Higher VO2 Max Linked to Lower Depression and Anxiety Risk in UK Biobank

This is an observational study in people. It followed 46,062 UK Biobank participants who had no depression or anxiety at the start. Observational work can show that two things go together. It cannot show that one causes the other.

Fitness was measured as VO2 max, the most oxygen a body can use during hard exercise. It is a standard marker of heart and lung fitness. Here it was estimated from a standardized submaximal exercise test, meaning participants were not pushed to their limit. The researchers, led by Liu Y, tracked new cases of depression and anxiety through linked health records coded with ICD-10, a standard system for recording diagnoses.

Over a median follow-up of 12.6 years, there were 2,190 cases of depression and 2,483 cases of anxiety. Compared with the least fit quarter of participants, the fittest quarter had a 24% lower risk of depression (hazard ratio 0.76, 95% confidence interval 0.64–0.91). Their anxiety risk was 17% lower (hazard ratio 0.83, 95% confidence interval 0.71–0.98). These results account for sociodemographic, lifestyle and clinical factors.

The pattern also held across the fitness range. For each 1-standard-deviation increase in VO2 max, depression risk was 10% lower (0.90, 0.84–0.96). Anxiety risk was 6% lower (0.94, 0.88–1.00), a result right at the edge of statistical significance. The authors report a straight-line relationship for depression. For anxiety the relationship was nonlinear, so the benefit did not rise in a steady line.

The study also reports that associations were stronger among people with a lower biological age.

The team also looked at blood proteins in a subset of 3,245 participants. They found seven plasma proteins that differed with fitness. Leptin and FABP4 were lower, and SPINT3 and INSL3 were higher. Several of these proteins were independently linked to mental health outcomes. The authors say this points to metabolic and neuroprotective pathways as possible explanations. That is a hypothesis, not a demonstrated mechanism.

For you

What does this mean for personal health? Aerobic fitness is already tied to heart health. This study adds that it may also go with a lower chance of common mental health diagnoses. But fitter people may differ from less fit people in ways that statistics cannot fully remove. Early, undiagnosed low mood could also make exercise harder. And because outcomes came from health records, people with symptoms who never sought care would not be counted.

The findings sit alongside another recent Arising report, on a separate UK Biobank study linking more REM sleep to lower risk of 83 diseases. Both are observational and both point to modifiable habits. Neither shows that changing the habit changes the outcome.

To watch next: randomized trials that assign people to supervised aerobic training and track depression and anxiety diagnoses over time, which would test whether fitness itself makes the difference.

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