Age-Dependent Heterogeneity in the Association Between Physical Activity and Mental Distress: A Causal Machine Learning Analysis of 3.2 Million U.S. Adults
For public health researchers and policymakers, this reveals that the well-known exercise-mental health link may not apply to young adults, whose distress may require interventions beyond physical activity.
Analyzing 3.2 million U.S. adults, the study found that the protective association between physical activity and mental distress strengthens with age, but is negligible in young adults (18-24), with odds ratios approaching 1.0 in recent years, indicating the benefit may not generalize to this group.
Physical activity (PA) is widely recognized as protective against mental distress, yet whether this benefit varies systematically across population subgroups remains poorly understood. Using pooled data from ten consecutive annual waves of the U.S. Behavioral Risk Factor Surveillance System (2015-2024; n = 3,242,218), we investigate heterogeneity in the association between leisure-time PA and frequent mental distress (FMD, >=14 days/month) across age groups. Survey-weighted logistic regression reveals a striking age gradient: the adjusted odds ratio for PA ranges from 0.89 among young adults (18-24) to 0.50 among adults aged 55-64, with the protective association strengthening monotonically with age. Temporal analysis across all ten years shows that the young-adult PA effect has been eroding over the past decade, with the 18-24 OR reaching 1.01 (null) in both 2018 and 2024 -- paralleling the deepening youth mental health crisis. Causal Forest via Double Machine Learning independently identifies age as the dominant driver of treatment effect heterogeneity (feature importance = 0.39, 2.5x the next predictor). E-value sensitivity analysis, propensity score overlap checks, placebo tests, and imputation comparisons confirm the robustness of the findings. These results suggest that the well-documented exercise--mental health link may not generalize to the youngest adult population, whose distress appears increasingly driven by stressors that PA alone cannot mitigate.