Cognitive Therapy and Research

, Volume 37, Issue 3, pp 476–482 | Cite as

Clarifying the Link Between Distress Intolerance and Exercise: Elevated Anxiety Sensitivity Predicts Less Vigorous Exercise

  • Samantha J. Moshier
  • Bridget A. Hearon
  • Amanda W. Calkins
  • Kristin L. Szuhany
  • Angela C. Utschig
  • Jasper A. J. Smits
  • Michael W. Otto
Original Article


Anxiety sensitivity, one measure of distress intolerance, has been increasingly shown to play a role in a variety of health behaviors. A number of reports now suggest that individuals with higher levels of anxiety sensitivity (AS) are less likely to engage in exercise. However, this finding has been inconsistent across sex and limited by measurement strategy. This study examined the relationship between AS and self-reported exercise in a mixed-sex sample of 233 individuals. Consistent with prediction, AS was negatively associated with engagement in vigorous-intensity exercise; however, the strength of this association when covarying for sex was dependent on the measurement strategy used (continuous vs. categorical ASI scores). Sex did not moderate the AS-vigorous exercise association. AS was not associated with moderate-intensity exercise or walking. Results suggest a role of distress intolerance in exercise behavior and confirm the importance of continued research on this topic.


Exercise Physical activity Anxiety sensitivity Distress intolerance 


  1. Anestis, M. D., Holm-Denoma, J. M., Gordon, K. H., Schmidt, N. B., & Joiner, T. E. (2008). The role of anxiety sensitivity in eating pathology. Cognitive Therapy and Research, 32, 370–385. doi: 10.1007/s10608-006-9085-y.CrossRefGoogle Scholar
  2. Bauman, A., Bull, F., Chey, T., Craig, C. L., Ainsworth, B. E., Sallis, J. F., et al. (2009). The international prevalence study on physical activity: Results from 20 countries. International Journal of Behavioral Nutrition and Physical Activity, 6, 21.PubMedCrossRefGoogle Scholar
  3. Bauman, A., Phongsavan, P., Schoeppe, S., & Owen, N. (2006). Physical activity measurement—A primer for health promotion. Promotion and Education, 13(2), 92–103.PubMedCrossRefGoogle Scholar
  4. Bernstein, A., Zvolensky, M. J., Kotov, R., Arrindell, W. A., Taylor, S., Sandin, B., et al. (2006). Taxonicity of anxiety sensitivity: A multi-national analysis. Journal of Anxiety Disorders, 20(1), 1–22.PubMedCrossRefGoogle Scholar
  5. Broman-Fulks, J. J., Deacon, B. J., Olatunji, B. O., Bondy, C. L., Abramowitz, J. S., & Tolin, D. F. (2010). Categorical or dimensional: A reanalysis of the anxiety sensitivity construct. Behavior Therapy, 41(2), 154–171.PubMedCrossRefGoogle Scholar
  6. Broman-Fulks, J. J., Green, B. A., Olatunji, B. O., Berman, M. E., Arnau, R. C., Deacon, B. J., et al. (2008). The latent structure of anxiety sensitivity—Revisited. Assessment, 15(2), 188–203. doi: 1073191107311284.PubMedCrossRefGoogle Scholar
  7. Brown, R. A., Lejuez, C. W., Kahler, C. W., Strong, D. R., & Zvolensky, M. J. (2005). Distress tolerance and early smoking lapse. Clinical Psychology Review, 25(6), 713–733. doi: 10.1016/j.cpr.2005.05.003.PubMedCrossRefGoogle Scholar
  8. Brown, W. J., Trost, S. G., Bauman, A., Mummery, K., & Owen, N. (2004). Test–retest reliability of four physical activity measures used in population surveys. Journal of Science and Medicine in Sport, 7(2), 205–215.PubMedCrossRefGoogle Scholar
  9. Brownson, R. C., Baker, E. A., Housemann, R. A., Brennan, L. K., & Bacak, S. J. (2001). Environmental and policy determinants of physical activity in the United States. American Journal of Public Health, 91(12), 1995–2003.PubMedCrossRefGoogle Scholar
  10. Calkins, A. W., Hearon, B. A., Capozzoli, M. C., & Otto, M. W. (2012). Psychosocial predictors of sleep dysfunction: The role of anxiety sensitivity, dysfunctional beliefs and neuroticism. Behavioral Sleep Medicine. doi: 10.1080/15402002.2011.643968.
  11. Craig, C. L., Marshall, A. L., Sjostrom, M., Bauman, A. E., Booth, M. L., Ainsworth, B. E., et al. (2003). International physical activity questionnaire: 12-Country reliability and validity. Medicine and Science in Sports and Exercise, 35(8), 1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB.PubMedCrossRefGoogle Scholar
  12. Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 15, 297–333.CrossRefGoogle Scholar
  13. DeMartini, K. S., & Carey, K. B. (2011). The role of anxiety sensitivity and drinking motives in predicting alcohol use: A critical review. Clinical Psychology Review, 31(1), 169–177.PubMedCrossRefGoogle Scholar
  14. Ekelund, U., Sepp, H., Brage, S., Becker, W., Jakes, R., Hennings, M., et al. (2006). Criterion-related validity of the last 7-day, short form of the International Physical Activity Questionnaire in Swedish adults. Public Health Nutrition, 9(2), 258–265.PubMedCrossRefGoogle Scholar
  15. Ekkekakis, P., Parfitt, G., & Petruzzello, S. J. (2011). The pleasure and displeasure people feel when they exercise at different intensities: Decennial update and progress towards a tripartite rationale for exercise intensity prescription. Sports Medicine, 41(8), 641–671. doi: 10.2165/11590680-000000000-00000.PubMedCrossRefGoogle Scholar
  16. Feldner, M. T., Zvolensky, M. J., Stickle, T. R., Bonn-Miller, M. O., & Leen-Feldner, E. W. (2006). Anxiety sensitivity-physical concerns as a moderator of the emotional consequences of emotion suppression during biological challenge: An experimental test using individual growth curve analysis. Behavior Research and Therapy, 44(2), 249–272.CrossRefGoogle Scholar
  17. Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire (IPAQ). (2005).
  18. Guiraud, T., Labrunee, M., Gayda, M., Juneau, M., & Gremeaux, V. (2012). Non-pharmacological strategies in cardiovascular prevention: 2011 highlights. Annals of Physical Rehabilitation Medicine, 55(5), 342–374.Google Scholar
  19. Hagstromer, M., Oja, P., & Sjostrom, M. (2006). The International Physical Activity Questionnaire (IPAQ): A study of concurrent and construct validity. Public Health Nutrition, 9(6), 755–762.PubMedCrossRefGoogle Scholar
  20. Hearon, B. A., Utschig, A. C., Smits, J. A., Moshier, S. J., & Otto, M. W. (2011). The role of anxiety sensitivity and eating expectancy in maladaptive eating behavior. Paper presented at the symposium Expanding the application of anxiety sensitivity to health behaviors. The 45th Annual Convention of the Association for Behavioral and Cognitive Therapies, Toronto, ON.Google Scholar
  21. Lee, I. M., Hsieh, C. C., & Paffenbarger, R. S, Jr. (1995). Exercise intensity and longevity in men. The Harvard Alumni Health Study. Journal of the American Medical Association, 273(15), 1179–1184.PubMedCrossRefGoogle Scholar
  22. Lejuez, C. W., Zvolensky, M. J., Daughters, S. B., Bornovalova, M. A., Paulson, A., Tull, M. T., et al. (2008). Anxiety sensitivity: A unique predictor of dropout among inner-city heroin and crack/cocaine users in residential substance use treatment. Behavior Research and Therapy, 46(7), 811–818.CrossRefGoogle Scholar
  23. Leyro, T. M., Zvolensky, M. J., & Bernstein, A. (2010). Distress tolerance and psychopathological symptoms and disorders: A review of the empirical literature among adults. Psychological Bulletin, 136(4), 576–600. doi: 10.1037/a0019712.PubMedCrossRefGoogle Scholar
  24. McAuley, E., Jerome, G. J., Elavsky, S., Marquez, D. X., & Ramsey, S. N. (2003). Predicting long-term maintenance of physical activity in older adults. Preventative Medicine, 37(2), 110–118.CrossRefGoogle Scholar
  25. McHugh, R. R., Daughters, S., Lejuez, C., Murray, H., Hearon, B., Gorka, S., et al. (2011). Shared variance among self-report and behavioral measures of distress intolerance. Cognitive Therapy & Research, 35(3), 266–275. doi: 10.1007/s10608-010-9295-1.
  26. McNally, R. J. (2002). Anxiety sensitivity and panic disorder. Biological Psychiatry, 52(10), 938–946.PubMedCrossRefGoogle Scholar
  27. McWilliams, L. A., & Asmundson, G. J. (2001). Is there a negative association between anxiety sensitivity and arousal-increasing substances and activities? Journal of Anxiety Disorders, 15(3), 161–170.PubMedCrossRefGoogle Scholar
  28. Peterson, R. A., & Reiss, S. (1993). Anxiety Sensitivity Index revised test manual. Worthington, OH: International Diagnostic Systems Publishing Corporation.Google Scholar
  29. Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behavior Research and Therapy, 24(1), 1–8.CrossRefGoogle Scholar
  30. Reiss, S., Peterson, R., Taylor, S., Schmidt, N., & Weems, C. F. (2008). Anxiety Sensitivity Index consolidated user manual: ASI, ASI-3, and CASI. Worthington, OH: International Diagnostic Systems.Google Scholar
  31. Sabourin, B. C., Hilchey, C. A., Lefaivre, M.-J., Watt, M. C., & Stewart, S. H. (2011). Why do they exercise less? Barriers to exercise in high-anxiety-sensitive women. Cognitive Behaviour Therapy, 40(3), 206–215. doi: 10(1080/16506073),2011,573572.PubMedCrossRefGoogle Scholar
  32. Sallis, J. F., Hovell, M. F., Hofstetter, C. R., Faucher, P., Elder, J. P., Blanchard, J., et al. (1989). A multivariate study of determinants of vigorous exercise in a community sample. Preventative Medicine, 18(1), 20–34.CrossRefGoogle Scholar
  33. Schmidt, N. B., Kotov, R., Lerew, D. R., Joiner, T. E., & Ialongo, N. S. (2005). Evaluating latent discontinuity in cognitive vulnerability to panic: A taxometric investigation. Cognitive Therapy and Research, 29, 673–691.CrossRefGoogle Scholar
  34. Slentz, C. A., Duscha, B. D., Johnson, J. L., Ketchum, K., Aiken, L. B., Samsa, G. P., et al. (2004). Effects of the amount of exercise on body weight, body composition, and measures of central obesity: STRRIDE—A randomized controlled study. Archives of Internal Medicine, 164(1), 31–39. doi: 10.1001/archinte.164.1.31164/1/31.PubMedCrossRefGoogle Scholar
  35. Smits, J. A., Berry, A. C., Tart, C. D., & Powers, M. B. (2008). The efficacy of cognitive-behavioral interventions for reducing anxiety sensitivity: A meta-analytic review. Behavior Research and Therapy, 46(9), 1047–1054.CrossRefGoogle Scholar
  36. Smits, J. A., Tart, C. D., Presnell, K., Rosenfield, D., & Otto, M. W. (2010). Identifying potential barriers to physical activity adherence: Anxiety sensitivity and body mass as predictors of fear during exercise. Cognitive Behaviour Therapy, 39(1), 28–36. doi: 10.1080/16506070902915261.PubMedCrossRefGoogle Scholar
  37. Smits, J. A., & Zvolensky, M. J. (2006). Emotional vulnerability as a function of physical activity among individuals with panic disorder. Depression and Anxiety, 23(2), 102–106. doi: 10.1002/da.20146.PubMedCrossRefGoogle Scholar
  38. Swain, D. P., & Franklin, B. A. (2006). Comparison of cardioprotective benefits of vigorous versus moderate intensity aerobic exercise. American Journal of Cardiology, 97(1), 141–147.PubMedCrossRefGoogle Scholar
  39. Tanasescu, M., Leitzmann, M. F., Rimm, E. B., Willett, W. C., Stampfer, M. J., & Hu, F. B. (2002). Exercise type and intensity in relation to coronary heart disease in men. Journal of the American Medical Association, 288(16), 1994–2000.PubMedCrossRefGoogle Scholar
  40. Troiano, R. P., Berrigan, D., Dodd, K. W., Masse, L. C., Tilert, T., & McDowell, M. (2008). Physical activity in the United States measured by accelerometer. Medicine and Science in Sports and Exercise, 40(1), 181–188. doi: 10.1249/mss.0b013e31815a51b3.PubMedGoogle Scholar
  41. Tull, M. T., & Gratz, K. L. (2008). Further examination of the relationship between anxiety sensitivity and depression: the mediating role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed. Journal of Anxiety Disorders, 22(2), 199–210.PubMedCrossRefGoogle Scholar
  42. WHO (Ed.). (2011). Global status report on noncommunicable diseases 2010. Geneva: W. H. Organization.Google Scholar
  43. Williams, D. M., Dunsiger, S., Ciccolo, J. T., Lewis, B. A., Albrecht, A. E., & Marcus, B. H. (2008). Acute affective response to a moderate-intensity exercise stimulus predicts physical activity participation 6 and 12 months later. Psychology of Sport and Exercise, 9(3), 231–245. doi: 10.1016/j.psychsport.2007.04.002.PubMedCrossRefGoogle Scholar
  44. Zvolensky, M. J., Forsyth, J. P., Bernstein, A., & Leen-Feldner, E. W. (2007). A concurrent test of the anxiety sensitivity taxon: Its relation to bodily vigilance and perceptions of control over anxiety-related events in a sample of young adults. Journal of Cognitive Psychotherapy, 21, 72–90.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Samantha J. Moshier
    • 1
  • Bridget A. Hearon
    • 1
  • Amanda W. Calkins
    • 1
  • Kristin L. Szuhany
    • 1
  • Angela C. Utschig
    • 1
  • Jasper A. J. Smits
    • 2
  • Michael W. Otto
    • 1
  1. 1.Department of Psychology, Center for Anxiety and Related DisordersBoston UniversityBostonUSA
  2. 2.Department of PsychologySouthern Methodist UniversityUniversity ParkUSA

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