Real-world quality of life and sleep outcomes in patients treated with THC- and CBD-rich Cannabis oil: a cross-sectional study.

Social anxiety disorder (SAD) is a prevalent psychiatric condition characterized by marked and persistent fear of social situations. Epidemiological estimates indicate a lifetime prevalence of approximately 4–13% across populations, placing it among the most common anxiety disorders and a leading psychiatric contributor to years lived with disability worldwide. Typically emerging during adolescence, untreated SAD frequently follows a chronic course, producing substantial impairment of personal functioning and considerable socioeconomic burden (; ; ). Although cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) have been established as first-line treatments, a substantial proportion of patients exhibit inadequate therapeutic responses or cannot tolerate pharmacological side effects, reflecting a well-documented phenomenon of treatment resistance (; ). Additional barriers, including stigma associated with psychiatric medication, avoidance of face-to-face psychotherapy, and limited treatment accessibility, further constrain the widespread implementation of conventional interventions (). Against this backdrop, identifying accessible, generally well-tolerated, and readily integrable adjunctive or alternative strategies has emerged as a priority in clinical research. Regular physical activity and structured exercise have attracted growing interest owing to their broad physical and psychological health benefits. Accumulating evidence indicates that higher levels of physical activity correlate with reduced anxiety symptomatology (; ), while targeted exercise training demonstrates clear potential for ameliorating symptoms across diverse anxiety disorders (; ). Exercise interventions offer notable advantages, including low cost, generally few adverse effects, and ready scalability in community settings, features that may render them particularly attractive for SAD patients who tend to avoid conventional medical environments. Recent reviews have further emphasised that exercise may improve mental health through neurobiological and psychosocial mechanisms, including modulation of stress pathways, enhancement of neuroplasticity, and promotion of emotional resilience (). Because much of this evidence derives from general or mixed anxiety samples, however, it cannot be uncritically extrapolated to SAD, whose defining feature is fear of social evaluation rather than diffuse anxiety. Exercise may nonetheless be especially pertinent to SAD: group and outdoor formats provide graded exposure to social situations, while gains in self-efficacy, body image, and physical competence target core maintaining factors of social-evaluative fear, extending beyond exercise’s general anxiolytic effects. This mini-review synthesizes the clinical evidence for exercise interventions in social anxiety, examines their relationship with mainstream therapies, explores putative mechanisms, identifies current research gaps, and outlines future directions, intending to inform integrative management strategies for SAD (). Accordingly, this review is organized around one primary question: Does exercise or structured physical activity have a role as an adjunctive intervention for clinically diagnosed SAD, and, if so, through what pathways? and four subsidiary questions: (i) what direct evidence exists for exercise interventions in clinically diagnosed SAD; (ii) what can be inferred, more cautiously, from indirect evidence in subclinical, analogue, or transdiagnostic samples; (iii) how exercise might be integrated with established psychological and pharmacological treatments, particularly CBT and exposure; and (iv) which psychological, physiological, and behavioral mechanisms have been proposed, and how well supported each is. To keep these distinctions explicit, evidence drawn from subclinical or non-SAD populations and from mechanistic or special-population studies is presented as indirect and labelled accordingly, and the speculative future directions are demarcated from the current evidence base. The principal empirical studies, together with their evidence proximity to exercise for SAD, are catalogued in .