Changes in perceived stress and repetitive negative thinking fully mediated the treatment effects of a transdiagnostic exercise intervention on global symptom severity, suggesting these may be key transdiagnostic mechanisms underlying the treatment effect of exercise.
Treatment effects on global symptom severity were fully mediated by changes in perceived stress at both 6 and 12 months.
Treatment effects on global symptom severity were fully mediated by changes in repetitive negative thinking at both 6 and 12 months.
Sleep quality was included as a mediator but was not reported as a significant mediator of treatment effects on global symptom severity.
The ImPuls intervention was a 6-month transdiagnostic group exercise program added to treatment-as-usual, tested across multiple mental health diagnoses.
Structural equation modeling was used as a secondary analysis of an RCT to test two path models of mediation from baseline to 6 and 12 months.
This research examined why exercise helps people with mental health problems feel better overall. The study tested a 6-month group exercise program called ImPuls, which was added to usual care, in nearly 400 physically inactive adults who had diagnoses such as depression, panic disorder, PTSD, agoraphobia, or insomnia. The researchers wanted to understand whether the mental health benefits of exercise came through specific psychological pathways — namely, reductions in perceived stress, reductions in repetitive negative thinking (such as rumination or worry), or improvements in sleep quality. The findings showed that both reduced stress perception and reduced repetitive negative thinking fully explained the link between the exercise program and improvements in overall mental health symptoms — and these effects held up both at the end of the 6-month intervention and at a 12-month follow-up. In other words, participants who exercised felt less stressed and engaged in less repetitive negative thinking, and these changes accounted for why their mental health symptoms improved. Sleep quality was examined but did not emerge as a significant mediator in the same way. This research suggests that exercise may help people with a range of mental health conditions by targeting psychological processes — specifically stress and repetitive negative thinking — that cut across diagnostic boundaries. This points to potential transdiagnostic mechanisms, meaning exercise could be beneficial not just for one specific disorder but across multiple mental health conditions. These findings may help clinicians and researchers better understand how to design and explain exercise-based mental health interventions.
Frei A, Studnitz T, Seiffer B, Welkerling J, Zeibig J, Herzog E, et al.. (2026). Changes in repetitive negative thinking and stress perception mediate treatment effects of a transdiagnostic exercise intervention.. Psychological medicine. https://doi.org/10.1017/S0033291725103085