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de Vos JH, Schruers KRJ, Debard G, Bonroy B, Linden DEJ, Leibold NK. The role of the peripheral and central adrenergic system in the construction of the subjective emotional experience of panic. Psychopharmacology (Berl) 2024; 241:627-635. [PMID: 38363344 PMCID: PMC10884065 DOI: 10.1007/s00213-024-06548-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
RATIONALE Although the study of emotions can look back to over 100 years of research, it is unclear which information the brain uses to construct the subjective experience of an emotion. OBJECTIVE In the current study, we assess the role of the peripheral and central adrenergic system in this respect. METHODS Healthy volunteers underwent a double inhalation of 35% CO2, which is a well-validated procedure to induce an intense emotion, namely panic. In a randomized, cross-over design, 34 participants received either a β1-blocker acting selectively in the peripheral nervous system (atenolol), a β1-blocker acting in the peripheral and central nervous system (metoprolol), or a placebo before the CO2 inhalation. RESULTS Heart rate and systolic blood pressure were reduced in both β-blocker conditions compared to placebo, showing effective inhibition of the adrenergic tone. Nevertheless, the subjective experience of the induced panic was the same in all conditions, as measured by self-reported fear, discomfort, and panic symptom ratings. CONCLUSIONS These results indicate that information from the peripheral and central adrenergic system does not play a major role in the construction of the subjective emotion.
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Affiliation(s)
- Jette H de Vos
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, P.O. Box 616 (VIJV-SN2), 6200 MD, Maastricht, The Netherlands
| | - Koen R J Schruers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, P.O. Box 616 (VIJV-SN2), 6200 MD, Maastricht, The Netherlands
- Department of Health Psychology, University of Leuven, Leuven, Belgium
- Mondriaan Mental Health Center, Maastricht, The Netherlands
| | - Glen Debard
- Mobilab & Care, Thomas More Kempen, Geel, Belgium
| | - Bert Bonroy
- Mobilab & Care, Thomas More Kempen, Geel, Belgium
| | - David E J Linden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, P.O. Box 616 (VIJV-SN2), 6200 MD, Maastricht, The Netherlands
| | - Nicole K Leibold
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, P.O. Box 616 (VIJV-SN2), 6200 MD, Maastricht, The Netherlands.
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Bendau A, Petzold MB, Kaminski J, Plag J, Ströhle A. Exercise as Treatment for "Stress-Related" Mental Disorders. Curr Neuropharmacol 2024; 22:420-436. [PMID: 37779399 PMCID: PMC10845075 DOI: 10.2174/1570159x22666230927103308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 10/03/2023] Open
Abstract
The beneficial impact of physical activity on preventing and treating mental disorders has captured growing (research) interest. This article aims to provide a concise overview of essential evidence regarding the effectiveness and underlying mechanisms of physical activity for individuals with mental disorders clustered as "stress-related" conditions. Empirical findings (e.g., longitudinalprospective studies, interventional randomized-controlled-trials, reviews, meta-analyses) regarding the effects of physical activity in the prevention and treatment of stress-related mental disorders are summarized. Furthermore, potential mechanisms underlying these effects are discussed, and recommendations regarding the use of physical activity are outlined. The majority of studies indicate good efficacy of physical activity in prospectively lowering the risk for the incidence of subsequent stress-related mental disorders as well as in the treatment of manifest disorders. Most evidence targets unipolar depressive disorder and, secondly, anxiety disorders. Research regarding posttraumatic stress disorder, obsessive-compulsive disorders, and somatoform disorders is promising but scarce. Physical activity seems to be useful as a stand-alone-treatment as well as in combination with other psychotherapeutic or pharmacological treatments. Multiple intertwined physiological, psychological, and social mechanisms are assumed to mediate the beneficial effects. Recommendations regarding physical activity can orientate on official guidelines but should consider the individual needs and circumstances of each subject. In summary, physical activity seems to be effective in the prevention and treatment of stressrelated mental disorders and, therefore, should be fostered in healthcare-settings. Future studies are needed to clarify partly inconsistent patterns of results and to close research gaps, e.g., concerning somatoform disorders.
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Affiliation(s)
- Antonia Bendau
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, CCM, Charitéplatz 1, 10117, Berlin, Germany
- HMU Health and Medical University Potsdam, Potsdam, Germany
| | - Moritz Bruno Petzold
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, CCM, Charitéplatz 1, 10117, Berlin, Germany
- Department of Psychology, MSB Medical School Berlin, Berlin, Germany
| | - Jan Kaminski
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, CCM, Charitéplatz 1, 10117, Berlin, Germany
| | - Jens Plag
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, CCM, Charitéplatz 1, 10117, Berlin, Germany
- HMU Health and Medical University Potsdam, Potsdam, Germany
- Oberberg Fachklinik Potsdam, Potsdam, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, CCM, Charitéplatz 1, 10117, Berlin, Germany
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Anger Å, Wallerblad A, Kaaman L, Broman R, Holmberg J, Lundgren T, Salomonsson S, Sundberg CJ, Martinsson L. Introducing Braining-physical exercise as adjunctive therapy in psychiatric care: a retrospective cohort study of a new method. BMC Psychiatry 2023; 23:566. [PMID: 37550641 PMCID: PMC10405422 DOI: 10.1186/s12888-023-05053-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Patients with severe mental disorders suffer from higher rates of poor somatic health and have shorter life expectancy than the average population. Physical activity can treat and prevent several diseases, e.g. cardiovascular and metabolic disorders as well as psychiatric symptoms. It is therefore of utmost importance to develop effective methods to integrate physical activity into psychiatric care. To meet this need, the physical activity intervention Braining was developed. This study aims to describe Braining, to assess the number of patients reached during the first years of pilot testing, to analyze clinical data in the group of patients participating in Braining 2017-2020 and to assess the intervention. METHODS In this descriptive retrospective study we analyzed data from all patients participating in Braining training sessions ≥ 3 times (n = 239), the Braining Participants. Regular patients at the clinic served as a comparison. Furthermore, medical records were studied for a smaller cohort (n = 51), the Braining Pilot Cohort. Data was analyzed using Chi-square and Fisher's tests. RESULTS During the introduction period of Braining, 580 patients attended an information meeting about Braining, or at least one training session. 239 patients participated in ≥ 3 training sessions, considered to be participants of Braining. These Braining Participants (n = 239), ages 19 to 82, males 23.4%, attended between 3 and 308 training sessions (median 9). The main diagnoses were affective and anxiety disorders. Number of diagnoses ranged from 0 to 10 (median = 2). For the subsample, the Braining Pilot Cohort (n = 51), participants attended between 3 and 208 training sessions (median = 20). Twelve percent were working full-time, and symptom severity of depression and general anxiety was moderate. Two thirds had ≥ 3 different classes of medication. Regarding metabolic morbidity, 28 had been diagnosed with hypertension, though blood lipids, blood glucose as well as blood pressure were within the normal range. Thirty-seven percent were prescribed Physical Activity on Prescription during 2017-2020. One severe adverse event was reported. CONCLUSIONS The Braining intervention reached all age-groups and patients with a wide and representative diagnostic panorama, suggesting that Braining could be a promising and safe method for implementing physical activity in a psychiatric patient population.
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Affiliation(s)
- Åsa Anger
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, Plan 7, 113 64, Stockholm, Sweden.
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Anna Wallerblad
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Leida Kaaman
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Rebecka Broman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, Plan 7, 113 64, Stockholm, Sweden
| | - Johan Holmberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, Plan 7, 113 64, Stockholm, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, Plan 7, 113 64, Stockholm, Sweden
| | - Sigrid Salomonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, Plan 7, 113 64, Stockholm, Sweden
| | - Carl Johan Sundberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Lina Martinsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, Plan 7, 113 64, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Abstract
The German Society of Pneumology initiated 2021 the AWMF S1 guideline Long COVID/Post-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendations describe current Long COVID/Post-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an explicit practical claim and will be developed and adapted by the author team based on the current increase in knowledge.
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Wintermann GB, Noack R, Steudte-Schmiedgen S, Weidner K. Cortisol response under low intensity exercise during cognitive-behavioral therapy is associated with therapeutic outcome in panic disorder–an exploratory study. PLoS One 2022; 17:e0273413. [PMID: 36048809 PMCID: PMC9436097 DOI: 10.1371/journal.pone.0273413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives
Patients with Panic Disorder (PD) show an abnormal stress-induced functioning of the Hypothalamic-Pituitary-adrenal (HPA)-axis. Different protocols for stress induction are of rather low relevance for the psychotherapeutic treatment. In practice, interoceptive exposure is often realized as Low Intensity Exercise (LIE), as compared to an incremental cycle exercise test to exhaustion. Currently, it is not known, whether LIE displays an effective interoceptive stressor 1.) leading to a significant anxiety induction; 2.) a comparable HPA- and Sympathetic-Adreno-Medullar (SAM)-axis response in both patients and healthy controls; 3.) stress responses under LIE are associated with treatment outcomes.
Patients and methods
N = 20 patients with PD and n = 20 healthy controls were exposed to ten minutes of LIE on an exercise bike. LIE was applied as part of the interoceptive exposure, during an intensive Cognitive-Behavioral Therapy (CBT) in a day clinic. Heart rate was monitored and salivary cortisol samples collected. Before and after the LIE, state anxiety/ arousal were assessed. In order to evaluate psychopathology, the Panic and Agoraphobia Scale, Mobility Inventory, Agoraphobic Cognitions Questionnaire and Body Sensations Questionnaire were applied, before (T1) and after five weeks (T2) of an intensive CBT.
Results
LIE led to a significant and similar heart rate increase in both groups. Cortisol decreased over time in both groups, especially in male patients. A higher psychopathology before, and after CBT, was associated with a significantly lower cortisol response under LIE.
Conclusions
In the present study, LIE led to a divergent stress response: while there was a significant heart rate increase, cortisol decreased over time, particularly in male patients. A lower reactivity of the HPA-axis seems to be associated with a lower treatment outcome, which may affect extinction based learning. The findings suggest, that interoceptive stimuli should be designed carefully in order to be potent stressors.
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Affiliation(s)
- Gloria-Beatrice Wintermann
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Saxony, Germany
- * E-mail:
| | - René Noack
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Saxony, Germany
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Saxony, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Saxony, Germany
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Machado S, Telles G, Magalhaes F, Teixeira D, Amatriain-Fernández S, Budde H, Imperatori C, Murillo-Rodriguez E, Monteiro D, Telles Correia D, Sá Filho AS. Can regular physical exercise be a treatment for panic disorder? A systematic review. Expert Rev Neurother 2022; 22:53-64. [DOI: 10.1080/14737175.2021.2005581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Sergio Machado
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
- Laboratory of Physical Activity Neuroscience, Neurodiversity Institute, Queimados-RJ, Brazil
- Intercontinental Neuroscience Research Group, Mérida, México
| | - George Telles
- Laboratory of Physical Activity Neuroscience, Physical Activity Sciences Post-Graduate Program (PGCAF), Salgado de Oliveira University, Niterói, Brazil
| | - Franklin Magalhaes
- Laboratory of Physical Activity Neuroscience, Physical Activity Sciences Post-Graduate Program (PGCAF), Salgado de Oliveira University, Niterói, Brazil
| | - Diogo Teixeira
- Faculty of Physical Education and Sport, ULHT, Lisbon, Portugal
| | - Sandra Amatriain-Fernández
- Institute for Systems Medicine (ISM) at the Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
| | - Henning Budde
- Institute for Systems Medicine (ISM) at the Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
| | | | - Eric Murillo-Rodriguez
- Integrative Neuroscience Laboratory, Escuela de Medicina, División Ciencias de La Salud, Universidad Anáhuac Mayab, Mérida, Mexico
| | - Diogo Monteiro
- Department of Human Kinetics, ESECS, Polytechnique Institute of Leiria, Leiria, Portugal
- Research Centre in Sports, Health and Human Development, CIDESD, Portugal
| | - Diogo Telles Correia
- Serviço de Psiquiatria. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Departamento de Psiquiatria. Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Alberto Souza Sá Filho
- Post Graduate Program of University Center of Anápolis (UniEVANGÉLICA), Anápolis, Brazil
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Wolf S, Seiffer B, Zeibig JM, Welkerling J, Bauer LL, Frei AK, Studnitz T, Rosenstiel S, Fiedler DV, Helmhold F, Ray A, Herzog E, Takano K, Nakagawa T, Kropp S, Franke S, Peters S, El-Kurd N, Zwanzleitner L, Sundmacher L, Ramos-Murguialday A, Hautzinger M, Sudeck G, Ehring T. Efficacy and cost-effectiveness of a Transdiagnostic group-based exercise intervention: study protocol for a pragmatic multi-site randomized controlled trial. BMC Psychiatry 2021; 21:540. [PMID: 34717567 PMCID: PMC8556805 DOI: 10.1186/s12888-021-03541-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mental disorders are prevalent and cause considerable burden of disease. Exercise has been shown to be efficacious to treat major depressive disorders, insomnia, panic disorder with and without agoraphobia and post traumatic stress disorder (PTSD). METHODS This pragmatic, two arm, multi-site randomised controlled trial will evaluate the efficacy and cost-effectiveness of the manualized, group-based six-months exercise intervention "ImPuls", among physically inactive patients with major depressive disorders, insomnia, panic disorder, agoraphobia and PTSD within a naturalistic outpatient context in Germany. A minimum of 375 eligible outpatients from 10 different study sites will be block-randomized to either ImPuls in addition to treatment as usual (TAU) or TAU only. ImPuls will be conducted by trained exercise therapists and delivered in groups of six patients. The program will combine (a) moderate to vigorous aerobic exercise carried out two-three times a week for at least 30 min with (b) behavior change techniques for sustained exercise behavior change. All outcomes will be assessed pre-treatment, post-treatment (six months after randomization) and at follow-up (12 months after randomization). Primary outcome will be self-reported global symptom severity assessed with the Brief Symptom Inventory (BSI-18). Secondary outcomes will be accelerometry-based moderate to vigorous physical activity, self-reported exercise, disorder-specific symptoms, quality-adjusted life years (QALY) and healthcare costs. Intention-to-treat analyses will be conducted using mixed models. Cost-effectiveness and cost-utility analysis will be conducted using incremental cost-effectiveness and cost-utility ratios. DISCUSSION Despite its promising therapeutic effects, exercise programs are currently not provided within the outpatient mental health care system in Germany. This trial will inform service providers and policy makers about the efficacy and cost-effectiveness of the group-based exercise intervention ImPuls within a naturalistic outpatient health care setting. Group-based exercise interventions might provide an option to close the treatment gap within outpatient mental health care settings. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register (ID: DRKS00024152 , 05/02/2021).
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Affiliation(s)
- Sebastian Wolf
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany.
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany.
| | - Britta Seiffer
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Johanna-Marie Zeibig
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Jana Welkerling
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Leonie Louisa Bauer
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Anna Katharina Frei
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Thomas Studnitz
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Stephanie Rosenstiel
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
| | - David Victor Fiedler
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
| | - Florian Helmhold
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Andreas Ray
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Eva Herzog
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Keisuke Takano
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Tristan Nakagawa
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Saskia Kropp
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Sebastian Franke
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Stefan Peters
- German Association for health-related Fitness and Exercise Therapy (German: DVGS), Hürth-Efferen, Germany
| | | | | | - Leonie Sundmacher
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Ander Ramos-Murguialday
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Martin Hautzinger
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Gorden Sudeck
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
| | - Thomas Ehring
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
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Jacinto M, Frontini R, Matos R, Antunes R. Effects of Exercise Programs on Anxiety in Individuals with Disabilities: A Systematic Review with a Meta-Analysis. Healthcare (Basel) 2021; 9:healthcare9081047. [PMID: 34442184 PMCID: PMC8393349 DOI: 10.3390/healthcare9081047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022] Open
Abstract
Anxiety symptoms are increasingly prevalent in individuals and may affect their quality of life. Physical exercise (PE) has been shown to be an effective method for reducing anxiety symptoms in the general population. The present study aimed to identify if PE programs can be a good method to reduce anxiety symptoms in individuals with disabilities, through the methodology of a systematic review with a meta-analysis. The PubMed, Web of Science, Scopus, and SPORTDiscus databases were used, considering the period from 2001 to 2021. The descriptors used were: “cerebral palsy”, “motor disability”, “physical disability”, “vision impairment”, “visual impairment”, “vision disability”, “intellectual disability”, “mental retardation”, “intellectual disabilities”, “hearing impairment”, “hearing disability”, “multiple disabilities”, “physical activity”, “exercise”, “sport”, “training”, and “anxiety”, with the Boolean operator “AND” or “OR”. The systematic review with a meta-analysis was carried out in the period between May and June 2021. The Z values (Z-values) obtained to test the null hypothesis, according to which the difference between means is zero, demonstrated a Z = 2.957, and a corresponding p-value of 0.003. Thus, we can reject the null hypothesis, and affirm that PE promotes positive effects and can be a good method or methodology for the reduction of anxiety symptoms of individuals with disabilities.
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Affiliation(s)
- Miguel Jacinto
- Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-248 Coimbra, Portugal
- Life Quality Research Centre (CIEQV), 2040-413 Rio Maior, Portugal; (R.F.); (R.M.); (R.A.)
- Correspondence:
| | - Roberta Frontini
- Life Quality Research Centre (CIEQV), 2040-413 Rio Maior, Portugal; (R.F.); (R.M.); (R.A.)
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria, 2410-541 Leiria, Portugal
| | - Rui Matos
- Life Quality Research Centre (CIEQV), 2040-413 Rio Maior, Portugal; (R.F.); (R.M.); (R.A.)
- School of Education and Social Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal
| | - Raul Antunes
- Life Quality Research Centre (CIEQV), 2040-413 Rio Maior, Portugal; (R.F.); (R.M.); (R.A.)
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria, 2410-541 Leiria, Portugal
- School of Education and Social Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal
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9
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Crombie KM, Cisler JM, Hillard CJ, Koltyn KF. Aerobic exercise reduces anxiety and fear ratings to threat and increases circulating endocannabinoids in women with and without PTSD. Ment Health Phys Act 2021; 20:100366. [PMID: 34149867 PMCID: PMC8208522 DOI: 10.1016/j.mhpa.2020.100366] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Reductions in state anxiety have been reported following an acute bout of aerobic exercise. However, less is known regarding anxiety and fear ratings to specific threatening stimuli following an acute bout of aerobic exercise in women with PTSD. Moreover, the mechanisms responsible for the anxiolytic effects of exercise are not fully understood, although recent studies suggest a role for the endocannabinoid (eCB) system. Thus, this study utilized a randomized, counterbalanced approach to examine anxiety and fear ratings to predictable or unpredictable electric shock administration and circulating concentrations of eCBs and mood states immediately following moderate-intensity aerobic exercise (30 min on treadmill at 70-75% maximum heart rate) and a quiet rest control condition in women with and without a history of trauma, and in women with PTSD (N=42). Results revealed that anxiety and fear ratings to unpredictable and predictable threats were significantly (p<.05) lower following exercise compared to quiet rest, with correlational analyses indicating those with greater increases in circulating eCBs had greater reductions in anxiety and fear ratings to unpredictable and predictable threats following exercise. Also, there were significant (p<.05) reductions in fatigue, confusion, total mood disturbance, and increases in positive affect following exercise for the entire sample. Non-trauma controls and PTSD groups reported significant (p<.05) increases in vigor, with additional mood improvements following exercise for the PTSD group (i.e., decreases in state anxiety, negative affect, tension, anger, and depression). Results from this study suggest that aerobic exercise exerts psychological benefits in women with PTSD, potentially due to exercise-induced increases in circulating concentrations of eCBs.
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Affiliation(s)
- Kevin M. Crombie
- Department of Kinesiology at the University of Wisconsin-Madison, Madison, WI – USA
- Department of Psychiatry at the University of Wisconsin – Madison, Madison, WI – USA
| | - Josh M. Cisler
- Department of Psychiatry at the University of Wisconsin – Madison, Madison, WI – USA
| | - Cecilia J. Hillard
- Neuroscience Research Center and Department of Pharmacology and Toxicology at the Medical College of Wisconsin, Milwaukee, WI – USA
| | - Kelli F. Koltyn
- Department of Kinesiology at the University of Wisconsin-Madison, Madison, WI – USA
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10
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To make a run for IT - A feasibility study of ICBT combined with physical exercise for patients with panic disorder. Psychiatry Res 2020; 293:113381. [PMID: 32911348 DOI: 10.1016/j.psychres.2020.113381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Guided Internet-based cognitive behavioural therapy (ICBT) is a recommended treatment for panic disorder promising to increase treatment availability, but there are some concerns regarding adherence, including adherence to the in vivo exposure given as home assignments. The aim of this study was to assess the feasibility of combining ICBT with physical exercise with the aim of improving adherence and treatment response to ICBT. METHOD 12 participants were included via routine clinical practice to an open pre- post trial of feasibility using ICBT and an aerobe exercise protocol. We used a mixed model design investigating multiple areas of adherence, participants' experience and clinical outcome. RESULTS 90.9% of the participants was considered completers in the ICBT program and the average adherence to the physical exercise was 93.1%. The experience of participating was summarized as "Hard work but worth it". Clinical outcomes effect sizes (d) ranged from 2.79 (panic severity) to .64 (Beck's anxiety index). CONCLUSION The sum results on adherence, qualitative and quantitative data all suggest that augmenting ICBT with an aerobic exercise protocol is feasible. We conclude that further research is warranted.
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Körperliche Aktivität in der Prävention und Behandlung von Angsterkrankungen. PSYCHOTHERAPEUT 2020. [DOI: 10.1007/s00278-020-00414-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Hu S, Tucker L, Wu C, Yang L. Beneficial Effects of Exercise on Depression and Anxiety During the Covid-19 Pandemic: A Narrative Review. Front Psychiatry 2020; 11:587557. [PMID: 33329133 PMCID: PMC7671962 DOI: 10.3389/fpsyt.2020.587557] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/14/2020] [Indexed: 01/08/2023] Open
Abstract
First reported in Dec 2019, the on-going COVID-19 pandemic has become a public health emergency of international concern (PHEIC). The isolation and quarantine during the COVID-19 pandemic limited the physical and social activities of the population, which contributed to the increased prevalence of mental disorder. Depression and anxiety are the most common mental illnesses conferring a serious impact on individuals' life quality. This review summarizes the mental health consequences of COVID-19, especially for depression and anxiety. Exercise as an intervention for anxiety and depression has been demonstrated in both of the animal studies and human clinical trials. The underlying mechanism including the regulation on the production of brain-derived neurotrophic factor (BDNF), D-β-hydroxybutyrate, synaptic transmission, hypothalamic pituitary adrenal (HPA) axis, tryptophan hydroxylase, GSK3β/β-catenin pathway, neuroinflammation, oxidative stress and PGC-1α1-PPAR axis. In addition, we summarized the exercise strategies to fight against anxiety and depression according to the information from American College of Sports Medicine (ACSM), World Health Organization and recent literatures about physical exercise during COVID-19.
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Affiliation(s)
- Shaojuan Hu
- College of Physical Education and Sports Science, HengYang Normal University, Hengyang, China
| | - Lorelei Tucker
- Department of Neuroscience and Regenerative Medicine, Augusta University, Augusta, GA, United States
| | - Chongyun Wu
- Laboratory of Laser Sports Medicine, College of Physical Education and Sports Science, South China Normal University, Guangzhou, China
| | - Luodan Yang
- Department of Neuroscience and Regenerative Medicine, Augusta University, Augusta, GA, United States
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The effects of acute yoga on anxiety symptoms in response to a carbon dioxide inhalation task in women. Complement Ther Med 2019; 47:102230. [PMID: 31780009 DOI: 10.1016/j.ctim.2019.102230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We investigated the efficacy of yoga for improving cognitive and physical anxiety symptoms, and its possible respiratory mechanism, in high-anxious women. METHODS Eighteen participants completed 40 min of guided yoga and a light stretching protocol in a randomized, counterbalanced order.The 7.5%CO2-inhalation task was administered before, immediately after and 1 h after the experimental conditions.State anxiety and panic were measured before and after each inhalation task.Tidal volume, ventilation and respiratory rate were measured during every 7.5%CO2-inhalation tasks. RESULTS There was no significant 3-way interaction(p > .05).There was a significant main effect of CO2-inhalation task on panic and respiratory measures(p < .05).When collapsed over inhalation task and condition, there was a small reduction in cognitive anxiety from baseline to immediately post and 1 -h post-condition(p < .05). CONCLUSIONS There appears to be an overall effect of general physical activity for attenuating anxiety cognitions irrespective of the physiological changes, indicating possible dissociation between the cognitive and physical symptoms of anxiety among women with anxiety sensitivity.
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Brown J, Del Pozzi AT, Hicks-Little C. Anxiety Disorders and Exercise: The Role for Health and Fitness Professionals. Strength Cond J 2019. [DOI: 10.1519/ssc.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Caldirola D, Perna G. Toward a personalized therapy for panic disorder: preliminary considerations from a work in progress. Neuropsychiatr Dis Treat 2019; 15:1957-1970. [PMID: 31371969 PMCID: PMC6628946 DOI: 10.2147/ndt.s174433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/20/2019] [Indexed: 12/18/2022] Open
Abstract
Although several treatment options for panic disorder (PD) are available, the best intervention for each individual patient remains uncertain and the use of a more personalized therapeutic approach in PD is required. In clinical practice, clinicians combine general scientific information and personal experience in the decision-making process to choose a tailored treatment for each patient. In this sense, clinicians already use a somehow personalized medicine strategy. However, the influence of their interpretative personal models may lead to bias related to personal convictions, not sufficiently grounded on scientific evidence. Hence, an effort to give some advice based on the science of personalized medicine could have positive effects on clinicians' decisions. Based on a narrative review of meta-analyses, systematic reviews, and experimental studies, we proposed a first-step attempt of evidence-based personalized therapy for PD. We focused on some phenomenological profiles, encompassing symptoms during/outside panic attacks, related patterns of physiological functions, and some aspects of physical health, which might be worth considering when developing treatment plans for patients with PD. We considered respiratory, cardiac, vestibular, and derealization/depersonalization profiles, with related implications for treatment. Given the extensiveness of the topic, we considered only medications and some somatic interventions. Our proposal should be considered neither exhaustive nor conclusive, as it is meant as a very preliminary step toward a future, robust evidence-based personalized therapy for PD. Clearly much more work is needed to achieve this goal, and recent technological advances, such as wearable devices, big data platforms, and the application of machine learning techniques, may help obtain reliable findings. We believe that combining the efforts of different research groups in this work in progress can lead to largely shared conclusions in the near future.
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Affiliation(s)
- Daniela Caldirola
- Humanitas University, 20090 Pieve Emanuele, Milan, Italy.,Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, 22032 Albese Con Cassano, Como, Italy
| | - Giampaolo Perna
- Humanitas University, 20090 Pieve Emanuele, Milan, Italy.,Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, 22032 Albese Con Cassano, Como, Italy.,Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 Maastricht, The Netherlands.,Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, Miami University, Miami, FL 33136 -1015, USA
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Kandola A, Vancampfort D, Herring M, Rebar A, Hallgren M, Firth J, Stubbs B. Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Curr Psychiatry Rep 2018; 20:63. [PMID: 30043270 PMCID: PMC6061211 DOI: 10.1007/s11920-018-0923-x] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW The purpose of this paper was to provide a comprehensive narrative review of the relationship between physical activity (PA) and anxiety and the rationale for including it as a treatment option for anxiety disorders. Several gaps in the literature are highlighted alongside recommendations for future research. RECENT FINDINGS PA in the general population has established efficacy in preventing and managing cardiovascular disease and improving wellbeing. Recent epidemiological data further suggests that people who are more active may be less likely to have anxiety disorders. In addition, evidence from systematic reviews of randomised control trials suggests that exercise training, a subset of PA, can reduce symptoms in anxiety and stress-related disorders, such as post-traumatic stress disorder, agoraphobia and panic disorder. Anxiety disorders are common, burdensome and costly to individuals and wider society. In addition to the profound negative impact on individuals' wellbeing and functioning, they are associated with worsened physical health, including a higher risk for cardiovascular diseases and premature mortality. Although pharmacotherapy and psychological interventions are helpful for many, these treatment approaches are not effective for everyone and are insufficient to address common physical health complications, such as the elevated risk of cardiovascular disease. Given the combined anxiolytic and physical health benefits of increased activity, PA presents a promising additional treatment option for people with anxiety disorders. However, there remain key gaps in the literature regarding the mechanisms underlying the effects of PA, optimal PA protocols, methods of improving adherence and the importance of physical fitness. These must be addressed for PA to be successfully implemented in mental health services.
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Affiliation(s)
- Aaron Kandola
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
- KU Leuven Department of Neurosciences, UPC KU Leuven, Kortenberg, Belgium
| | - Matthew Herring
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Amanda Rebar
- Physical Activity Research Group, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Mats Hallgren
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Joseph Firth
- NICM Health Research Institute, School of Science and Health, University of Western Sydney, Sydney, Australia
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Aylett E, Small N, Bower P. Exercise in the treatment of clinical anxiety in general practice - a systematic review and meta-analysis. BMC Health Serv Res 2018; 18:559. [PMID: 30012142 PMCID: PMC6048763 DOI: 10.1186/s12913-018-3313-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/19/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Anxiety disorders are common, yet treatment options in general practice are often limited to medication or CBT. There is a lack of evidence for the effectiveness of exercise in the treatment of anxiety in patients who present to general practice and also about the intensity of exercise required to lead to improvement. The aim of this systematic review was to assess the use of exercise versus waiting list control groups in the treatment of anxiety and also to assess the benefit of high intensity exercise vs low intensity exercise. Long term follow up scores were also analysed. We included patients who met diagnostic criteria for anxiety disorders or had clinically raised anxiety levels on a validated rating scale and performed a subgroup analysis of the outcomes between the two groups. The intervention was any aerobic exercise programme carried out for at least two weeks, or exercise carried out at high intensity for at least two weeks. The comparison groups were either a waiting list control group or low intensity exercise. METHOD Systematic review of randomised controlled trials. Three databases were searched; CENTRAL, Medline and Embase. Outcome assessment was based on validated anxiety rating scales. The quality of the studies was appraised according to the Cochrane Risk of Bias tool. Effect sizes were calculated using the standardised mean difference. RESULTS Fifteen studies were identified with a total of 675 patients. Nine trials had participants with diagnosed anxiety disorders and six trials had participants with raised anxiety on a validated rating scale. Aerobic exercise was effective in the treatment of raised anxiety compared to waiting list control groups (effect size - 0.41, 95% CI = - 0.70 to - 0.12). High intensity exercise programmes showed greater effects than low intensity programmes. There was no significant difference in outcomes between groups of patients with diagnosed anxiety disorders and patients who had raised anxiety on a rating scale. Conclusions were limited by the small number of studies and wide variation in the delivery of exercise interventions. CONCLUSION Exercise programmes are a viable treatment option for the treatment of anxiety. High intensity exercise regimens were found to be more effective than low intensity regimens. The results have implications for the use of exercise schemes in General Practice.
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Affiliation(s)
- Elizabeth Aylett
- Thaxted Surgery, Margaret Street, Thaxted, Dunmow, Essex, CM6 2QN England
| | - Nicola Small
- NIHR School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, the University of Manchester, Williamson Building, Oxford Road, Manchester, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, the University of Manchester, Williamson Building, Oxford Road, Manchester, UK
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Lattari E, Budde H, Paes F, Neto GAM, Appolinario JC, Nardi AE, Murillo-Rodriguez E, Machado S. Effects of Aerobic Exercise on Anxiety Symptoms and Cortical Activity in Patients with Panic Disorder: A Pilot Study. Clin Pract Epidemiol Ment Health 2018; 14:11-25. [PMID: 29515644 PMCID: PMC5827302 DOI: 10.2174/1745017901814010011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 11/28/2017] [Accepted: 12/01/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The effects of the aerobic exercise on anxiety symptoms in patients with Panic Disorder (PD) remain unclear. Thus, the investigation of possible changes in EEG frontal asymmetry could contribute to understand the relationship among exercise, brain and anxiety. OBJECTIVE To investigate the acute effects of aerobic exercise on the symptoms of anxiety and the chronic effects of aerobic exercise on severity and symptoms related to PD, besides the changes in EEG frontal asymmetry. METHODS Ten PD patients were divided into two groups, Exercise Group (EG; n=5) and Control Group (CG; n=5), in a randomized allocation. At baseline and post-intervention, they submitted the psychological evaluation through Panic Disorder Severity Scale (PDSS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), EEG frontal asymmetry, and maximal oxygen consumption (VO2max). On the second visit, the patients of EG being submitted to the aerobic exercise (treadmill, 25 minutes, and 50-55% of heart rate reserve) and the CG remained seated for the same period of time. Both groups submitted a psychological evaluation with Subjective Units of Distress Scale (SUDS) at baseline, immediately after (Post-0), and after 10 minutes of the rest pause (Post-10). The patients performed 12 sessions of aerobic exercise with 48-72 hours of interval between sessions. RESULTS In EG, SUDS increased immediately after exercise practice and showed chronic decrease in BAI and BDI-II as well as increased in VO2max (Post-intervention). CONCLUSION Aerobic exercise can promote increase in anxiety acutely and regular aerobic exercise promotes reduction in anxiety levels.
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Affiliation(s)
- Eduardo Lattari
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Henning Budde
- Faculty of Human Sciences, Medical School Hamburg, Kaiserkai 1, 20457 Hamburg, Germany, Lithuanian Sports University, Kaunas, Lithuania, Physical Activity, Physical Education, Health and Sport Research Centre (PAPESH), Sports Science Department, School of Science and Engineering, Reykjavik University, Reykjavik, Iceland
| | - Flávia Paes
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | | | | | - Antônio Egídio Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Eric Murillo-Rodriguez
- Laboratorio de Neurociencias Moleculares e Integrativas. Escuela de Medicina, Division Ciencias de la Salud, Universidad Anahuac Mayab. Merida, Yucatan. Mexico
| | - Sérgio Machado
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
- Laboratory of Physical Activity Neuroscience, Physical Activity Sciences Post-Graduate Program (PGCAF), Salgado de Oliveira University, Niteroi, Brazil
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Lindenberger BL, Plag J, Schumacher S, Gaudlitz K, Bischoff S, Bobbert T, Dimeo F, Petzold MB, Kirschbaum C, Dudás Z, Ströhle A. Clinical and neurobiological effects of aerobic exercise in dental phobia: A randomized controlled trial. Depress Anxiety 2017; 34:1040-1048. [PMID: 28556577 DOI: 10.1002/da.22659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Physical activity has shown to be effective in anxiety disorders. For specific phobia, no studies are available that systematically examined the effects of an aerobic exercise intervention on phobic fear within a randomized-controlled design. Therefore, we investigated the acute effect of a standardized aerobic training on clinical symptoms of dental phobia as well as on stress-related neurobiological markers. METHODS Within a crossover design, 30 patients with dental phobia (mean age: 34.1 years; mean score of the Dental Anxiety Scale: 18.8) underwent two minor dental interventions separated by 7 days. Dental treatment was performed after 30 min of physical activity at either 20% VO2 max (control) or 70% VO2 max (intervention), respectively. To control for habituation, patients were randomly assigned to one of the two conditions prior to the first intervention. Moreover, saliva samples were collected at five times in order to determine changes in salivary cortisol (sC) and alpha-amylase (sAA) due to treatment. RESULTS In comparison to baseline, aerobic exercise within 70% VO2 max significantly reduced clinical anxiety and sC concentrations before, during, and after the dental treatment. In contrast, the control condition led to decreased sAA levels at different time points of measurement. Habituation occurred at the second study day, independent of the order. CONCLUSIONS Our study provides evidence for an effect of moderate-intense exercise on clinical symptoms and sC in patients with dental phobia. Therefore, acute aerobic exercise might be a simple and low-cost intervention to reduce disorder-specific phobic fear.
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Affiliation(s)
- Brigitt L Lindenberger
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Plag
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Schumacher
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Gaudlitz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sophie Bischoff
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Bobbert
- Department of Endocrinology, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fernando Dimeo
- Section of Sports Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz B Petzold
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Clemens Kirschbaum
- Department of Biological Psychology, Technische Universität Dresden, Dresden, Germany
| | - Zsuzsa Dudás
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Stonerock GL, Hoffman BM, Smith PJ, Blumenthal JA. Exercise as Treatment for Anxiety: Systematic Review and Analysis. Ann Behav Med 2016; 49:542-56. [PMID: 25697132 DOI: 10.1007/s12160-014-9685-9] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Exercise has been shown to reduce symptoms of anxiety, but few studies have studied exercise in individuals preselected because of their high anxiety. PURPOSE The objective of this study is to review and critically evaluate studies of exercise training in adults with either high levels of anxiety or an anxiety disorder. METHODS We conducted a systematic review of randomized clinical trials (RCTs) in which anxious adults were randomized to an exercise or nonexercise control condition. Data were extracted concerning anxiety outcomes and study design. Existing meta-analyses were also reviewed. RESULTS Evidence from 12 RCTs suggested benefits of exercise, for select groups, similar to established treatments and greater than placebo. However, most studies had significant methodological limitations, including small sample sizes, concurrent therapies, and inadequate assessment of adherence and fitness levels. CONCLUSIONS Exercise may be a useful treatment for anxiety, but lack of data from rigorous, methodologically sound RCTs precludes any definitive conclusions about its effectiveness.
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Affiliation(s)
- Gregory L Stonerock
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3119, Durham, NC, 27710, USA,
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Lifestyle Behaviours Add to the Armoury of Treatment Options for Panic Disorder: An Evidence-Based Reasoning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:7017-43. [PMID: 26095868 PMCID: PMC4483746 DOI: 10.3390/ijerph120607017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 11/16/2022]
Abstract
This article presents an evidence-based reasoning, focusing on evidence of an Occupational Therapy input to lifestyle behaviour influences on panic disorder that also provides potentially broader application across other mental health problems (MHP). The article begins from the premise that we are all different. It then follows through a sequence of questions, examining incrementally how MHPs are experienced and classified. It analyses the impact of individual sensitivity at different levels of analysis, from genetic and epigenetic individuality, through neurotransmitter and body system sensitivity. Examples are given demonstrating the evidence base behind the logical sequence of investigation. The paper considers the evidence of how everyday routine lifestyle behaviour impacts on occupational function at all levels, and how these behaviours link to individual sensitivity to influence the level of exposure required to elicit symptomatic responses. Occupational Therapists can help patients by adequately assessing individual sensitivity, and through promoting understanding and a sense of control over their own symptoms. It concludes that present clinical guidelines should be expanded to incorporate knowledge of individual sensitivities to environmental exposures and lifestyle behaviours at an early stage.
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The brain acid–base homeostasis and serotonin: A perspective on the use of carbon dioxide as human and rodent experimental model of panic. Prog Neurobiol 2015; 129:58-78. [DOI: 10.1016/j.pneurobio.2015.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/16/2015] [Accepted: 04/20/2015] [Indexed: 12/14/2022]
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Hovland A, Johansen H, Sjøbø T, Vøllestad J, Nordhus IH, Pallesen S, Havik OE, Martinsen EW, Nordgreen T. A Feasibility study on Combining Internet-Based Cognitive Behaviour Therapy with Physical Exercise as Treatment for Panic Disorder—Treatment Protocol and Preliminary Results. Cogn Behav Ther 2015; 44:275-87. [DOI: 10.1080/16506073.2015.1022596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gaudlitz K, Plag J, Dimeo F, Ströhle A. Aerobic exercise training facilitates the effectiveness of cognitive behavioral therapy in panic disorder. Depress Anxiety 2015; 32:221-8. [PMID: 25515221 DOI: 10.1002/da.22337] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 10/22/2014] [Accepted: 11/02/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Physical activity has been discussed as a therapeutic alternative or add-on for the treatment of anxiety disorders. We studied whether aerobic exercise compared to physical activity with low impact can improve the effect of cognitive behavioral therapy (CBT) in patients with panic disorder (PD) with/without agoraphobia. METHODS Forty-seven patients received group CBT treatment over 1 month, which was augmented with an 8-week protocol of either aerobic exercise (three times/week, 30 min, 70% VO(2) max; n = 24) or a training program including exercises with very low intensity (n = 23) in a randomized controlled double-blind design. The primary outcome measure was the total score on the Hamilton Anxiety Scale (Ham-A). A 2 × 3 analysis of covariance (ANCOVA) with baseline value as a covariate was conducted for data analysis. RESULTS Time × group interaction for the Ham-A revealed a significant effect (P = .047, η(2) p = .072), which represented the significant group difference at a 7-month follow-up. For the other clinical outcome measures no statistical significance emerged, although improvement was more sustained in the exercise group. CONCLUSIONS For patients with PD, regular aerobic exercise adds an additional benefit to CBT. This supports previous results and provides evidence about the intensity of exercise that needs to be performed.
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Affiliation(s)
- Katharina Gaudlitz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - University Medicine Berlin, Berlin, Germany
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Amaral JMXD, Spadaro PTM, Pereira VM, Silva ACDOE, Nardi AE. The carbon dioxide challenge test in panic disorder: a systematic review of preclinical and clinical research. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 35:318-31. [DOI: 10.1590/1516-4446-2012-1045] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 12/28/2012] [Indexed: 11/22/2022]
Affiliation(s)
- Julio Mario Xerfan do Amaral
- Universidade Federal do Rio de Janeiro, Brazil; UFRJ, Brazil; National Science and Technology Institute for Translational Medicine
| | - Pedro Tadeu Machado Spadaro
- Universidade Federal do Rio de Janeiro, Brazil; UFRJ, Brazil; National Science and Technology Institute for Translational Medicine
| | | | | | - Antonio Egidio Nardi
- UFRJ, Brazil; National Science and Technology Institute for Translational Medicine
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Hovland A, Nordhus IH, Sjøbø T, Gjestad BA, Birknes B, Martinsen EW, Torsheim T, Pallesen S. Comparing physical exercise in groups to group cognitive behaviour therapy for the treatment of panic disorder in a randomized controlled trial. Behav Cogn Psychother 2013; 41:408-32. [PMID: 22874661 PMCID: PMC3675676 DOI: 10.1017/s1352465812000446] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have suggested that physical exercise can reduce symptoms for subjects suffering from panic disorder (PD). The efficacy of this intervention has so far not been compared to an established psychotherapy, such as cognitive behaviour therapy (CBT). Assessment of controlled long-term effects and the clinical significance of the treatment are also lacking. AIM To compare physical exercise to CBT as treatment for PD, and assess controlled long-term and clinically significant effects. METHOD PD-patients were randomized to either three weekly sessions of physical exercise (n = 17), or one weekly session of CBT (n = 19). Both treatments ran for 12 weeks, were manualized and administered in groups. Patients were assessed twice before the start of treatment, at post-treatment and at 6 and 12 months thereafter. Primary outcome-measures consisted of the Mobility Inventory (MI), the Agoraphobia Cognitions Questionnaire (ACQ) and the Body Sensations Questionnaire (BSQ). RESULTS A two-way repeated measures MANOVA of these measures demonstrated a significant effect of time, F(16, 544) = 7.28, p < .01, as well as a significant interaction effect, F(16, 544) = 1.71, p < .05, in favour of CBT. This finding was supported by the assessment of clinically significant changes of avoidant behaviour and of treatment-seeking one year later. CONCLUSION Group CBT is more effective than group physical exercise as treatment of panic disorder, both immediately following treatment and at follow-up assessments.
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Affiliation(s)
- Anders Hovland
- University of Bergen, and Solli District Psychiatric Centre-DPS, Nesttun, Norway.
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Asmundson GJG, Fetzner MG, Deboer LB, Powers MB, Otto MW, Smits JAJ. Let's get physical: a contemporary review of the anxiolytic effects of exercise for anxiety and its disorders. Depress Anxiety 2013; 30:362-73. [PMID: 23300122 DOI: 10.1002/da.22043] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 11/17/2012] [Accepted: 11/29/2012] [Indexed: 01/09/2023] Open
Abstract
Research over the past few decades has focused on the therapeutic effects of physical exercise among those affected by mood disorders. Only recently has attention turned to maladaptive and persistent expressions of anxiety, with a growing body of evidence indicating promise for exercise as an effective treatment for some of the anxiety disorders. The current review provides a comprehensive account of contemporary research examining the anxiolytic effects of exercise for anxiety disorders. We synthesize pertinent research regarding the effects of various types of exercise within the different anxiety disorders, consider impact of various types of exercise regimens on anxiety, and examine potential anxiolytic mechanisms responsible for positive mental health gains. We conclude with important considerations for implementing exercise as a treatment for clinically significant anxiety as well as future research directions.
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Affiliation(s)
- Gordon J G Asmundson
- Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan.
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SMITH JCARSON. Effects of Emotional Exposure on State Anxiety after Acute Exercise. Med Sci Sports Exerc 2013; 45:372-8. [DOI: 10.1249/mss.0b013e31826d5ce5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jayakody K, Gunadasa S, Hosker C. Exercise for anxiety disorders: systematic review. Br J Sports Med 2013; 48:187-96. [DOI: 10.1136/bjsports-2012-091287] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Zschucke E, Gaudlitz K, Ströhle A. Exercise and physical activity in mental disorders: clinical and experimental evidence. J Prev Med Public Health 2013; 46 Suppl 1:S12-21. [PMID: 23412549 PMCID: PMC3567313 DOI: 10.3961/jpmph.2013.46.s.s12] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 12/07/2012] [Indexed: 12/13/2022] Open
Abstract
Several epidemiological studies have shown that exercise (EX) and physical activity (PA) can prevent or delay the onset of different mental disorders, and have therapeutic benefits when used as sole or adjunct treatment in mental disorders. This review summarizes studies that used EX interventions in patients with anxiety, affective, eating, and substance use disorders, as well as schizophrenia and dementia/mild cognitive impairment. Despite several decades of clinical evidence with EX interventions, controlled studies are sparse in most disorder groups. Preliminary evidence suggests that PA/EX can induce improvements in physical, subjective and disorder-specific clinical outcomes. Potential mechanisms of action are discussed, as well as implications for psychiatric research and practice.
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Affiliation(s)
- Elisabeth Zschucke
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - Katharina Gaudlitz
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
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DeBoer LB, Powers MB, Utschig AC, Otto MW, Smits JAJ. Exploring exercise as an avenue for the treatment of anxiety disorders. Expert Rev Neurother 2012; 12:1011-22. [PMID: 23002943 PMCID: PMC3501262 DOI: 10.1586/ern.12.73] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Lindsey B DeBoer
- Southern Methodist University, 6116 N. Central Expressway, Ste. 1100, Dallas, TX 75206, USA
| | - Mark B Powers
- Southern Methodist University, 6116 N. Central Expressway, Ste. 1100, Dallas, TX 75206, USA
| | | | | | - Jasper AJ Smits
- Southern Methodist University, 6116 N. Central Expressway, Ste. 1100, Dallas, TX 75206, USA
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Abstract
The evidence-based pharmacotherapy of panic disorder continues to evolve. This paper reviews data on first-line pharmacotherapy, evidence for maintenance treatment, and management options for treatment-refractory patients. A Medline search of research on pharmacotherapy was undertaken, and a previous systematic review on the evidence-based pharmacotherapy of panic disorder was updated. Selective serotonin reuptake inhibitors remain a first-line pharmacotherapy of panic disorder, with the serotonin noradrenaline reuptake inhibitor venlafaxine also an acceptable early option. Temporary co-administration of benzodiazepines can be considered. Maintenance treatment reduces relapse rates, but further research to determine optimal duration is needed. For patients not responding to first-line agents several pharmacotherapy options are available, but there is a notable paucity of data on the optimal choice.
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Pappens M, Smets E, Vansteenwegen D, Bergh O, Diest I. Learning to fear suffocation: A new paradigm for interoceptive fear conditioning. Psychophysiology 2012; 49:821-8. [DOI: 10.1111/j.1469-8986.2012.01357.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 12/05/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Meike Pappens
- Research Group on Health Psychology; University of Leuven; Leuven; Belgium
| | - Elyn Smets
- Research Group on Health Psychology; University of Leuven; Leuven; Belgium
| | - Debora Vansteenwegen
- Center for the Psychology of Learning and Experimental Psychopathology; University of Leuven; Leuven; Belgium
| | - Omer Bergh
- Research Group on Health Psychology; University of Leuven; Leuven; Belgium
| | - Ilse Diest
- Research Group on Health Psychology; University of Leuven; Leuven; Belgium
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Esquivel G, Dandachi A, Knuts I, Goossens L, Griez E, Schruers K. Effects of acute exercise on CO(2) -induced fear. Depress Anxiety 2012; 29:155-8. [PMID: 21898704 DOI: 10.1002/da.20860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 05/27/2011] [Accepted: 05/28/2011] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Acute exercise has shown to reduce the effects of experimental panic provocation in healthy volunteers and in patients with panic disorder. Recent evidence suggests that when larger amounts of CO(2) are inhaled, a large proportion of healthy subjects can also develop an affective response consistent with definitions of a panic attack. Our aim was to test whether exercise can show antipanic effects in healthy subjects when exposed to higher concentrations of CO(2). METHODS Thirty-one healthy subjects, on four separate occasions in a randomized Latin square design, performed either moderate/hard or very-light exercise immediately followed by either a single or a double 35% CO(2)/65% O(2) inhalation. RESULTS Compared to very-light exercise, when subjects performed moderate/hard exercise they reported a reduction in panic symptoms on the Panic Symptom List and the Visual Analogue Scale of Fear but no difference on the Visual Analogue Scale of Discomfort after a double CO(2) inhalation. After a single CO(2) inhalation, reductions were only seen on the Panic Symptom List. CONCLUSIONS After intense exercise, subjects had less panic symptoms when exposed 35% CO(2), particularly after a double inhalation.
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Affiliation(s)
- Gabriel Esquivel
- Academic Anxiety Center and School for Mental Health and Neurosciences, Health and Life Sciences, Maastricht University, Maastricht, The Netherlands.
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Exercise and physical activity in mental disorders. Eur Arch Psychiatry Clin Neurosci 2011; 261 Suppl 2:S186-91. [PMID: 21935629 DOI: 10.1007/s00406-011-0254-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 08/17/2011] [Indexed: 01/09/2023]
Abstract
Exercise (EX) and physical activity (PA) have been shown to prevent or delay the onset of several mental disorders and to have therapeutic effects in different groups of psychiatric disorders. This review focuses on studies investigating EX as therapeutic intervention in anxiety disorders, affective disorders, eating disorders, schizophrenia, and substance use disorders. Despite EX being discussed as a potential therapy for several decades, adequately powered randomized, controlled trials are sparse in most disorder groups. Nevertheless, evidence points toward disorder-specific benefits that can be induced by EX/PA. Mechanisms of the therapeutic effects of EX/PA are summarized, including metabolic and physiological as well as psychological aspects. Finally, implications for research and therapeutic practice are illustrated.
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Sardinha A, Araújo CGS, Soares-Filho GLF, Nardi AE. Anxiety, panic disorder and coronary artery disease: issues concerning physical exercise and cognitive behavioral therapy. Expert Rev Cardiovasc Ther 2011; 9:165-75. [PMID: 21453213 DOI: 10.1586/erc.10.170] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psychological factors such as stress and depression have already been established as primary and secondary cardiovascular risk factors. More recently, the role of anxiety in increasing cardiac risk has also been studied. The underlying mechanisms of increased cardiac risk in panic disorder patients seem to reflect the direct and indirect effects of autonomic dysfunction, as well as behavioral risk factors associated with an unhealthy lifestyle. Implications of the comorbidity between panic and cardiovascular disease include higher morbidity, functional deficits, increased cardiovascular risk, and poor adherence to cardiac rehabilitation or exercise programs. This article probes the most recent evidence on the association between coronary artery disease, anxiety and panic disorder, and discusses the potential role of incorporating regular physical exercise and cognitive behavioral therapy in the treatment of this condition.
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Affiliation(s)
- Aline Sardinha
- Laboratory of Panic and Respiration, Psychiatry Institute, Federal University of Rio de Janeiro (IPUB/UFRJ), National Institute for Translational Medicine (INCT-TM, CNPq), Rio de Janeiro, Brazil.
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Vigorous exercise increases brain lactate and Glx (glutamate+glutamine): a dynamic 1H-MRS study. Neuroimage 2011; 57:1324-30. [PMID: 21640838 DOI: 10.1016/j.neuroimage.2011.05.048] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 05/07/2011] [Accepted: 05/17/2011] [Indexed: 01/12/2023] Open
Abstract
Vigorous exercise increases lactate and glucose uptake by the brain in excess of the increase in brain oxygen uptake. The metabolic fate of this non-oxidized carbohydrate entering the brain is poorly understood, but accumulation of lactate in the brain and/or increased net synthesis of amino acid neurotransmitters are possible explanations. Previous proton magnetic resonance spectroscopy (1H-MRS) studies using conventional pulse sequences have not detected changes in brain lactate following exercise. This contrasts with 1H-MRS studies showing increased brain lactate when blood lactate levels are raised by an intravenous infusion of sodium lactate. Using a J-editing 1H-MRS technique for measuring lactate, we demonstrated a significant 19% increase in lactate in the visual cortex following graded exercise to approximately 85% of predicted maximum heart rate. However, the magnitude of the increase was insufficient to account for more than a small fraction of the non-oxidized carbohydrate entering the brain with exercise. We also report a significant 18% increase in Glx (combined signal from glutamate and glutamine) in visual cortex following exercise, which may represent an activity-dependent increase in glutamate. Future studies will be necessary to test the hypothesis that non-oxidized carbohydrate entering the brain during vigorous exercise is directed, in part, toward increased net synthesis of amino acid neurotransmitters. The possible relevance of these findings to panic disorder and major depression is discussed.
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Sardinha A, Araújo CGSD, Nardi AE. Treinamento físico intervalado como ferramenta na terapia cognitivo-comportamental do transtorno de pânico. JORNAL BRASILEIRO DE PSIQUIATRIA 2011. [DOI: 10.1590/s0047-20852011000300013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Este trabalho consiste no relato da utilização de um programa de exercícios físicos aeró-bicos intervalados no contexto da terapia cognitivo-comportamental em um caso de transtorno de pânico e agorafobia. São descritos os procedimentos utilizados, bem como os resultados positivos obtidos na redução da ansiedade cardíaca e na ansiedade cotidiana em relação a situações que exigem esforço físico.
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Pappens M, Van den Bergh O, De Peuter S, Bresseleers J, Vansteenwegen D, Van Diest I. Defense reactions to interoceptive threats: A comparison between loaded breathing and aversive picture viewing. Biol Psychol 2010; 84:98-103. [DOI: 10.1016/j.biopsycho.2010.02.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 02/01/2010] [Accepted: 02/11/2010] [Indexed: 11/30/2022]
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The acute antipanic and anxiolytic activity of aerobic exercise in patients with panic disorder and healthy control subjects. J Psychiatr Res 2009; 43:1013-7. [PMID: 19289240 DOI: 10.1016/j.jpsychires.2009.02.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 02/13/2009] [Accepted: 02/17/2009] [Indexed: 11/22/2022]
Abstract
Regular physical activity is anxiolytic in both healthy subjects and patients with panic disorder. In contrast, acute exercise may induce acute panic attacks or increase subjective anxiety in patients with panic disorder more than in other people. The effects of quiet rest or an aerobic treadmill exercise (30 min at an intensity of 70% of the maximal oxygen uptake, VO2max) on cholecystokinin tetrapeptide (CCK-4) induced panic attacks were studied in a crossover design in 12 patients with panic disorder and 12 matched healthy subjects. The effects of CCK-4 (25 microg in patients and 50 microg in control subjects) were measured with the Acute Panic Inventory (API) score, comparing panic attack frequencies, total score, and subscores for anxiety and somatic symptoms. CCK-4-induced panic attacks were less frequent after prior exercise: they occurred in 15 (62.5%) subjects after rest (9 patients and 6 control subjects), but only 5 (20.8%) subjects after exercise (4 patients and 1 control subject). In both conditions, CCK-4 administration induced a significant increase in the total API score and the anxiety and somatic symptoms subsores. However, compared to prior rest, exercise resulted in a significantly reduced CCK-4-induced increase of the total API score and the anxiety subscore. In patients with panic disorder exercise increased the total API score and the somatic symptoms subscale but not the anxiety subscore. Patients with panic disorder showed increased somatic but not anxiety symptoms after an acute bout of exercise. Severity of CCK-4-induced panic and anxiety, on the other hand was reduced by exercise. These findings suggest that in addition to exercise training an acute bout of exercise may be used to reduce anxiety and panic attack frequency and intensity in panic disorder patients.
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Smits JAJ, Meuret AE, Zvolensky MJ, Rosenfield D, Seidel A. The effects of acute exercise on CO(2) challenge reactivity. J Psychiatr Res 2009; 43:446-54. [PMID: 18603261 DOI: 10.1016/j.jpsychires.2008.05.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 05/22/2008] [Accepted: 05/27/2008] [Indexed: 11/30/2022]
Abstract
The present study examined the effects of acute exercise on anxiogenic responding to 65% O(2)/35% CO(2) challenge. Participants (N=92) were 51 female and 41 male volunteers ranging in age from 17 to 24 (M=19.43, SD=1.31). Participants had no history of panic attacks and were randomized to moderate treadmill exercise (i.e., 70% of HR(max)) or quiet rest prior to taking a single vital capacity inhalation of 35% CO(2)/65% O(2). Gender and measures of negative affectivity and anxiety sensitivity were included in the design as control variables. Results indicated participants who exercised prior to challenge showed significantly reduced reactivity compared to their counterparts who rested prior to challenge. Importantly, the effect sizes for the advantage of exercise over rest remained in the medium to large range (i.e., partial eta(2)>.07) after controlling for the effects of gender, anxiety sensitivity, and negative affectivity. These findings are the first to demonstrate that the anti-panic effects of exercise are unique from, and cannot be better explained by, established risk factors of CO(2) challenge reactivity.
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Affiliation(s)
- Jasper A J Smits
- Department of Psychology, Southern Methodist University, Dallas, TX 75275, USA.
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