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Exercise and Anxiety Disorders

Exploring exercise as an avenue for the treatment of anxiety disorders.

DeBoer LB, Powers MB, Utschig AC, Otto MW, Smits JA.
Expert Rev Neurother. 2012 Aug;12(8):1011-22.

Anxiety disorders constitute a significant public health problem. Current gold standard treatments are limited in their effectiveness, prompting the consideration of alternative approaches. In this review, we examine the evidence for exercise as an intervention for anxiety disorders. This evidence comes from population studies, studies of nonclinical anxiety reduction, as well as a limited number of studies of clinically anxious individuals. All of these studies provide converging evidence for consistent beneficial effects of exercise on anxiety, and are consistent with a variety of accounts of the mechanism of anxiety reduction with exercise. Further study of clinical populations is encouraged, as are studies of the mechanism of change of exercise interventions, which have the potential to help refine exercise intervention strategies. Likewise, studies that identify moderators of treatment efficacy will assist clinicians in deciding how and for whom to prescribe exercise.

Walking as Adjunctive Treatment for Anxiety Disorders?

Merom D, Phongsavan P, Wagner R, Chey T, Marnane C, Steel Z, Silove D, Bauman A.
Promoting walking as an adjunct intervention to group cognitive behavioral therapy for anxiety disorders: A pilot group randomized trial.

Journal of Anxiety Disorders, 2007.

A group randomized trial of adding a home-based walking program to a standard group cognitive behavioral therapy (GCBT+EX) was compared with groups receiving GCBT and educational sessions (GCBT+ED). The study was implemented in an outpatient clinic providing GCBT for clients diagnosed with panic disorder, generalized anxiety disorder or social phobia. Pre- and post-treatment measures included the self-report depression, anxiety, and stress scale (DASS-21) and measures of physical activity. From January 2004 to May 2005, six groups were allocated to GCBT+EX (n=38) and five to GCBT+ED (n=36). Analysis of covariance for completed cases (GCBT+EX, n=21; GCBT+ED, n=20), adjusting for the group design, baseline DASS-21 scores, and anxiety diagnosis showed significant effect for GCBT+EX on depression, anxiety, and stress (regression coefficients=-6.21, -3.41, and -5.14, respectively, p<0.05) compared to the GCBT+ED. The potential of exercise interventions as adjunct to GCBT for anxiety disorder needs to be further explored.

Can Aerobic Exercise Reduce Chances of Panic Attack?

by Joan Arehart-Treichel
Psychiatric News, January 20, 2006

A young career woman in Chicago, "Liz," was under a lot of stress. The stress led to anxiety, which led to chest pains, which led to a panic attack. She rushed to the hospital emergency room, convinced that she was seriously ill. If Liz had engaged in strenuous physical activity shortly before her panic attack set in, could she have prevented it? Perhaps, a new study out of Germany suggests.

Previous researchers found that physical exercise can reduce anxiety in both healthy individuals and those with panic disorder. Andreas Stroehle, M.D., an assistant professor of psychiatry at Charite-University Medicine Berlin, and coworkers decided to build on that work by conducting a small pilot crossover-design study to see whether an acute round of exercise can prevent panic attacks. A compound called cholecystokinin tetrapeptide (CCK-4) is known to induce panic attacks reliably in healthy subjects. So Stroehle and his colleagues wanted to see whether exercise or rest would alter CCK-4-induced panic attacks.

They first had 15 healthy subjects, average age 26 years, engage in 30 minutes of aerobic exercise (treadmill walking) before receiving CCK-4. After that, the subjects' psychological responses to CCK-4 were measured with the Acute Panic Inventory. The subjects then remained in a quiet, restful state before getting CCK-4 the second time. Once again, their psychological responses to CCK-4 were measured with the Acute Panic Inventory. Finally, Stroehle and his group measured the subjects' psychological responses to CCK-4 under the two conditions.

Panic attacks occurred in 12 subjects after rest, but in only six subjects after exercise, the researchers found. In both conditions, CCK-4 administration was followed by a significant increase in Acute Panic Inventory scores. However, prior exercise resulted in significantly lower scores than quiet rest.

"Our results for the first time suggest that exercise has an acute antipanic activity," they wrote in the December 2005 American Journal of Psychiatry. The challenge now, Stroehle and his colleagues continued, is to determine whether acute exercise can also prevent panic attacks in individuals with panic disorder, and if so, what the optimum dosage (intensity and duration) of acute exercise is for preventing an attack. "We are doing further studies in patients," Stroehle told Psychiatric News.

Also to be answered, Stroehle said, is whether acute exercise might counter a panic attack after it has begun. "Because most panic attacks resolve within about 30 minutes, the beneficial effects [of exercise after an attack has started] are questionable. In addition, in most of the situations where panic attacks occur, cognitive strategies may be more appropriate and applicable than exercise."

Does Aerobic Exercise Have Anti-panic Effects?

Strohle A, Feller C, Onken M, Godemann F, Heinz A, Dimeo F.
The acute antipanic activity of aerobic exercise.
American Journal of Psychiatry, 2005;162:2376-8.

OBJECTIVE: Regular physical activity is anxiolytic for both healthy subjects and patients with panic disorder. However, the acute antipanic activity of exercise has not yet been studied systematically. METHOD: The effects of quiet rest or aerobic treadmill exercise (30 minutes at 70% of maximum oxygen consumption) on cholecystokinin tetrapeptide (CCK-4)-induced panic attacks were studied in a crossover design in 15 healthy subjects. The effects were measured with the Acute Panic Inventory. RESULTS: Panic attacks occurred in 12 subjects after rest but in only six subjects after exercise. In both conditions, CCK-4 administration was followed by a significant increase in Acute Panic Inventory scores; however, prior exercise resulted in significantly lower scores than quiet rest. CONCLUSIONS: Aerobic exercise has an acute antipanic activity in healthy subjects. If the authors' results are confirmed in patients, the optimum intensity and duration of acute exercise for achieving antipanic effects will have to be characterized.

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