood from
Thompson & Thomas exercise withdrawal in regular
[24] exercisers.
Baekeland [23] To investigate the effect on sleep
of a prolonged exercise
withdrawal period on regular
exercisers and sleep.
Chan & Grossman [26] To examine the psychological
effect of exercise withdrawal on
runners.
Antunes et al. [22] To investigate the affective
response of exercise addiction and
13
biochemical markers in athletes
during exercise withdrawal.
Berlin, Kop & Deuster [25] Investigate exercise withdrawal
effects on depressive
symptomatology.
Morris et al. [33] To investigate the emotional
effects of an exercise withdrawal
period among regular exercisers.
Poole et al. [34] To examine the response of
exercise withdrawal on negative
mood.
Ablin et al. [20] Examine effect of sleep and/or
Participants
13 male (M age = 29.8 years).
Exercised at least 3 times/week in
the past two years.
14 health college students. Students'
exercised at least 3 days/week.
60 runners (28 males, 32
females, > 15 and < 50 years). Ran
at least 3 times/week, minimum of
1 year, 20 miles per week.
18 runners between ages 18 and
40 years (18 males). Exercised for
no < 5 times/week in the past two
years.
40 participants (18 males, 22
females, M age = 31.3 years).
Participated in at least 30
consecutive minutes of aerobic
exercise 3 days/week in the prior six
months.
40 male runners between the ages of
18–52 years (M age = 37 years).
Participants ran a minimum of 3
times per week, 10 miles each week,
in the last 3 months.
26 healthy adults (13 males, 13
females, M age = 25.5 years).
Participants exercised at least 30
consecutive minutes, 3 days per
week for the previous 6 months.
87 healthy adults (37 males, 57
Exercise withdrawal protocol
6-Week exercise withdrawal period.
Participants were divided into
exercise withdrawal group (n = 7)
and separate control group (n = 6)
who maintained exercise routine.
1-Month exercise withdrawal
period. All participated in
withdrawal period.
4-Week exercise withdrawal period.
The experimental group, prevented
runners (n = 30), were unable to
continue running for a 4-week
period. The control group (n = 30)
continued running as usual. Both
groups consisted of 16 females and
14 males.
2-Week exercise withdrawal period.
Divided into control (n = 10) who
had no addiction symptoms, and
exercise addiction group (n = 8).
All participated in exercise
cessation period, minimum 7 days
and maximum 14 days.
2-Week exercise withdrawal period.
Participants were randomized to
either stop (n = 20) or continue
(n = 20) regular exercise activities.
2-Week exercise withdrawal period.
After the first two weeks of the
study the participants were
randomly assigned to either the
deprived group or control group.
The deprived group (n = 20) was
required to withdrawal from
running for two weeks. Control
group (n = 20) continued exercise
as usual.
2-Week exercise withdrawal period.
Participants were randomly
assigned to either control group
(n = 13), maintain normal exercise
routine, or experimental group
(n = 13), exercise withdrawal.
10-Day withdrawal period.
Measure(s)
Profile of Mood States, State-
Trait Anxiety Inventory
Exercise Deprivation
Questionnaire
Profile of Mood States,
Rosenberg Self-Esteem Scale,
Zung Depression Scale
Brunel Mood Scale
Profile of Mood States, Beck
Depression Inventory-II,
Multidimensional Fatigue
Inventory
General Health Questionnaire,
Zung anxiety and depression
scales
Profile of Mood States, General
Health Questionnaire-28
Multidimensional Fatigue
Results Findings
Increase in total mood Exercise withdrawal group
A.A. Weinstein et al.
disturbance; increase in showed higher mood
anxiety disturbance scores compared
with the control group. Total
mood disturbance increased
171% for withdrawal group,
while the control group
decreased 79%.
Increase in total mood After 1 month of exercise
disturbance deprivation, participants had
decreased appetite and sleep
depth. Participants reported
increased sleep interruptions,
sexual tension, and need for
social interaction.
Increase in total mood Significantly higher symptoms
disturbance; lower self- of psychological distress were
esteem; increase in observed among prevented
depressive symptoms runners, specifically: increased
total mood disturbance,
increased depression and lower
levels of self-esteem.
Increase in total mood After the 2-week exercise
disturbance withdrawal higher levels of
negative mood (depression,
fatigue, confusion, anger) and
loss of vigor was observed
among the group of individuals
with exercise addiction
symptoms.
Increase in total mood Participants experienced
disturbance; increase in increased depressive mood
depressive symptoms; symptoms and fatigue.
increase in fatigue
Decrease in general well- The deprived group displayed
being; increase in statistically significantly
depressive symptoms; increased negative mood on all
increase in anxiety of the measurements.
Increase in total mood Increased negative mood was
disturbance; decrease in observed in the exercise
general well-being withdrawal group.
Increase in fatigue; no Fatigue was increased in
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General Hospital Psychiatry 49 (2017) 11–18
 Table 1 (continued)
Authors Purpose
exercise deprivation on the
development of pain, fatigue,
negative mood, somatic symptoms
and cognition.
Gauvin & Szabo [28] To study the effect of exercise
withdrawal on mood in college
students.
Glass et al. [29] Examine the effect of exercise
withdrawal on somatic symptoms
among healthy individuals.
Szabo & Parkin [35] To investigate the psychological
response of training deprivation
among brown and black belt level
martial artists.
14
Zeller et al. [38] To examine the effect of exercise
deprivation on quality of life.
Hausenblas et al. [30] To determine effects of exercise
withdrawal on regular exercisers.
Matthews [31] To measure exercise addiction and
withdrawal symptoms of exercise
addicts and non-addicts.
Mondin et al. [32] To investigate the psychological
effect of exercise withdrawal
period on habitual exercisers.
Tooman [37] Study the effects of exercise
Participants
females, M age = 27.2 years). Run
at least 5 days/week and sleep 7–9 h
per/night.
21 college students (14 males, 7
females, M age = 23.6 years).
Exercised at least 3 times/week, in
the past 4 months, respondents
exercises 7.52 h per week on
average.
18 healthy adults (7 males, 11
females, M age = 25.2 years).
Participants exercised 4 or more
hours/week.
20 martial artists (10 males, 10
females, M age = 28.4 years).
Participants trained 3.6 times per
week on average, or 6.5 h per week.
26 health athletes (18 males, 8
females, M age = 41.7 years).
Athletes participated in no < 4 h/
week aerobic exercise.
40 undergraduate students (14
males, 26 females, M
age = 20.5 years). Participants
engaged in moderate and/or
strenuous exercised 5 or more
times/week and were exercise
dependent.
62 members of a suburban fitness/
health club. Participants were
designated as either non-addicts
(n = 35 13 males, 22 females, M
age = 39.9 years) or exercise
addicts (n = 27, 8 males, 19
females, M age = 41 years).
10 habitual exercisers (6 males, 4
females, M age = 27.4 years).
Participants exercised 45 min per
day, 6–7 days out of the week.
40 participants (27 males, 13
Exercise withdrawal protocol
Participants were randomized to
one of four groups: exercise
cessation, sleep restriction, both, or
neither.
1-Week of exercise withdrawal.
Participants were randomly
assigned to experimental group
(n = 12) requiring exercise
withdrawal between days 15 and 21
of the study, or control group
(n = 9) that maintained regular
schedule of exercise.
1-Week exercise withdrawal period.
Baseline data was collected prior to
the start of the 7-day exercise
withdrawal period, and again on
the 7th day of exercise withdrawal.
1-Week exercise withdrawal. All 20
participants refrained from their
martial arts training routine.
7-Days exercise withdrawal. All
participated in exercise withdrawal
period.
3-Day of exercise withdrawal.
Participants were asked to respond
to a pager to respond to
questionnaires throughout the day.
3-Day exercise withdrawal. Three
treatment conditions: continued
exercise, planned exercise
withdrawal (notice given to
participants), and exercise
withdrawal with no notice.
3-Day exercise withdrawal period.
The study duration was 5 days, the
first day participants were asked to
exercise as usual then abstain from
exercise for the following three
days, then resume exercise as usual
on the fifth day.
2-Day exercise withdrawal period.
Measure(s)
Inventory, Center for
Epidemiological Studies
Depression Scale, Perceived
Stress Scale, Profile of Mood
States
Well-Being Questionnaire
Multidimensional Fatigue
Inventory, Beck Depression
Inventory, Speilberger State-
Trait Anxiety Inventory
Well-Being Questionnaire,
Profile of Mood States
Inventory
Medical Outcomes Study Short
Form-36
Exercise-Induced Feeling
Inventory
Profile of Mood States
State-Trait Anxiety Inventory,
Profile Mood States,
Depression Adjective Checklist
Profile of Mood States,
Results Findings
difference in depressive response to the exercise
symptoms; no difference deprivation. Other statistically
A.A. Weinstein et al.
in general well-being; no significant mood disturbances
difference in total mood were not replicated in this
disturbance sample.
No difference in general Experimental group had
well-being scores elevated physical symptoms
during exercise withdrawal.
Exercise withdrawal was not
statistically significant for the
assessment of psychological
well-being.
Increase in fatigue; Three of the 18 participants
increase in depressive experienced significant
symptoms; increase in increases in depressive
anxiety symptoms, which was
determined as a 10% increase in
symptoms after 1-week of
exercise deprivation.
Decrease in general well- Statistically significant increases
being; increase in total in mood disturbance, negative
mood disturbance affect, depression, anger, and
tension were observed during
the deprivation period. Results
also showed a moderate
decrease for vigor and positive
affect.
Decrease in general well- Statistically significant
being reductions were seen for
vitality, emotional role, and
physical role functioning after
exercise cessation.
Increase in total mood Participants with higher
disturbance exercise dependence had similar
symptoms when deprived from
exercise as they did on non-
exercise days.
Increase in total mood Statistically significant
disturbance differences were found between
the continued-exercise group
and the two exercise withdrawn
groups. Planned-layoff group
than the continued-exercise
group.
Increase in anxiety; Increased total mood
increase in total mood disturbance was observed
disturbance; increase in during the exercise withdrawal
depressive symptoms period.
Increase in total mood Statistically significant changes
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General Hospital Psychiatry 49 (2017) 11–18

Table 1 (continued)
Authors Purpose
deprivation on muscle tension,
mood, and anxiety.
Aidman & Woollard [21] Examine association between self-
reported exercise addiction and
responses of scheduled training
withdrawal among competitive
runners and the emotional and
physiological response.
Conboy [27] To determine if runners
experience dysphoria during
15
exercise withdrawal.
Thaxton [36] Examine response of a brief bout
of exercise deprivation on habitual
runners.
Participants
females). All individuals ran at least
3 days/week for at least 30 min per
session for at least two months prior
to study.
60 club-level runners (30 males, 30
females, M age = 24.2 years). Ran
at least 5 days/week to train for a
major regional competition with
no < 5 uninterrupted training
sessions a week in the 4 weeks
leading up to the study.
61 participants (51 males, 10
females, M age = 34.6 years).
33 runners (24 males, 9 females, M
age = 36 years). Participants
exercised regularly Monday through
Friday for at least 30 min for the
past year.
Exercise withdrawal protocol
Participants were assigned to either
competitive group (n = 20; 13
males, 7 females, M
age = 28.7 years) or recreational
group (n = 20; 14 males, 6 females,
M age = 25 years).
1-Day withdrawal period
with < 24 h' notice. 15 male and 15
female participants were randomly
assigned to this exercise cessation.
The remaining 30 participants
continued regularly scheduled
training.
1-Day no running day. Run/No Run
design was used. Investigators
asked participants to complete 10
mood assessments on Run days and
2 mood assessments on No Run
days.
24-Hour exercise withdrawal.
Participants randomly were
randomly assigned to one of four
groups: (a) pretest-running-test
(n = 6); (b) pretest-no running-test
(n = 9); (c) no pretest-running-test
(n = 11); (d) no pretest-no running
test (n = 7).
A.A. Weinstein et al.
Measure(s) Results Findings
Cognitive-Somatic Anxiety disturbance; no were seen in confusion, state
Questionnaire, State-Trait difference in anxiety anxiety, and tension. No
Anxiety Inventory statistically significant increases
were observed for depression,
anger, or fatigue during 2-day
exercise withdrawal.
Profile of Mood States Increase in total mood Statistically significant
disturbance increased were observed in total
mood disturbance after missing
scheduled training session for
the experimental group
compared with control group.
Profile of Mood States Increase in total mood Total mood disturbance
disturbance increases were observed on “no
run” days.
Profile of Mood States Increase in total mood Statistically significant increase
disturbance in total mood disturbance
scores.
General Hospital Psychiatry 49 (2017) 11–18
A.A. Weinstein et al.
screened using these inclusion criteria. Studies that did not meet these
inclusion criteria on further inspection were then excluded. Two of the
authors (AAW and CK) independently reviewed the articles to de-
termine inclusion. The authors agreed 100% on the articles to be in-
cluded and therefore no further discussion or third reviewer involve-
ment was needed.
3. Results
Nineteen experimental exercise deprivation studies met inclusion
criteria for the present review (see Table 1) [20–38]. These studies
investigated a variety of specific mental health measures: depressive
symptoms (k = 6), anxiety (k = 5), fatigue (k = 3), and self-esteem
(k = 1). In addition, studies examined general mood symptoms
(k = 15) and general well-being (k = 6). Results showed a consistent
pattern for adverse effects of exercise withdrawal on these mental
health measures, particularly depressive symptoms and anxiety.
For the studies reviewed, depressive symptoms consistently oc-
curred following the cessation of exercise. Depressive symptoms in-
cludes a variety of complaints, including fatigue, tension, confusion,
lower self-esteem, insomnia, and irritability [25,27,28,36]. However,
the severity of these symptoms did not reach the level of a clinical di-
agnosis. Exercise deprivation also consistently resulted in an increase in
general anxiety (state anxiety) [24,26,32,33], but no information was
provided regarding anxiety disorders based on clinical diagnostic cri-
teria.
Regarding general mood symptoms and general well-being, results
indicated consistent negative changes in both general mood and well-
being [21,22,24–28,31–37]. The most frequently reported feelings were
guilt, irritability, anger, confusion, restlessness, tension, frustration,
stress, and sluggishness (loss of vigor).
The studies were characterized by substantial differences in mul-
tiple factors, including different lengths exercise deprivation periods
(range = 1 day to 6 weeks; median 7 days), different activities engaged
in by the exercisers (i.e., martial arts, running), different assessment
tools (i.e., Profile of Mood States, General Health Questionnaire), and
different levels of baseline activity levels (i.e., 45 min/session for
6–7 days/week, 30 min/session for 3 days/week) making direct com-
parisons between studies difficult. Despite these differences, the un-
favorable mental health consequences of controlled exercise with-
drawal were consistently found across the various studies.
One of the factors that was important is the length of the exercise
withdrawal period. Table 1 is ordered from the longest duration of
exercise withdrawal to the shortest. It became clear that the mental
health consequences of exercise withdrawal were more severe with
longer duration of exercise withdrawal. Specifically, two weeks of ex-
ercise withdrawal or longer was consistently related to statistically
significant decreases in mental health [22–26,33,34] whereas the
shorter periods of exercise withdrawal resulted in inconsistent findings.
4. Discussion
Experiencing time periods of inactivity is quite common, especially
for individuals that are hospitalized or are experiencing acute or
chronic health issues [19]. For individuals that were previously active
prior to this period of inactivity, the change in activity level can be
particularly detrimental to their mental health.
The reviewed literature consistently demonstrates that there are
mental health consequences that accompany the withdrawal of ex-
ercise. The present review points to the need for research on potential
determinants of the negative impact of exercise withdrawal. A few
studies have investigated various potential determinants including fit-
ness level, autonomic nervous system dysregulation as measured by
heart rate variability, and inflammation [18,34,39] but there are no
clear mechanisms that have been identified.
In 1995, a review of the literature on exercise deprivation was
16
General Hospital Psychiatry 49 (2017) 11–18
conducted [40]. At that time, few experimental studies of exercise
withdrawal existed and the review focused on non-experimental in-
vestigations. Similar conclusions regarding the adverse effects of ex-
ercise deprivation on well-being were found. However, many limita-
tions in the literature were identified including inconsistencies in the
methodology and the focus on a single group of exercisers (runners)
[40]. In the twenty years since this pioneering research, the literature
has advanced with the increased inclusion of experimental designs and
diverse groups of participants, but the fundamental limitations that
existed twenty years ago still exist: methodological inconsistencies and
the lack of investigation of underlying determinants for the decrease in
mental health following exercise withdrawal.
Limitations to the current state of the literature need to be further
considered. First, individuals that volunteer to participate in the ex-
perimental withdrawal of exercise are most likely not extremely dedi-
cated exercisers [41]. Therefore, it is likely that individuals willing to
enroll in these types of investigations are different from individuals who
would not agree to stop exercising for research purposes [23].
Another limitation in the literature is the inconsistency in the length
of time of the exercise inactivity. It is difficult to draw systematic
conclusions on the data when > 50% of the studies reviewed had
withdrawal time periods of one week or less. For many of the partici-
pants in these studies, this would imply that three or less exercise ses-
sions were missed which is a minimal amount of missed activity ses-
sions. Again, this points to the idea that the present research most likely
underestimates the extent of mental health issues that are secondary to
periods of inactivity. In an experimental study, we have shown that
acute bouts of exercise has short-term positive effects on mood [42],
which is dampened if individuals have mental health problems such as
depression. Longer periods of exercise withdrawal would most likely
induce more negative mood symptoms compared to short periods of
exercise withdrawal. This systematic review suggests that exercise
withdrawal periods that are longer than two weeks are needed to find
consistent adverse effects of reduced exercise on negative mood and
reduced psychological wellbeing [22–26,33,34].
The use of varied assessments of mental health and/or mood also
complicates the summary of the literature. The most commonly used
assessment tool was the Profile of Mood States [43]. This instrument is
frequently used in the exercise literature [44], but is not as frequently
used when examining clinical issues. In future research, it would be
helpful to include assessments that have been shown to have diagnostic
implications. Finally, a limitation in the experimental withdrawal of
exercise is that the participants in these studies cannot be blinded to the
condition that they have been randomized to and their beliefs on the
beneficial effects of exercise may be conveyed through their negative
responses to the assessments of mental health that are given. This does
not impact the generalizability of this research to clinical scenarios
since patients that have activity restrictions will also be aware of their
predicament. However, experimental manipulation of exercise is dif-
ferent from exercise withdrawal because of external factors (i.e., injury,
sickness, vacation). With negative factors such as injury, there will be
additional factors that affect mental health, such as pain. Pain is asso-
ciated with decrements in mental health including depression and an-
xiety [45]. With positive factors such as vacation, there will be addi-
tional factors that might act as a buffer against the negative impact on
mental health [46], such as the relief from work stress. The experi-
mental manipulation of exercise withdrawal does not allow for in-
vestigation of how these factors impact mental health. Therefore, future
work needs to include both experimental and real-world modeling of
exercise withdrawal.
Another potential factor that can influence the impact of exercise
withdrawal on mental health is the individuals' level of commitment to
exercise. The more important exercise is to an individual (i.e., high-
level athlete, compulsive exerciser, individuals with anorexia that uti-
lize exercise), the more likely it is that the individual will have a more
adverse reaction to its removal. In one of the investigations reviewed,
A.A. Weinstein et al.
participants with exercise addiction symptoms were compared to a
group of participants without exercise addiction symptoms [22] after
an exercise withdrawal period. The participants with exercise addiction
symptoms had higher levels of various mental health symptoms in-
cluding depression, anger, and fatigue compared to the participants
without symptoms of exercise addiction. This demonstrates that in-
dividuals with high levels of commitment to exercise may experience
higher levels of symptoms when exercise is removed.
The present findings may have important clinical implications. A
recent meta-analysis investigating the relationship between general
activity restriction and mental health showed that the relationship be-
tween activity restriction and depressive symptoms relationship was
much stronger among medical populations [19] reinforcing the need to
assess the changes in mental health of individuals that have reduced
activity levels secondary to a medical condition. Since exercise with-
drawal may be a significant contributor to increased negative mental
health in medical patients, psychosocial/behavioral interventions (i.e.,
behavioral activation therapy) may be particularly efficacious in these
populations [47]. This suggestion would need to be investigated using
randomized controlled trials before it can be implemented.
5. Conclusions
This systematic review indicates that withdrawal of exercise has a
negative impact on the mental health among healthy individuals who
exercise regularly. The data also suggest that the adverse mental health
effect of exercise withdrawal increases with longer durations of reduced
physical activity. The available literature is limited by the methodolo-
gical variability of the investigations in this area. The clinical im-
plications include the assessment and monitoring of mental health
consequences of the cessation of exercise following medical interven-
tions, chronic physical limitations and other conditions associated with
involuntary reduced physical activity.
Supplementary data to this article can be found online at http://dx.
doi.org/10.1016/j.genhosppsych.2017.06.001.
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