Perceived Stress and Domain-Specific Physical Activity in Relation to Anxiety and Somatic Symptom Burden Among Romanian Adults: A Cross-Sectional Online Survey.
Fadgyas Stanculete M, Căpățînă O, Chihaia C • Medicina (Kaunas, Lithuania) • 2026
Perceived stress showed the strongest association with both anxiety and somatic symptom burden, while vigorous leisure-time activity was specifically and inversely associated with somatic symptoms, an association concealed when using a single total activity score.
Key Findings
Results
Perceived stress was strongly correlated with both anxiety and somatic symptom burden in Romanian adults.
Perceived stress correlated with anxiety at rho = 0.486 and with somatic symptoms at rho = 0.428.
Both correlations were statistically significant after Benjamini-Hochberg false-discovery-rate adjustment (adjusted p < 0.001).
In fully adjusted multivariable models, a one-standard-deviation-higher PSS-14 score was associated with 5.57 more BAI points (95% CI 4.50–6.63).
The same one-SD increase in PSS-14 was associated with 2.12 more PHQ-15 points (95% CI 1.62–2.63).
Median perceived stress score was 24 on the 14-item Perceived Stress Scale.
Results
Vigorous leisure-time physical activity was inversely associated with somatic symptom burden, independent of perceived stress.
Vigorous leisure-time activity was inversely correlated with somatic symptoms at rho = -0.205 (FDR-adjusted p = 0.002).
In the fully adjusted multivariable model, vigorous leisure-time activity was associated with -0.84 PHQ-15 points per standard deviation (95% CI -1.35 to -0.32).
This association with somatic symptoms remained statistically significant after adjustment for perceived stress.
The association between vigorous leisure-time activity and anxiety (BAI) was no longer statistically significant after adjustment for perceived stress.
Results
Total physical activity was not associated with either anxiety or somatic symptom outcomes.
Using a single total activity score, no statistically significant association was found with BAI or PHQ-15.
The authors note that 'the use of a single total activity score concealed a more specific inverse association between vigorous leisure-time activity and somatic symptoms.'
Physical activity was measured using the Global Physical Activity Questionnaire, which distinguishes work, transport, and leisure domains.
Domain-specific scores were log(1 + x)-transformed and standardized for analysis.
Methods
The study sample of 307 Romanian adults had median scores indicating mild levels of anxiety and somatic symptoms.
The cross-sectional online survey included 307 Romanian adults aged 18–65 years.
Median anxiety score (Beck Anxiety Inventory) was 10.
Median somatic symptom score (PHQ-15) was 7.
Covariates in multivariable models included sex, age group, education, body mass index, and religious affiliation.
Robust standard errors (HC3) were used in multivariable linear models to account for potential heteroscedasticity.
Results
Domain-specific physical activity showed differential associations with mental health outcomes that varied by domain and symptom type.
Vigorous leisure-time activity was inversely associated with somatic symptoms but not significantly with anxiety after full adjustment.
Work-domain and transport-domain physical activity were not reported as significantly associated with either outcome.
Sedentary time was examined as an additional variable alongside domain-specific activity.
Sensitivity analyses included participation vs. non-participation, symptom severity categories, total activity, and exclusion of an extreme activity value.
What This Means
This research suggests that how stressed a person feels is more strongly linked to anxiety and physical (somatic) symptoms than how much they exercise overall. In a study of 307 Romanian adults, researchers found that people who reported higher perceived stress also reported more anxiety symptoms and more unexplained physical complaints, even after accounting for factors like age, sex, education, and body weight. The relationship was strong enough that each meaningful increase in stress scores corresponded to notably higher anxiety and somatic symptom scores.
The study also found that not all exercise is equal when it comes to mental and physical health. Only vigorous physical activity done during leisure time — such as running, swimming, or intense sports — was linked to fewer somatic (physical) symptoms. This link held up even after accounting for stress levels. Importantly, when researchers looked at total physical activity (combining work, transport, and leisure), this specific benefit disappeared, suggesting that lumping all activity together hides meaningful differences. Physical activity done at work or for transportation did not show the same benefit.
This research suggests that future studies and public health efforts should distinguish between different types and contexts of physical activity rather than treating all movement as equivalent. The findings are based on a cross-sectional online survey, meaning the data reflects one point in time and cannot determine cause and effect — it is unclear whether exercise reduces symptoms or whether people with fewer symptoms are more able to exercise vigorously. Longitudinal studies with objective activity measurements and more representative samples are needed to confirm these patterns.
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Fadgyas Stanculete M, Căpățînă O, Chihaia C. (2026). Perceived Stress and Domain-Specific Physical Activity in Relation to Anxiety and Somatic Symptom Burden Among Romanian Adults: A Cross-Sectional Online Survey.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina62081530