Introduction: There is a positive association between exercise and improved mental health in the general population. Although there is a greater burden of psychological distress among lesbian, gay, and bisexual (LGB) people, little is known about the association between exercise and mental health in this population. The authors explored the association between exercise and poor mental health reported by LGB adults in the United States. Methods: Our analyses used data from the 2017 Behavioral Risk Factor Surveillance System survey. Multiple regression analyses were used to determine the association between exercising and mental health days adjusting for sociodemographic characteristics. Results: Data were available for 6371 LGB participants. LGB adults who participated in any exercise reported almost 1.0 day less of poor mental health in the past 30 days compared with LGB adults who did not exercise (P ≤ .01). LGB adults who met one or both of the physical activity guidelines had between 1.2 and 1.7 days less of poor mental health compared with those who did not meet the guidelines (P ≤ .01). Conclusion: Fewer days of poor mental health were reported by LGB adults who exercised. Determining whether physical activity interventions, including aerobic and strengthening exercises, could improve mental health outcomes in LGB adults should be studied.

Mental illness is a public health concern in the United States, with half of all people experiencing mental illness at some point in their life.1,2 Lesbian, gay, and bisexual (LGB) people are more likely to experience poor mental health when compared with their heterosexual peers.38 A longitudinal study found that bisexual participants had higher odds of major depression, anxiety, and suicidal ideation (2.1, 1.9, and 3.9, respectively) compared with heterosexual participants.4 Gay men and lesbian women were 1.5 times more likely to report major depression and 3 times more likely to report anxiety and suicidal ideation than their heterosexual peers.4 Other researchers have also found worse mental health outcomes among LGB participants, including psychological distress, mental disorders, anxiety and depression, or low well-being scores.38

The Minority Stress Theory explains how stigma and discrimination are linked to the higher prevalence of physical health problems and mental distress among the LGB population.9,10 According to the theory, LGB people experience an excess of social stressors as a result of recurrent stigma, discrimination, victimization, identity concealment, and internalized homophobia, which eventually increases the risk of mental health problems.9,10 Research has linked experiences of minority stress with depression, greater depressive symptoms, anxiety, suicidal ideation, and substance use.1114 However, some members of the LGB community may not only be able to cope with these challenges but thrive despite experiencing minority stress. This ability, known as resilience or a positive adaptation to minority stress, has been shown to attenuate the negative health impacts of stress.15 Resilience can be individual or community based. Individual resilience includes the qualities that people possess that help in coping with stress (eg, internal locus of control), whereas community resilience is more ecological and includes community norms and values; shared cultural identities; social support; community resources, such as a lesbian, gay, bisexual, transgender, and queer (LGBTQ) community center; advocacy; and LGBTQ affirming laws and policies.15

There is a positive association between physical activity or exercise and improved mental health. Exercise has been found to reduce psychological distress, including depression, stress, anxiety, and poor mental health, while improving a sense of well-being and quality of life.1622 Although most studies have focused on the mental health benefits of aerobic exercise, muscular strengthening exercise or a combination of aerobic and strengthening exercises are associated with improved mental health.1622 There are several mechanisms, including physiological, psychological, and inflammatory, by which exercise is thought to improve mental health outcomes.16

According to the physical activity guidelines revised by the U.S. Department of Health and Human Services, adults are recommended to get 150 to 300 minutes of moderate-intensity aerobic exercise or 75 to 150 minutes of vigorous-intensity aerobic exercise per week.23 In addition, it is recommended that adults perform muscular strengthening exercise 2 or more days per week. Research in the general population has found that people who met physical activity guidelines were 3 times more likely to report positive mental health compared with those who do not meet these guidelines.19

A paucity of research has explored the relationship between physical activity/exercise and mental health outcomes among the LGB population. Previous research regarding exercise and mental health of LGB people has been disease focused, with great emphasis on HIV and cancer.2427 The purpose of this study was to determine whether exercise was associated with fewer days of poor mental health reported by LGB adults in the United States. The research questions included: Does participating in any exercise or physical activity in the past month result in reporting fewer days of poor mental health during that month? Did those who met aerobic physical activity and/or muscular strengthening exercise guidelines in a month report fewer days of poor mental health in that month? The goal of this study is to determine if doing any exercise is associated with fewer days of poor mental health among LGB adults or if meeting exercise guidelines is required.

Methods

Study Design, Data Collection, and Participants

This study was a secondary data analysis of data from the 2017 US Behavioral Risk Factor Surveillance System (BRFSS) cross-sectional survey. BRFSS is a random digit dial (landline and cell phone), health-related telephone survey of over 400,000 noninstitutionalized adults aged 18 years and older.28 It is a collaboration between the Centers for Disease Control and Prevention and US states and territories. In 2014, the BRFSS included a sexual orientation question as an optional module. In 2017, 28 states included this question.

Measures

Detailed exercise and physical activity questions are asked in the core component of the BRFSS survey in odd years only.29 Thus, we used the 2017 BRFSS data since the 2019 survey data were not yet available at the time of the data analyses, and these questions were not asked in 2018. The exercise module includes questions on both aerobic and muscle strengthening exercise. To determine aerobic exercise amounts, participants were asked the following questions: “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?”29 Participants who responded “yes” were then asked about the type of physical activity or exercise. The surveyor conducting the survey used the Physical Activity Coding List, which includes 76 different physical activities or exercises, to confirm the type of physical activity or exercise with the participant.29 Participants were then asked, “How many times per week or per month did you take part in this activity during the past month?” and “And when you took part in this activity, for how many minutes or hours did you usually keep at it?”29 The participants were then asked the same series of questions for the next most frequent physical activity or exercise.29 Each of the 76 types of physical activity had an assigned intensity or metabolic equivalent value based on values from Compendium of Physical Activities. To determine if participants had met the U.S. Department of Health and Human Services’ guidelines for aerobic physical activity, an algorithm was applied, using intensity, time, and frequency, and the results were coded into a new variable within the data set.22,29 Those who accumulated 150+ minutes of moderate or 75+ minutes of vigorous aerobic physical activity weekly were considered to have met the recommended guidelines for aerobic physical activity. All others were considered to not meet these guidelines.30

For the strengthening exercise, participants were asked the number of times that they did exercise to strengthen their muscles, such as yoga, sit-ups or push-ups, or using weight machines or free weights.29 Based on the answer to this question, a variable was created to indicate whether or not participants met the muscle strengthening guidelines: performing muscular strengthening exercise 2 or more times per week. A new variable was calculated to identify participants who met both guidelines (aerobic physical activity and muscle strengthening guidelines), met only the aerobic physical activity guideline, met only the muscle strengthening guideline, or did not meet either guideline.30 To answer the first research question, we used the initial question asking about any physical activity or exercise in the past month. To answer the second research question, we used the aerobic and strengthening exercise guideline variable that indicated whether participants met both guidelines, one guideline, or neither guidelines.

Participants in the BRFSS were also asked demographic questions, disability questions, a sexual orientation question, and a mental health question. For this analysis, we used the demographic data for age, race/ethnicity, education, income, and employment. The disability question was related to mobility: “Do you have serious difficulty walking or climbing stairs?”29 The sexual orientation question was “Do you consider yourself to be: straight, lesbian or gay, bisexual, or other?”29 Participants who identified as lesbian or gay and indicated that their sex was female were recoded as lesbian women, while those who indicated their sex was male were recoded as gay men. Participants who identified as bisexual and indicated that their sex was female were recoded as bisexual women, while those who indicated their sex was male were recoded as bisexual men. Participants who identified as straight, other, or refused to answer were omitted from this analysis.

Participants were also asked about mental health days using the following question, “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?”29 This answer was treated as a continuous variable ranging from 0 to 30. Participants were also asked if they had ever been told that they have a depressive disorder, including depression, major depression, dysthymia, or minor depression.

Statistical Analysis

Descriptive statistics were calculated to address the data profile, and chi-square (χ2) tests were used to determine significant differences in demographic characteristics between (1) those who did any exercise and those who did not and (2) those who met the physical activity guidelines and those who did not. Weighted data were used for these analyses. Multivariate regression analyses were performed to determine the differences in the number of poor mental health days (dependent variable) between (1) those who did any exercise and those who did not (independent variable) and (2) those who met both guidelines, one guideline, or neither guidelines (independent variable). Covariates included the following sociodemographics: educational attainment, age, race/ethnicity, income, employment status, and mobility disability, which have been found to influence mental health.3136 Multicollinearity did not exist among the sociodemographics, as all tolerances were greater than 0.1. We conducted a sensitivity analysis to determine whether having a depressive disorder might explain why LGB adults were less likely to exercise or meet the physical activity guidelines than those without a depressive disorder because of the potential for reverse causation between mental health and exercise (ie, people who are depressed being less likely to exercise). SAS complex survey procedures (version 9.3; SAS Institute Inc, Cary, NC) were used for the statistical analyses. Significance was set at P < .05.

Results

Descriptive Characteristics

Complete data on all variables of interest were available for 6371 out of 6414 participants who identified as LGB in the 2017 BRFSS. Twenty-six percent identified as gay men, 16% as lesbian women, 20% as bisexual men, and 38% as bisexual women. Descriptive characteristics of the participants are provided in Tables 1 and 2. Seventy-five percent of participants reported doing some exercise in the past month. Although doing any exercise did not differ by sexual orientation, participants who reported doing any exercise were more likely to (1) have a college degree, (2) identify as white, (3) make more than $75,000, (4) be able to work, and (5) not have a mobility disability (Table 1). Forty percent of participants did not meet either exercise guidelines, whereas about 25% either met both guidelines or the aerobic guideline only. There were significant differences by sexual orientation, and each of the sociodemographic characteristics for participants meeting both, one, or neither of the guidelines (Table 2).

Table 1

Demographic Characteristics of Those Who Did Any Exercise in the Past Month by Sexual Orientation

Did Any Exercise
VariableYesNoTotalχ2, P value
All, n (%weighted)4706 (74.67)1708 (25.33)6414
Days of poor mental health, mean (SD)6.18 (9.38)8.99 (11.46)6.93 (10.06)
Sexual orientation, n (%weighted) 3.96, .27
 Lesbian914 (15.76)354 (18.85)1268 (16.54)
 Bisexual male863 (19.07)342 (21.03)1205 (19.57)
 Bisexual female1628 (38.68)563 (35.28)2191 (37.81)
 Gay male1301 (26.49)449 (24.85)1750 (26.08)
Educational attainment, n (%weighted) 34.42, <.01
 Did not graduate high school214 (8.73)153 (15.27)367 (10.38)
 High school graduate890 (25.39)477 (26.72)1367 (25.73)
 Some college1321 (34.53)536 (37.95)1857 (35.40)
 College graduate2273 (31.19)535 (19.83)2808 (28.31)
 Not reported8 (0.16)7 (0.23)15 (0.18)
Age, n (%weighted), y 15.77, <.01
 25–34973 (25.13)296 (22.37)1269 (24.43)
 35–44594 (13.45)223 (14.56)817 (13.73)
 45–54760 (13.18)290 (14.31)1050 (13.46)
 55–64817 (9.98)334 (13.30)1151 (10.82)
 65+740 (7.35)322 (10.78)1062 (8.22)
 18–24822 (30.91)243 (24.67)1065 (29.33)
Race/ethnicity, n (%weighted) 20.98, <.01
 Black315 (10.35)185 (17.26)500 (12.10)
 Other260 (7.22)103 (5.28)363 (6.73)
 Multi211 (3.01)69 (2.36)280 (2.85)
 Hispanic443 (16.59)183 (18.93)626 (17.18)
 White3406 (61.45)1136 (54.78)4542 (59.76)
 Not reported71 (1.38)32 (1.40)103 (1.38)
Income, n (%weighted) 53.83, <.01
 <$10,000228 (6.10)118 (6.63)346 (6.23)
 $10,000–$24,999880 (18.73)515 (30.92)1395 (21.82)
 $25,000–$49,9991057 (21.41)380 (24.18)1437 (22.11)
 $50,000–$74,999648 (12.25)195 (10.25)843 (11.74)
 ≥$75,0001386 (28.13)274 (14.88)1660 (24.78)
 Not reported507 (13.38)226 (13.14)733 (13.32)
Employment, n (%weighted) 17.66, <.01
 Unemployed316 (9.12)121 (8.90)437 (9.07)
 Out of labor force (eg, retired)1262 (25.09)419 (22.48)1681 (24.43)
 Unable to work302 (5.83)277 (11.96)579 (7.38)
 Employed2803 (58.83)876 (55.61)3679 (58.02)
 Not reported23 (1.12)15 (1.06)38 (1.10)
Mobility disability, n (%weighted)54.50, <.01
 Yes496 (9.25)479 (22.84)975 (12.69)
 No4199 (90.63)1223 (76.80)5422 (87.13)
 Not reported11 (0.12)6 (0.36)17 (0.18)

Abbreviation: χ2, Rao–Scott chi-square statistic. Note: χ2 and P values are significant at P ≤ .05.

Table 2

Demographic Characteristics of Health by Meeting Physical Activity Guidelines (Met Both, Met Aerobic, Met Strength, and Met Neither)

VariableMet bothMet aerobicMet strengthMet neitherχ2, P value
All, n (%weighted)1339 (22.31)1935 (27.93)615 (10.68)2482 (39.08)
Days of poor mental health, mean (SD)5.41 (8.97)6.01 (9.37)7.08 (9.88)8.43 (10.93)
Sexual orientation, n (%weighted) 19.12, .02
 Lesbian252 (11.79)404 (17.72)105 (16.70)497 (18.37)
 Bisexual male270 (21.44)342 (19.47)101 (16.47)486 (19.49)
 Bisexual female432 (36.29)645 (39.61)239 (34.25)866 (38.52)
 Gay male385 (30.48)544 (23.20)170 (32.580)633 (23.63)
Educational attainment, n (%weighted) 23.86, .02
 Did not graduate high school47 (8.39)97 (10.10)29 (8.27)192 (12.42)
 High school graduate213 (21.16)385 (26.27)117 (27.93)636 (27.26)
 Some college378 (37.27)549 (35.09)169 (29.23)749 (36.10)
 College graduate699 (33.12)901 (28.38)298 (34.36)898 (23.99)
 Not reported2 (0.06)3 (0.16)2 (0.20)7 (0.23)
Age, n (%weighted), y 29.98, .01
 25–34307 (26.81)333 (23.97)168 (31.47)451 (21.47)
 35–44153 (11.62)235 (13.00)80 (12.75)343 (15.63)
 45–54216 (12.27)318 (14.08)86 (13.08)425 (13.90)
 55–64225 (10.37)396 (12.24)66 (4.68)457 (11.73)
 65+202 (6.54)373 (9.54)76 (6.04)401 (8.77)
 18–24236 (32.39)280 (27.16)139 (31.98)405 (28.50)
Race/ethnicity, n (%weighted) 44.27, <.01
 Black83 (11.38)107 (7.60)50 (10.44)255 (16.14)
 Other80 (6.04)96 (5.67)33 (6.39)153 (7.98)
 Multi68 (4.05)88 (3.39)24 (1.81)99 (2.09)
 Hispanic132 (20.08)155 (14.33)87 (21.98)242 (16.16)
 White955 (57.08)1460 (67.46)414 (59.00)1687 (56.06)
 Not reported21 (1.37)29 (1.55)7 (0.38)46 (1.57)
Income, n (%weighted) 36.94, <.01
 <$10,00051 (6.20)95 (5.75)28 (5.79)170 (6.78)
 $10,000–$24,999229 (17.89)362 (20.51)132 (20.20)667 (25.62)
 $25,000–$49,999279 (21.87)464 (19.57)142 (22.91)540 (23.98)
 $50,000–$74,999218 (12.95)237 (11.24)73 (8.95)311 (12.22)
 ≥$75,000433 (29.46)567 (29.63)176 (29.15)479 (17.48)
 Not reported129 (11.63)210 (13.29)64 (13.01)315 (13.92)
Employment, n (%weighted) 26.65, <.01
 Unemployed78 (7.52)140 (9.65)31 (10.34)187 (9.30)
 Out of labor force (eg, retired)346 (23.06)581 (28.92)159 (22.04)586 (22.69)
 Unable to work67 (4.32)119 (5.78)47 (5.04)343 (10.82)
 Employed841 (64.18)1089 (54.65)376 (62.11)1344 (55.74)
 Not reported7 (0.93)6 (1.00)2 (0.48)22 (1.45)
Mobility disability, n (%weighted)38.23, <.01
 Yes107 (6.33)226 (9.65)94 (12.30)538 (18.39)
 No1227 (93.36)1707 (90.29)521 (87.70)1935 (81.57)
 Not reported5 (0.32)2 (0.06)0 (0.00)9 (0.05)

Abbreviation: χ2, Rao–Scott chi-square statistic. Note: χ2 and P values are significant at P ≤ .05.

The mean number of poor mental health days per month for the LGB participants in total was 6.9 (SD = 10.1). People who reported any exercise during the past month had a mean of 6.2 days (SD = 9.4) compared with those who did not report any exercise who had a mean of 9.0 days (SD = 11.5). Those who met both the aerobic activity and muscular strength guidelines had a mean of 5.4 poor mental health days (SD = 9.0) compared with those who only met the aerobic activity guideline with 6.0 (SD = 9.4), those who only met the muscular strength guideline with 7.1 (SD = 9.9), and those who did not meet either guideline with 8.4 (SD = 10.9).

Multiple Regression Analysis

After accounting for sociodemographics in the multivariate analysis, participants who did any exercise in the past month reported fewer poor mental health days, with a significant reduction by −0.89 (95% confidence interval [CI], −1.34 to −0.50; P < .01; in Table 3). Participants who met aerobic or strength guidelines had a significantly lower number of poor mental health days by −1.22 days (95% CI, −1.75 to −0.69; P < .01) and −1.72 days (95% CI, −2.47 to −0.97; P < .01), respectively. Moreover, when meeting both guidelines, the number of poor mental health days was significantly reduced by −1.29 days (95% CI, −2.14 to −0.45; P < .01).

Table 3

Multiple Regression Analyses—Number of Days of Poor Mental Health by Exercising Any in the Past Month and Meeting Physical Activity Guidelines

Doing Any ExerciseMet PA guidelines
VariablesEstimate (95% CI)P valueEstimate (95% CI)P value
Intercept8.48 (7.60 to 9.19)<.018.80 (7.94 to 9.66)<.01
Exercise any
 Yes−0.89 (−1.34 to −0.50)<.01<.01
 NoREFREFREF
Met PA guidelines
 Both−1.29 (−2.14 to −0.45)
 Aerobic−1.22 (−1.75 to −0.69)
 Strength−1.72 (−2.47 to −0.97)
 NeitherREFREF
Sexual orientation
 Lesbian0.10 (−0.56 to 0.73).760.02 (−0.64 to 0.68).76
 Bisexual male0.29 (−0.29 to 0.88).340.23 (−0.36 to 0.83).34
 Bisexual female1.64 (0.79 to 2.41)<.011.54 (0.70 to 2.38)<.01
 Gay maleREFREFREFREF
Educational attainment
 Did not graduate high school4.22 (3.00 to 4.72)<.014.16 (3.24 to 5.08)<.01
 High school graduate0.63 (−0.03 to 1.43).090.64 (−0.12 to 1.40).09
 Some college1.09 (0.29 to 1.89)<.011.07 (0.25 to 1.89)<.01
 College graduateREFREFREFREF
Age, y
 18–24REFREFREFREF
 25–34−1.86 (−2.72 to −1.21)<.01−1.86 (−2.62 to −1.10)<.01
 35–44−2.67 (−3.31 to −2.05)<.01−2.74 (−3.39 to −2.09)<.01
 45–54−4.91 (−6.07 to −3.60)<.01−4.98 (−6.30 to −3.66)<.01
 55–64−6.77 (−7.24 to −5.87)<.01−6.91 (−7.63 to −6.18)<.01
 65+−8.68 (−9.40 to −7.92)<.01−8.72 (−9.51 to −7.94)<.01
Race/ethnicity
 Black−3.51 (−3.87 to −3.03)<.01−3.55 (−3.99 to −3.10)<.01
 Other−0.90 (−2.64 to 0.27).23−0.96 (−2.45 to 0.53).23
 Multi0.82 (−0.70 to 2.44).300.90 (−0.67 to 2.47).30
 Hispanic−1.95 (−2.63 to −1.21)<.01−1.87 (−2.60 to −1.15)<.01
 WhiteREFREFREFREF
Income
 <$10,000−0.06 (−1.03 to 1.63).93−0.15 (−1.53 to 1.22).93
 $10,000–$24,9991.41 (0.71 to 2.45)<.011.39 (0.51 to 2.27)<.01
 $25,000–$49,9990.84 (0.19 to 1.67).030.77 (0.01 to 1.53).03
 $50,000–$74,9991.17 (0.38 to 2.20).011.11 (0.17 to 2.04).01
 ≥$75,000REFREFREFREF
 Not reported
Employment
 Unemployed4.86 (4.02 to 5.78)<.014.78 (3.91 to 5.64)<.01
 Out of labor force (eg, retired)0.39 (−0.06 to 1.04).170.38 (−0.17 to 0.93).17
 Unable to work8.07 (6.51 to 9.00)<.017.91 (6.58 to 9.24)<.01
 EmployedREFREFREFREF
Mobility disability
 Yes3.01 (2.38 to 3.68)<.013.15 (2.45 to 3.84)<.01
 NoREFREFREFREF

Abbreviations: CI, confidence interval; PA, physical activity; REF, reference category. Note: Bold values are significant at P ≤ .05.

Table 3 also shows consistent significant findings among sociodemographics. The number of self-reported poor mental health days was lower among older age groups, compared with the youngest (18–24 y), and among black and Hispanic participants, compared with white participants (P ≤ .01). Bisexual women self-reported more days of poor mental health (P < .01) compared with gay men and lesbian women, as did participants who did not graduate from high school or who had completed some college compared with those who were college graduates ( P < .01). More days of poor mental health were also found among those who were unable to work or who were unemployed compared with those who were currently employed (P < .01) and among participants in lower ($10,000–$25,000, $25,000–$50,000, and $50,000–$75,000) income brackets compared with the highest (>$75,000) income bracket (P ≤ .01).

For the sensitivity analyses, doing any exercise (P = .16) or meeting both or one of the physical activity guidelines (P = .51) was not significantly associated with being told whether or not they had a depressive disorder. This suggests that having a diagnosis of a depressive disorder did not fully explain the associations found between exercise and meeting physical activity guidelines and poor mental health days for LGB participants.

Discussion

The LGB adults who participated in any exercise reported almost 1.0 day less of poor mental health compared with LGB adults who did not exercise. In addition, LGB adults who met one or both of the physical activity guidelines had between 1.2 and 1.7 days less of poor mental health in the past 30 days compared with those who did not meet the guidelines after adjusting for several sociodemographic characteristics. These findings are consistent with a previous study among the general population, which found a reduced mental health burden regardless of the forms of exercise.17

Less is known about the potential mechanisms (eg, psychological, physiological, or inflammatory), which may explain our findings. Psychological mechanisms, including stress relief, such as distraction from problems or worries, and self-efficacy, may be possible mechanisms by which physical activity reduces the psychological distress due to minority stress among LGB people. For example, physical activity is a method for escaping from daily stress or worries. Through escapism, a person is able to cope with emotional distress by suppressing acknowledgment of the stressor.37,38 For LGB people, physical activity may be a way to escape, even if for only a short time, from the stigma and discrimination experienced in daily life. However, there is a need to acknowledge that the physical activity contexts (eg, fitness facilities) might, in themselves, be a source of stress rather than an escape for some LGB people, resulting from discrimination, stereotypes, and homophobia within the physical activity contexts.3941 Self-efficacy has been shown to boost mental health via exercise, which may increase self-efficacy through the skill mastery to improve mental health outcomes.38 For LGB people, skill mastery attained through physical activity may lead to improved mental health. For example, the mastery of riding a bicycle could translate to improved self-efficacy and mental health.

Research on physical activity within LGB populations finds similar rates of participation among lesbian and bisexual women and their heterosexual peers or even higher rates among lesbians.42 For men, the result is mixed, with some studies finding similar rates of physical activity between gay men and heterosexual men and others finding lower rates of physical activity among gay men.43,44 Barriers to physical activity among LGB adults include phobias (homophobia, transphobia, and biphobia); fear of bullying, violence, discrimination, rejection, harassment, or being misgendered; fitness facilities that are unwelcoming (eg, a lack of same-sex couples memberships or universal/gender-neutral change rooms); gender binary activities (eg, women’s tennis); and a lack of sensitivity among fitness professionals.40,41,45 Because of the numerous health benefits associated with physical activity, including the mental health benefit found in our study, it is important to make physical activity and exercise programs, policies, and practices accessible to all LGB adults. Strategies for overcoming barriers may include making fitness facilities safe and inclusive spaces as well as creating diversity and sensitivity training for fitness professionals and programs that are nonbinary.

Consistent with previous research, lower income and unemployment were associated with more days of poor mental health among LGB participants. The stress and anxiety associated with unemployment and underemployment and the inability to pay bills or afford essentials, such as food, rent, or medicine, are well documented contributors to poor mental health.31,32,35,46,47 Greater job security, reduced unemployment, and a livable minimum wage are upstream factors that have positive impacts on mental health.46,47 LGB populations may be particularly vulnerable to poor mental health associated with employment due to workplace discrimination.48 There is currently no federal law to prohibit workplace discrimination based on sexual orientation, and only 22 states have laws prohibiting workplace discrimination of all employees based on sexual orientation and gender identity, with an additional 6 states prohibiting discrimination against public employees only.49 Without legal protections, LGB employees experience anxiety about disclosure, which, in turn, increases psychological distress.50,51 Research has also shown that LGB adults experience discrimination in hiring practices and compensation leading to higher unemployment and lower income, despite high rates of higher education.52,53 These multiple layers of discrimination in employment and compensation may contribute to psychological distress among LGB people, as postulated in the Minority Stress Theory.

We found fewer days of self-reported poor mental health among black and Hispanic participants. This finding was not expected, given concerns for greater experiences of discrimination and minority stress based on intersecting identities.54,55 However, the prevalence of any mental illness within the general adult population in 2017 reflects similar trends for minorities.1 This may also be due to measurement error or potential concerns with the cultural validity of the mental health questions.56 There also could be elements of either individual or community resilience within these populations, which may buffer against minority stress and bolster mental health. Researchers have found that belonging to multiple stigmatized groups may increase the mental health challenges associated with minority stress for some. However, for others, multiple identities may increase resilience through positive cultural identity, community and cultural connectedness, social support, and cultural resources.57,58 Further research is needed to better understand how both mental health and physical activity behaviors may differ for LGB adults who identify as racial/ethnic minorities and how these may be impacted by individual and/or community resilience. We also found that participants aged 50+ years reported fewer days of poor mental health compared with adults aged 18–24 years. This finding may support the socioemotional selectivity theory that posits that as people age, they become more focused on emotional health and social relationships.59

Limitations

Causation cannot be determined because this study used data from a cross-sectional survey. Physical activity may have resulted in fewer days of poor mental health, or poor mental health days may have resulted in a lower amount of monthly physical activity, among participants. We attempted to address the concern of reverse causation by examining the relationship between depression and physical activity outcomes, and we found no significant relationship between depression and exercise or meeting the physical activity guidelines. However, further research is needed to determine the potential explanatory mechanisms and directionality of these associations. Physical activity amount, type, duration, and frequency were self-reported and subject to self-report bias. Additional limitations include self-selection bias, social desirability bias, and recall bias. Finally, mental health was assessed based on participant perception, and self-report and was not evaluated using a standardized, validated questionnaire, such as the Patient Health Questionnaire.

Conclusion

Exercising and meeting physical activity guidelines resulted in fewer days of poor mental health being reported by LGB adults in the United States. This is an important finding because LGB people have a greater mental health burden thought to be exasperated by minority stress. More research is needed to understand the correlates, moderators, and mediators of physical activity among the LGB population in order to ensure that physical activity programs are accessible for LGB adults. Determining whether physical activity interventions, including aerobic and muscle strengthening exercises, could improve mental health outcomes in LGB adults should be considered.

Acknowledgment

No competing financial interests exist.

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If the inline PDF is not rendering correctly, you can download the PDF file here.

Pharr, Flatt, Kachen, and Olakunde are with Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA. Chien is with the Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA.

Pharr (jennifer.pharr@unlv.edu) is corresponding author.
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    Nam B, Jun H, Fedina L, Shah R, DeVylder JE. Sexual orientation and mental health among adults in four US cities. Psychiatry Res. 2019;273:134140. PubMed ID: 30641343 doi:10.1016/j.psychres.2018.12.092

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  • 4.

    Spittlehouse JK, Boden JM, Horwood LJ. Sexual orientation and mental health over the life course in a birth cohort. Psychol Med. 2020;50(8):13481355. PubMed ID: 31190681 doi:10.1017/S0033291719001284

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    Gilmour H. Sexual orientation and complete mental health. Health Rep. 2019;30(11):310. PubMed ID: 31747043

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    Bränström R. Minority stress factors as mediators of sexual orientation disparities in mental health treatment: a longitudinal population-based study. J Epidemiol Community Health. 2017;71(5):446452. PubMed ID: 28043996 doi:10.1136/jech-2016-207943

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  • 7.

    Semlyen J, King M, Varney J, Hagger-Johnson G. Sexual orientation and symptoms of common mental disorder or low wellbeing: combined meta-analysis of 12 UK population health surveys. BMC Psychiatry. 2016;16(1):67. doi:10.1186/s12888-016-0767-z

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    • PubMed
    • Search Google Scholar
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  • 8.

    MacNamara A, Collins D, Bailey R, Toms M, Ford P, Pearce G. Promoting lifelong physical activity and high level performance: realising an achievable aim for physical education. Phys Educ Sport Pedagogy. 2011;16(3):265278. doi:10.1080/17408989.2010.535200

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36(1):3856. doi:10.2307/2137286

  • 10.

    Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674. doi:10.1037/0033-2909.129.5.674

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Lehavot K, Simoni JM. The impact of minority stress on mental health and substance use among sexual minority women. J Consult Clin Psychol. 2011;79(2):159. PubMed ID: 21341888 doi:10.1037/a0022839

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Lewis RJ, Derlega VJ, Brown D, Rose S, Henson JM. Sexual minority stress, depressive symptoms, and sexual orientation conflict: focus on the experiences of bisexuals. J Soc Clin Psychol. 2009;28(8):971992. doi:10.1521/jscp.2009.28.8.971

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Everett BG, Hatzenbuehler ML, Hughes TL. The impact of civil union legislation on minority stress, depression, and hazardous drinking in a diverse sample of sexual-minority women: a quasi-natural experiment. Soc Sci Med. 2016;169:180190. PubMed ID: 27733300 doi:10.1016/j.socscimed.2016.09.036

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Haas AP, Eliason M, Mays VM, et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. J Homosex. 2010;58(1):1051. doi:10.1080/00918369.2011.534038

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    de Lira AN, de Morais NA. Resilience in lesbian, gay, and bisexual (LGB) populations: an integrative literature review. Sexual Res Soc Pol. 2018;15(3):272282. doi:10.1007/s13178-017-0285-x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Mikkelsen K, Stojanovska L, Polenakovic M, Bosevski M, Apostolopoulos V. Exercise and mental health. Maturitas. 2017;106:4856. PubMed ID: 29150166 doi:10.1016/j.maturitas.2017.09.003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Chekroud SR, Gueorguieva R, Zheutlin AB, et al. Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional study. Lancet Psychiatry. 2018;5(9):739746. PubMed ID: 30099000 doi:10.1016/S2215-0366(18)30227-X

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Skead NK, Rogers SL. Running to well-being: a comparative study on the impact of exercise on the physical and mental health of law and psychology students. Int J Law Psychiatry. 2016;49:6674. PubMed ID: 27241463 doi:10.1016/j.ijlp.2016.05.012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Bowe AK, Owens M, Codd MB, Lawlor BA, Glynn RW. Physical activity and mental health in an Irish population. Irish J Med Sci. 2019;188(2):625631. doi:10.1007/s11845-018-1863-5

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Evans M, Rohan KJ, Howard A, Ho S, Dubbert PM, Stetson BA. Exercise dimensions and psychological well-being: a community-based exercise study. J Clin Sport Psychol. 2017;11(2):107125. doi:10.1123/jcsp.2017-0027

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Cherubal AG, Suhavana B, Padmavati R, Raghavan V. Physical activity and mental health in India: a narrative review. Int J Soc Psychiatry. 2019;65(7–8):656667. PubMed ID: 31478452 doi:10.1177/0020764019871314

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Nosrat S, Whitworth JW, Ciccolo JT. Exercise and mental health of people living with HIV: a systematic review. Chronic Illness. 2017;13(4):299319. PubMed ID: 29119865 doi:10.1177/1742395317694224

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