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121

Review article                  UDC: 796.011.1:159.922.63
received: 2018-09-14

PSYCHOLOGICAL BENEFITS OF EXERCISE AND PHYSICAL 
ACTIVITY IN OLDER ADULTS

Petra DOLENC 1& Mojca PETRIČ 2

1 University of Primorska, Faculty of Education, Koper, Slovenia
2 Psychiatric Hospital Begunje, Slovenia

Corresponding Author:
Petra DOLENC

University of Primorska, Faculty of Education, Cankarjeva 5, 6000 Koper, Slovenia
Phone: +386 5 663 12 52

E-mail: petra.dolenc@pef.upr.si

ABSTRACT

While regular physical activity has been shown to positively impact health and 
physical functioning across all age groups an active lifestyle may in particular have 
beneficial effects in advanced age. The objective of this article is to provide a brief 
overview of a contemporary research on the benefits of physical activity for psychologi-
cal health and quality of life in the elderly. Older adults are more vulnerable than other 
age groups regarding mental health problems, such as depression and anxiety. Many 
cross-sectional and experimental studies discussed in the article confirm the impor-
tance of a physically active lifestyle for preventing or reducing mental health problems 
and improving the quality of life among elderly people.

Keywords: mental health, physical activity, quality of life, late adulthood.

POZITIVNI PSIHOLOŠKI UČINKI GIBALNE/ŠPORTNE
AKTIVNOSTI PRI STAREJŠIH ODRASLIH

IZVLEČEK

Redna gibalna/športna aktivnost pozitivno vpliva na gibalne zmogljivosti in zdravje 
posameznikov v vseh starostnih skupinah, predvsem pa ima aktivni življenjski slog lah-
ko ugodne učinke v obdobju starosti. Namen prispevka je predstaviti pregled literature 



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s področja preučevanja koristi gibalne aktivnosti za psihološko zdravje in kakovost 
življenja pri starejših odraslih. Slednji so v primerjavi z drugimi posamezniki bolj do-
vzetni za različne težave v duševnem zdravju, kot sta depresija in anksioznost. Številne 
presečne in eksperimentalne študije, o katerih razpravljamo v prispevku, ugotavljajo, 
da je aktivni življenjski slog ključen za preprečevanje ali zmanjšanje težav v duševnem 
zdravju ter izboljšanje kakovosti življenja pri starejši populaciji.

Ključne besede: duševno zdravje, gibalna aktivnost, kakovost življenja, pozna od-
raslost

INTRODUCTION

It is becoming increasingly apparent that successful aging is possible if people 
maintain certain healthy lifestyle habits throughout their lives (Mora, 2013). Among 
these habits, we also include physical activity (PA). According to the World Health 
Organization (WHO, 2015), a regular PA among older people is highly recommended 
for the promotion of an active lifestyle: older adults should participate in at least 50 
minutes of moderate intensity and 75 minutes of vigorous intensity level PA per week.

In a number of recent studies, PA has been identified as a key factor for improving 
health and quality of life in older adults (Daskalopoulou et al., 2017; Gill et al., 2013; 
Murtagh et al., 2014). As population aging is progressing rapidly in many industrialized 
countries, it is important to understand the relationship between PA and the physical 
and mental well-being of older people (King & King, 2010). 

The health benefits of PA in older adults have been well established in the scien-
tific literature (Musich, Wang, Hawkins, & Greame, 2017). Regular PA can reduce 
the morbidity and mortality from many chronic diseases, postpone disability and pro-
long independent living (Kokkinos, 2012; Warburton & Bredin, 2017). There is good 
evidence that being physically active reduces the risk of developing cardiovascular 
and metabolic disease through better control of blood pressure, cholesterol and waist 
circumference (Earnest et al., 2013). Physical activities and exercise programmes are 
important for building and maintaining bone density; they also improve neuromuscular 
capacity, increasing strength and muscle mass, which in turn may reduce the risk of 
falls (Meléndez-Ortega, 2007). PA is also associated with a reduction in age-related 
diseases such as dementia and Alzheimer’s disease (Reiner, Niermann, Jekauc, & Woll, 
2013). Conversely, prolonged sedentary behaviour is associated with deleterious health 
outcomes, including cardiovascular disease incidence and mortality, type II diabetes 
and cancer incidence (Biswas et al., 2015). 

In addition to all the positive effects on physical health, there is growing evidence 
that PA is beneficial for mental health, well-being (Mochcovitch, Deslandes, Freire, 
Garcia, & Nardi, 2016; Netz, Wu, Becker, & Tenenbaum, 2005) and even cognitive 
functioning (Colcombe & Kramer, 2003; Gajewski & Falkenstein, 2016) in older 



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adults. Multiple studies have found a positive association between exercise and PA 
and the alleviation of symptoms of anxiety and depression (Lee et al., 2014; Lindwall, 
Rennemark, Halling, Berglund, & Hassmén, 2007).

OBJECTIVES

The purpose of this contribution is to present an overview of empirical literature 
regarding the benefits of PA on mental health and well-being, the possible mechanisms 
explaining PA effects on mental health and the association between PA and quality of 
life in the elderly. 

Electronic databases PubMed, PsycINFO, Scopus, and SPORTDiscus were 
searched for literature sources in May 2018 for the last two decades (between 1997 
and 2017 inclusive). Different keywords were used: physical activity, exercise, mental 
health, quality of life, psychological well-being, older adults.

PHYSICAL ACTIVITY EFFECTS ON MENTAL HEALTH AND                  
WELL-BEING IN OLDER ADULTS

The aging process is associated with an increased prevalence of both physical and 
mental health concerns (Wrosch, Schult, Miller, Lupien, & Dunne, 2007). Poor mental 
health is an important consideration for older adults, since it seems to be a substantial 
component of the perceived quality of life and can also affect health status (Cho, Mar-
tin, Margrett, MacDonald, & Poon, 2011). 

Depression is the most common mental disorder in this age group, which affects 
approximately 5 % and 7 % of the world’s older population (WHO, 2016) although 
significant depressive symptoms (which do not meet the diagnostic criteria for major 
depression) are much more prevalent among community-dwelling old adults. Mental 
health problems in later life are under-identified by health professionals and by older 
people themselves; therefore, to promote well-being in later life, it seems crucial to 
prevent or adequately address mental health problems. Given the high cost of health 
care and prescription medication, it is important to consider the relationships between 
the modifiable behaviours and lifestyles that might affect the mental health, such as PA 
(Parker, Strath, & Swartz, 2008).

Penninx and colleagues (2002) examined the exercise effects on emotional func-
tion in 438 older participants with high and low depressive symptomatology. After an 
18-month walking program, a significant reduction of depressive symptoms (assessed 
by the Centre for Epidemiologic Studies Depression scale – CES-D; Radloff, 1977) 
was reported for both persons with initially high and low depressive symptomatol-
ogy, hinting at the possible antidepressant effect of PA. These findings illustrate that 
aerobic exercise may have significant beneficial emotional effects among the general 
older population. In a similar study conducted by Blumenthal et al. (1999), a 16-week 



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randomized controlled trial was performed to assess the effectiveness of an aerobic 
exercise program compared with standard medication for treatment of older patients 
with major depressive disorder. One hundred fifty-six men and women were assigned 
randomly to a program of aerobic exercise, antidepressants, or combined exercise and 
medication. Anxiety was assessed using the Hamilton Rating Scale for Depression 
(HAM-D; Linden, Borchelt, Barnow, & Geiselman, 1995) and the Beck Depression 
Inventory (BDI; Beck, Steer, & Garbin, 1988). The investigators demonstrated that 
exercise training program including supervised sessions of walking and jogging are 
equally as effective as a standard antidepressant therapy in reducing depression symp-
toms among older clinically depressed persons (Blumenthal et al., 1999). Some authors 
also emphasize that traditional treatments for depression such as psychotherapy and 
antidepressant medications are not effective for all patients, therefore, alternative ap-
proaches are recommended, especially the use of aerobic exercise (Blumenthal, Smith, 
& Hoffman, 2012).

In a recent meta-analytic study, Silveira and colleagues (2013) evaluated the ef-
fect of aerobic training and strength training as a treatment for depression in patients 
diagnosed with major depressive disorder. The meta-analysis concluded that physical 
exercise, mainly aerobic training, improves the response to depression treatment. How-
ever, the efficacy of exercise in the treatment of depression was influenced by age and 
severity of symptoms.

Mummery and colleagues (2004) examined the dose-response relationship between 
PA and mental health, comparing different levels of PA involvement. The study included 
337 independent living older adults ranging from 55 to 89 years of age. Activity status 
was assessed using the Active Australia questionnaire, whereas health status was assessed 
using the 12-Item Short Form Health Survey (SF-12; Jenkinson, Chandola, Coulter, & 
Bruster, 2001). Participants in the moderately active group (150-420 minutes of PA per 
week) and highly active group (>420 minutes of PA per week) displayed significantly 
higher mental health status than those who were classified as inactive (< 150 minutes 
of PA per week) when controlling for physical health status. A meta-analytic study con-
ducted by Conn (2010) synthesized depressive symptom outcomes of 38 supervised and 
22 unsupervised PA interventions among healthy adults. The obtained findings showed 
that both supervised and unsupervised PA interventions are effective in reducing depres-
sive symptoms among adults without clinical depression. 

In a recent longitudinal study, the relationship between the quantity and type of 
PA and subsequent depression in 3,497 adults aged between 65 and 75 was exam-
ined. Total PA was measured using the Physical Activity Scale for the Elderly (PASE; 
Washburn, McAuley, Katula, Mihalko, & Boileau, 1999), while depressive symptoms 
were measured by the Patient Health Questionnaire (PHQ-9; Martin, Rief, Klaiberg, 
& Braehler, 2006). The participants who practised the highest levels of PA and whose 
activity profile included athletic activity were at lower risk for depression in older age 
(Joshi et al., 2016).

Given the prevalence of depressive symptoms and the low rate of diagnosis among 
older adults, the promotion and maintenance of moderate-intensity aerobic PA could be 



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a recommended way for improving psychological well-being for all older people (Bri-
dle, Spanjers, Patel, Atherton, & Lamb, 2012; Lee et al., 2014; Mummery, Schofield, 
& Caperchione, 2004).

Watanabe and colleagues (2000) examined the effect of an acute PA program of 
different exercise conditions on the level of anxiety among older adults. Seventy-three 
healthy participants were randomly assigned to either water exercise group or land 
exercise group. The state of anxiety was assessed before and after the exercise. The ob-
tained results showed that both exercise groups scored lower on anxiety after exercise, 
suggesting that the participation in these types of exercise can help to reduce anxiety 
levels in older persons. Moreover, in a meta-analytic review of cross-sectional studies, 
a greater amount of physical exercise was associated with preferable levels of both 
positive and negative effects (Arent, Landers, & Etnier, 2000). Stubbe and colleagues 
have found that accumulating more PA is correlated with higher satisfaction with life 
(Stubbe et al., 2007).

The effects of regular PA on the person’s mood have mainly been studied using 
aerobic exercise but evidence indicates that other types of exercise, such as strength 
or flexibility training, can also reduce depressive symptoms, while less consensus ex-
ists with respect to anxiety symptoms (Peluso & Andrade, 2005). Chodzko-Zajko and 
colleagues (2009) reported that both aerobic exercise training and resistance exercise 
training produce clinically meaningful improvements in depression in clinical patients, 
with response rates ranging from 25 % to 88 %, whereas the findings are less consistent 
among the seniors without clinical depression. 

In a recent systematic review, Mochcovitch and colleagues (2016) evaluated the 
efficacy of regular PA on anxiety symptoms in older adults without anxiety disorders. 
All analysed studies have shown that regular and supervised PA was directly related to 
decreased anxiety symptoms in older individuals. The authors concluded that regular 
PA may be effective for reducing anxiety levels in older adults, however, more studies 
are needed to identify the ideal PA modality, frequency, duration and intensity for opti-
mizing the positive effects of exercise on anxiety in this population.

Although research consistently points to an inverse correlation between exercise and 
mental health, some authors indicated conflicting results it this relationship, emphasiz-
ing the importance of instrumentation used to measure PA (Parker et al., 2008). Due to 
lower complexity and relative low cost, most studies use subjective techniques, such as 
questionnaires, to assess PA. In general, subjective methods are accurate for measur-
ing structured exercise but tend to overestimate moderate and vigorous PA and under-
estimate sedentary behaviour (Dyrstad, Hansen, Holme, & Anderssen, 2014). On the 
other hand, objective PA measures (i.e., pedometers, accelerometers) are increasingly 
used to evaluate the relationship between PA and mental health in older adults (Fox, 
McKenna, & Davis, 2007; Loprinzi, 2013). Parker and colleagues (2008) examined the 
relationship between one week of PA and mental health among 84 adults aged 55 to 
87 as measured by pedometers, accelerometers and the PASE questionnaire. Objective 
PA assessment instruments were more sensitive in detecting the small but significant 
relationship between PA and mental health (in terms of positive affect, negative affect, 



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and satisfaction with life) relative to the subjective PA measurement technique. These 
results suggest that objective instruments may be preferable for assessing PA patterns 
among older adults. A study conducted by Loprinzi (2013) examined the association 
between accelerometer-assessed PA and depression symptoms among 708 older adults 
(65+ years). They wore an accelerometer for at least four days, and completed data on 
the study covariates along with depression, as assessed by the PHQ-9. After controlling 
for age, gender, race-ethnicity, body mass index, marital status, education, comorbidity 
index, and physical functioning, both light, and moderate-to-vigorous intensity PA was 
associated with lower depression levels. 

MECHANISMS UNDERLYING THE RELATIONSHIP BETWEEN 
PHYSICAL ACTIVITY AND MENTAL HEALTH

The relationship between PA and mental health has been widely investigated and 
several hypotheses including neurobiological, psychological and social mechanisms 
have been proposed to explain this relationship (Deslandes et al., 2009; Lubans et al., 
2016). Physiological mechanisms that are often discussed involve monoamine, endor-
phin and thermogenic hypothesis (Mikkelsen et al., 2017). Exercise is associated with 
the increased synthesis and release of both neurotransmitters and neurotrophic factors, 
and these increases may be associated with neurogenesis, angiogenesis and neuroplas-
ticity (Matta Mello Portugal et al., 2013). The monoamine hypothesis proposes that 
exercises lead to balanced levels of neurotransmitters (such as dopamine, serotonin, 
and norepinephrine) which are usually imbalanced in people suffering from depression. 
Therefore, this hypothesis suggests that PA can work in a similar way as anti-depres-
sants, medications that can help relieve symptoms of depression (Toups et al., 2011). 
The thermogenic hypothesis states that PA facilitates an increase in body temperature. 
Consequently, the increased temperature in specific brain region can lead to a more re-
laxed state, and, consequently, mood enhancement (DeBoer, Powers, Utschig, Otto, & 
Smits, 2012). The endorphin hypothesis originated from runners experiencing a feeling 
of euphoria or high after long distances. It states that the release of β-endorphins in the 
brain following exercise produces a morphine-like effect which reduces the sensation 
of pain and provides a state of positive mood and an overall enhanced sense of well-
being (Dishman & O’Connor, 2009).

Alternatively, psychological mechanisms for positive changes in mood and effect as 
a result of PA include the distraction hypothesis and the self-efficacy hypothesis (Peluso 
& Andrade, 2005; Shaw, Gorely, & Corban, 2005). The distraction hypothesis suggests 
that exercise distracts people from depressive worries and negative thoughts. Partici-
pating in PA or other distracting activities (e.g. relaxation, social contacts) gives people 
a break from daily hassles and stressors and provide the opportunity to relax and per-
haps put things in perspective. (Peluso & Andrade, 2005). The self-efficacy hypothesis 
is centred on the notion that exercise brings better physical competence which results in 
positive feelings of achievement, increased sense of ability and self-confidence. While 



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these feelings are associated specifically to the exercise domain, it is hypothesized that 
they may generalize to other areas of life, resulting in an increase of psychological 
well-being (Shaw et al., 2005).

The social interaction hypothesis proposes that social interaction and support from 
other people in an exercise setting provides a significant proportion of the PA effect on 
mental health (Crone, Smith, & Gough, 2009). Research confirmed the relationship 
between social network ties and positive mental state in the older population, showing 
that people who are more socially connected tend to report greater emotional well-
being compared to those who have fewer social ties (Litwin & Shiovitz-Ezra, 2011). 
Especially for some excluded groups, such as older people or people with depression, 
the opportunity for social interaction may be particularly important for their psycho-
logical health. 

PHYSICAL ACTIVITY AND QUALITY OF LIFE IN OLDER ADULTS

An important component in determining the health status of an individual, par-
ticularly during the process of aging, is quality of life (QoL). QoL is a global, multidi-
mensional construct representing overall relative satisfaction with life. The concept of 
QoL includes different domains such as functional ability, psychological well-being, 
social relationships, socioeconomic status, living environment, daily activities, health, 
cultural and ethical values (Bowling, 2005). Older adults are often more concerned 
with their QoL than their longevity per se, so improving and maintaining a high QoL 
assumes great importance among the elderly. Because QoL is adversely impacted by 
illness and disability, an improved physical function might be expected to cause a paral-
lel increase in QoL (Fleg, 2012). 

PA has been consistently associated with enhanced well-being and QoL in later life 
(Netz et al., 2005). Different studies conducted on older adults from the general popula-
tion have found that physical exercise may improve social interactions, self-esteem and 
global QoL. Furthermore, it may also contribute to increased independence in activities 
of daily living in older adults (Taylor et al., 2004; Warburton & Bredin, 2017).

Flynn et al. (2009) have investigated the effects of exercise training on health sta-
tus and QoL (assessed by the Kansas City Cardiomyopathy Questionnaire – KCCQ; 
Green, Porter, Bresnahan, & Spertus, 2000) in 2,331 older adults with heart failure. 
The intervention included usual care plus aerobic exercise training, consisting of 36 
supervised sessions followed by home-based training, compared to usual care alone. 
The results demonstrate that the participation in an exercise training program provides 
a modest but statistically significant improvement in patient-reported health status and 
QoL compared with usual care. Similarly, Austin and colleagues (2005) aimed to de-
termine whether a cardiac rehabilitation programme improved health-related quality of 
life of 200 patients with heart failure aged 60 to 89. Patients were randomised to one of 
two interventions, outpatient clinic based care (standard care) or clinic based care plus 
cardiac rehabilitation, including a 24-week of low resistance training. Health-related 



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quality of life was measured with the Minnesota living with heart failure question-
naire (MLHF; Rector, Kubo, & Cohn, 1993) and the EuroQoL questionnaire (Brooks 
& de Charro, 1996) at baseline and 24 weeks. Patients attending cardiac rehabilitation 
attained a significant improvement in health-related QoL compared to the patients in 
standard care. 

To establish the association between PA and QoL in older adults, Vagetti and col-
leagues (2014) conducted a systematic review of the literature in the period between 
2000 and 2012. In general, the studies included in this review showed a positive as-
sociation between PA and many but not all domains of QoL. Results indicated that PA 
was often associated with the following QoL domains: functional capacity; general 
life autonomy; past, present and future activities; intimacy and mental health. These 
associations suggest that PA may promote physical independence as well as essential 
mental health aspects of QoL. 

Although the results of recent literature suggest a positive and consistent influence 
on the relationship between PA and QoL in older adults, the mechanisms underlying 
these effects are still unclear. Self-efficacy – commonly defined as the belief in one’s 
capabilities to achieve a goal or an outcome, appears to be an important variable that 
mediates the relationship between PA and QoL (Vagetti et al., 2014). Researchers have 
consistently shown that when PA is associated with significant increases in self-effi-
cacy, improvements in health-related QoL are most likely to occur (Mudrak, Stochl, 
Slepicka, & Elavsky, 2016). Efficacy beliefs also predict the behaviour and perfor-
mance of older adults with mobility problems, balance difficulties, and are therefore at 
risk for falls (Rejski & Mihalko, 2001; McAuley et al., 2011). 

Furthermore, exercise and PA have been proposed to impact the QoL and well-be-
ing through their moderating and mediating effects on constructs such as self-concept 
and self-esteem. In particular, physical self-esteem has repeatedly been shown to be 
an important mental health status indicator in the context of PA and QoL relationship 
(Phillips, Wójcicki, & McAuley, 2013). 

PA and QoL play an important role in enhancing successful aging (Choi, Lee, Lee, 
& Jung, 2017). According to Vagetti et al. (2014), evidence on the impact of PA fre-
quency and intensity on QoL domains is still limited. Therefore, further longitudinal 
and intervention studies are needed to better understand this influence. 

CONCLUSION

Growth in the elderly population means an increased risk for poor mental health 
outcomes such as depression, anxiety, and serious constraints on the QoL among older 
people. In recent years, a substantial body of literature has tried to explain the mental 
health benefits of PA in older adults. Although most of the studies discussed in this arti-
cle report an inverse, dose-dependent relationship between PA participation and mental 
health outcomes, some questions remain unanswered, such as the right amount of ex-
ercise (e.g. frequency and intensity) to improve this protective response. Also, further 



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studies using objective PA measures can contribute significantly to establish clear links 
between the amount of exercise and specific mental health benefits in older adults.

Regular PA and exercise are important for healthy aging and are beneficial for 
chronic disease management. However, there is evidence that as people age, they tend 
to exercise progressively less and most of them do not meet the recommended PA 
levels, particularly those living in less affluent areas (McPhee et al., 2016). Greater 
consideration of all psychological benefits of physical exercise is needed among health 
and exercise professionals working with the elderly. The main challenge is to find effec-
tive ways to encourage older adults to increase PA and reduce sedentary behaviour. It is 
therefore important to develop strategies to overcome barriers to exercise and stimulate 
participation in such activities that will be adapted to the needs and interests of older 
individuals. 

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