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Bottoms L, Prat Pons M, Fineberg NA, Pellegrini L, Fox O, Wellsted D, Drummond LM, Reid J, Baldwin DS, Hou R, Chamberlain S, Sireau N, Grohmann D, Laws KR. Effects of exercise on obsessive-compulsive disorder symptoms: a systematic review and meta-analysis. Int J Psychiatry Clin Pract 2023; 27:232-242. [PMID: 36541901 DOI: 10.1080/13651501.2022.2151474] [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: 07/05/2022] [Revised: 10/11/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis assessed the efficacy of exercise in reducing OCD symptoms. METHODS We searched PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, Scopus and grey literature until March 2022. The study was preregistered at Prospero (CRD42021283931). We included randomised controlled and pre-post trials assessing physical activity as an intervention for OCD. Risk of bias was assessed using the Cochrane ROBINS-I tool and the RoB2 tool. RESULTS The analysis included 6 trials (N = 92); 2 were RCTS and 4 were pre-post design studies. A random-effects meta-analysis of pre-post data identified a large reduction of OCD symptoms following exercise (g = 1.33 [95%CI 1.06-1.61]; k = 6). Exercise was also associated with significant pre-post reductions in anxiety (g = 0.71 [95%CI 0.37-1.05; k = 4) and depression (g = 0.57 [95%CI 0.26-0.89]; k = 2). Risk of bias was moderate-high in uncontrolled trials on the ROBINS-I and RCTs showed 'some concerns' on the RoB2. CONCLUSION Exercise was associated with a large pre-post reduction of OCD symptoms; however, few trials were of robust quality and all were at risk of bias. Further well-powered and better quality RCTs are required to assess the role of exercise as an intervention for OCD.KEY POINTSStudies exploring exercise as an adjunct therapy for OCD have small participant numbers, therefore a systematic review and meta-analysis is needed to estimate potential efficacy.Pre-post analysis shows that exercise was associated with a large reduction of OCD symptomsThe current systematic review and meta-analysis points to the potential for exercise to be beneficial for the treatment for OCD symptoms. However, more well-powered and better controlled RCTs are required to fully assess the benefit of exercise for the treatment of OCD symptoms.
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Affiliation(s)
- Lindsay Bottoms
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Montserrat Prat Pons
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Naomi A Fineberg
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Luca Pellegrini
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Oliver Fox
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Queen Square Institute of Neurology, University College London, London, UK
| | - David Wellsted
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Lynne M Drummond
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- South West London and St George's NHS Trust and School of Life and Medical Science, London, UK
| | - Jemma Reid
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Cornwall Partnership NHS Foundation Trust, Cornwall, UK
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Ruihua Hou
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Samuel Chamberlain
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Dominique Grohmann
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Keith R Laws
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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de Carvalho CD, Valentim RR, Navegantes LCC, Papoti M. Comparison between low, moderate, and high intensity aerobic training with equalized loads on biomarkers and performance in rats. Sci Rep 2022; 12:18047. [PMID: 36302946 PMCID: PMC9610360 DOI: 10.1038/s41598-022-22958-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 10/21/2022] [Indexed: 01/24/2023] Open
Abstract
This study investigated the physiological and molecular responses of Wistar Hannover rats, submitted to three 5-week chronic training models, with similar training loads. Twenty-four Wistar Hanover rats were randomly divided into four groups: control (n = 6), low-intensity training (Z1; n = 6), moderate-intensity training (Z2; n = 6) and high-intensity training (Z3; n = 6). The three exercise groups performed a 5-week running training three times a week, with the same prescribed workload but the intensity and the volume were different between groups. An increase in maximal speed was observed after four weeks of training for the three groups that trained, with no difference between groups. Higher rest glycogen was also observed in the soleus muscle after training for the exercise groups compared to the control group. We also found that the Z2 group had a higher protein content of total and phosphorylated GSK3-β compared to the control group after five weeks of training. In conclusion, the present study shows that five weeks of treadmill training based on intensity zones 1, 2, and 3 improved performance and increased resting glycogen in the soleus muscle, therefore intensity modulation does not change the training program adaptation since the different program loads are equalized.
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Affiliation(s)
- Carlos Dellavechia de Carvalho
- grid.11899.380000 0004 1937 0722Ribeirão Preto Medical School, Department of Orthopedics and Anesthesiology, University of São Paulo, Avenida Bandeirantes, Ribeirão Preto, Monte Alegre, 3900 Brazil
| | - Rafael Rossi Valentim
- grid.11899.380000 0004 1937 0722Ribeirão Preto Medical School, Department of Physiology, University of São Paulo, Avenida Bandeirantes, Ribeirão Preto, Monte Alegre, 3900 Brazil
| | - Luiz Carlos Carvalho Navegantes
- grid.11899.380000 0004 1937 0722Ribeirão Preto Medical School, Department of Physiology, University of São Paulo, Avenida Bandeirantes, Ribeirão Preto, Monte Alegre, 3900 Brazil
| | - Marcelo Papoti
- grid.11899.380000 0004 1937 0722Ribeirão Preto Medical School, Department of Orthopedics and Anesthesiology, University of São Paulo, Avenida Bandeirantes, Ribeirão Preto, Monte Alegre, 3900 Brazil ,grid.11899.380000 0004 1937 0722School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, Ribeirão Preto, Monte Alegre, São Paulo 3900 Brazil
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Acute effect of physical exercise on negative affect in borderline personality disorder: A pilot study. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e7495. [DOI: 10.32872/cpe.7495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background
Physical exercise is an evidence-based treatment to reduce symptoms and negative affect in several psychiatric disorders, including depressive, anxiety, and psychotic disorders. However, the effect of physical exercise on negative affect in patients with borderline personality disorder (BPD) has not yet been investigated. In this pilot study, we tested the safety, acceptability, and potential acute effects on negative affect of a single session of aerobic physical exercise in adults with BPD.
Method
After completing a negative mood induction procedure, 28 adults with BPD were randomly assigned to a 20-minute single session of stationary bicycle or a control condition (emotionally neutral video).
Results
No adverse effects attributed to the physical exercise were reported and it was considered acceptable to patients. Following the negative mood induction, both conditions decreased the level of negative affect with a medium effect size but there was no significant difference between them.
Conclusion
The results suggest that a single 20-minute session of physical exercise does not produce a reduction of negative affect in BPD. Future research should consider the duration and intensities of physical exercise with the greatest potential to reduce negative affect both acutely and in a more prolonged manner in this patient group.
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Begdache L, Sadeghzadeh S, Pearlmutter P, Derose G, Krishnamurthy P, Koh A. Dietary Factors, Time of the Week, Physical Fitness and Saliva Cortisol: Their Modulatory Effect on Mental Distress and Mood. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127001. [PMID: 35742250 PMCID: PMC9222387 DOI: 10.3390/ijerph19127001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023]
Abstract
Background: The purpose of the study was to assess the effect of diet quality and physical fitness on saliva cortisol, mood, and mental distress. These relationships were compared between a peak weekday (Wednesday) and a weekend day (Saturday) when mood may fluctuate. Methods: Forty-eight healthy college students participated in the study. Participants completed the Mood and Anxiety Symptom (MASQ) and Kessler Psychological Distress Scale 10 questionnaires on Wednesday and Saturday and recorded their diet for three days. Saliva was collected before and after a workout for cortisol extraction. Results: SA had significantly higher saliva cortisol levels post-workout but lower MASQ scores on Saturday (p < 0.05). There was a very significant association between MASQ scores on Wednesday (p = 0.005), which became less significant on Saturday. In addition, lower BMI values and high-fat consumption were associated with higher cortisol levels after exercise (p < 0.05). Conclusions: There is a strong link between dietary factors, cortisol levels, mood, and time of the week. In addition, our results suggest that saliva cortisol levels may not be directly linked to negative affect but are influenced by diet quality when mental distress exists. In addition, physical fitness may play a role in improving mood during weekends.
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Affiliation(s)
- Lina Begdache
- Health and Wellness Studies, Binghamton University, Binghamton, NY 13902, USA
- Correspondence:
| | | | - Paul Pearlmutter
- Department of Biomedical Engineering, Binghamton University, Binghamton, NY 13902, USA; (P.P.); (A.K.)
| | - Gia Derose
- Department of Biological Sciences, Binghamton University, Binghamton, NY 13902, USA;
| | - Pragna Krishnamurthy
- Department of Integrative Neuroscience, Binghamton University, Binghamton, NY 13902, USA;
| | - Ahyeon Koh
- Department of Biomedical Engineering, Binghamton University, Binghamton, NY 13902, USA; (P.P.); (A.K.)
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Katz TC, Bui TH, Worhach J, Bogut G, Tomczak KK. Tourettic OCD: Current understanding and treatment challenges of a unique endophenotype. Front Psychiatry 2022; 13:929526. [PMID: 35966462 PMCID: PMC9363583 DOI: 10.3389/fpsyt.2022.929526] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Obsessive compulsive disorder (OCD) and chronic tic disorders (CTD) including Tourette Syndrome (TS) are often comorbid conditions. While some patients present with distinct symptoms of CTD and/or OCD, a subset of patients demonstrate a unique overlap of symptoms, known as Tourettic OCD (TOCD), in which tics, compulsions, and their preceding premonitory urges are overlapping and tightly intertwined. The specific behaviors seen in TOCD are typically complex tic-like behaviors although with a compulsive and partially anxious nature reminiscent of OCD. TOCD is not classified within the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) as an independent diagnostic entity, but mounting evidence suggests that TOCD is an intermediate neuropsychiatric disorder distinct from either TS or OCD alone and as such represents a unique phenomenology. In this review of TOCD we discuss clinical, genetic, environmental, neurodevelopmental, and neurocircuit-based research to better characterize our current understanding of this disorder. TOCD is characterized by earlier age of onset, male predominance, and specific symptom clusters such as lower tendency toward compulsions related to checking, cleaning, and reassurance seeking and higher tendency toward compulsions such as rubbing, tapping, or touching associated with symmetry concerns or thoughts of exactness. Functional magnetic resonance imaging (fMRI) imaging suggests that TOCD symptoms may arise from involvement of an intermediate neurocircuitry distinct from classic OCD or classic CTD. Small cumulative contributions from multiple genetic loci have been implicated, as have environmental factors such as infection and perinatal trauma. In addition, this review addresses the treatment of TOCD which is especially complex and often treatment resistant and requires pharmacology and behavioral therapy in multiple modalities. Given the distressing impact of TOCD on patients' functioning, the goal of this review is to raise awareness of this distinct entity toward the goal of improving standards of care.
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Affiliation(s)
- Tamar C Katz
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States
| | - Thanh Hoa Bui
- Tic Disorders and Tourette Syndrome Program, Department of Neurology, Boston Children's Hospital, Boston, MA, United States
| | - Jennifer Worhach
- Tic Disorders and Tourette Syndrome Program, Department of Neurology, Boston Children's Hospital, Boston, MA, United States
| | - Gabrielle Bogut
- Tic Disorders and Tourette Syndrome Program, Department of Neurology, Boston Children's Hospital, Boston, MA, United States
| | - Kinga K Tomczak
- Tic Disorders and Tourette Syndrome Program, Department of Neurology, Boston Children's Hospital, Boston, MA, United States
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Brierley MEE, Albertella L, Rotaru K, Destree L, Thompson EM, Liu C, Christensen E, Lowe A, Segrave RA, Richardson KE, Kayayan E, Chamberlain SR, Grant JE, Lee RSC, Hughes S, Yücel M, Fontenelle LF. The role of psychological distress in the relationship between lifestyle and compulsivity: An analysis of independent, bi-national samples. CNS Spectr 2021; 28:1-10. [PMID: 34895362 PMCID: PMC7614722 DOI: 10.1017/s1092852921001048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Poor mental health is a state of psychological distress that is influenced by lifestyle factors such as sleep, diet, and physical activity. Compulsivity is a transdiagnostic phenotype cutting across a range of mental illnesses including obsessive-compulsive disorder, substance-related and addictive disorders, and is also influenced by lifestyle. Yet, how lifestyle relates to compulsivity is presently unknown, but important to understand to gain insights into individual differences in mental health. We assessed (a) the relationships between compulsivity and diet quality, sleep quality, and physical activity, and (b) whether psychological distress statistically contributes to these relationships. METHODS We collected harmonized data on compulsivity, psychological distress, and lifestyle from two independent samples (Australian n = 880 and US n = 829). We used mediation analyses to investigate bidirectional relationships between compulsivity and lifestyle factors, and the role of psychological distress. RESULTS Higher compulsivity was significantly related to poorer diet and sleep. Psychological distress statistically mediated the relationship between poorer sleep quality and higher compulsivity, and partially statistically mediated the relationship between poorer diet and higher compulsivity. CONCLUSIONS Lifestyle interventions in compulsivity may target psychological distress in the first instance, followed by sleep and diet quality. As psychological distress links aspects of lifestyle and compulsivity, focusing on mitigating and managing distress may offer a useful therapeutic approach to improve physical and mental health. Future research may focus on the specific sleep and diet patterns which may alter compulsivity over time to inform lifestyle targets for prevention and treatment of functionally impairing compulsive behaviors.
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Affiliation(s)
- Mary-Ellen E Brierley
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia
| | - Lucy Albertella
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia
| | - Kristian Rotaru
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia
- Monash Business School, Monash University, Caulfield, Victoria, Australia
| | - Louise Destree
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia
| | - Emma M Thompson
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia
| | - Chang Liu
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia
| | - Erynn Christensen
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia
| | - Amelia Lowe
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia
| | - Rebecca A Segrave
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia
| | - Karyn E Richardson
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia
| | - Edouard Kayayan
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia
| | - Samuel R Chamberlain
- Department of Psychiatry, University of Southampton, Southampton, United Kingdom
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Jon E Grant
- Department of Psychiatry and Behavioural Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Rico S C Lee
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia
| | - Sam Hughes
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia
| | - Murat Yücel
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia
| | - Leonardo F Fontenelle
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
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Freedman DE, Richter MA. A narrative review of exercise and obsessive-compulsive disorder. Gen Hosp Psychiatry 2021; 71:1-10. [PMID: 33887525 DOI: 10.1016/j.genhosppsych.2021.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Individuals with obsessive-compulsive disorder (OCD) suffer significant distress due to their condition; however, there can be multiple barriers to treatment. Even following OCD-tailored treatment, symptoms often remain. Exercise may be an effective and available approach to managing OCD, and yet, there are no specifically dedicated reviews, limiting integration into clinical practice. This study aimed to provide an overview of the literature on exercise and OCD. METHOD Four databases, the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and EMBASE, were systematically searched. 1534 records were screened and the reference lists of eligible articles were examined. For this review, 11 extracted studies were narratively explored. RESULTS Two observational and nine interventional studies were included, of which one article focused on youth and ten studies focused on adults. Physical activity likely reduces the risk of metabolic syndrome or general health conditions. Several pre-post studies demonstrated exercise's benefits for OCD symptoms, while the only randomized controlled trial showed negative findings for its efficacy in reducing obsessions and compulsions. CONCLUSIONS The evidence for aerobic exercise's long-term benefits for the symptoms of OCD is mixed, but remains promising. Potential mechanisms of exercise's effects and future directions for research are explored.
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Affiliation(s)
- David E Freedman
- Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences Centre, Canada.
| | - Margaret A Richter
- Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences Centre, Canada
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Alghadir AH, Gabr SA. Hormonal Function Responses to Moderate Aerobic Exercise in Older Adults with Depression. Clin Interv Aging 2020; 15:1271-1283. [PMID: 32821089 PMCID: PMC7423410 DOI: 10.2147/cia.s259422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/14/2020] [Indexed: 12/02/2022] Open
Abstract
Background Poor daily life physical activities among older people were related to depressive mood especially memory loss. In addition to that, the change in physical ability is significantly associated with the score of depression among older age. Objective The present study aimed to evaluate the effects of a supervised aerobic training program with moderate intensity for 12 weeks on mood profiles and hormonal levels of the hypothalamus-pituitary-adrenal axis (HPA axis) of older adults. Methods A total of 80 individuals of both gender (90 males, 110 females) of ages ranged between 65 and 95 years were recruited for this study. Based upon the profile of mood states (POMS) analysis, the participants were classified into two groups: control group (n=30) and depressive group (n=50). Leisure-time physical activity (LTPA), adrenal hormones such as ACTH, corticosterone (CORT), cortisol, DHEA/S, and cortisol:DHEA/S ratio were measured at baseline and post-intervention of moderate aerobic exercise for 12 weeks. Results Older adults with higher depressive scores showed a remarkable change in the level of adrenal hormones compared to control. There was a significant increase in the level of ACTH, CORT, cortisol, and cortisol:DHEA/S ratio, and decrease in DHEA/S. Compared to females, males showed an improvement in depressive mood score along with an increase in LPTA, DHEA/S and decrease in ACTH, CORT, cortisol, cortisol:DHEA/S ratio following 12 weeks of supervised aerobic training, respectively. Conclusion The findings of this study showed that 12 weeks of supervised exercise interventions are promising non-drug therapeutic strategies in improving depression among older adults. The potential performance in a psychological state occurs physiologically via optimizing the levels of the hormones of the HPA axis.
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Affiliation(s)
- Ahmad H Alghadir
- Rehabilitation Research Chair (RRC), College of Applied Medical Sciences (CAMS), King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sami A Gabr
- Rehabilitation Research Chair (RRC), College of Applied Medical Sciences (CAMS), King Saud University, Riyadh, Kingdom of Saudi Arabia
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Abrantes AM, Farris SG, Minami H, Strong DR, Riebe D, Brown RA. Acute Effects of Aerobic Exercise on Affect and Smoking Craving in the Weeks Before and After a Cessation Attempt. Nicotine Tob Res 2019; 20:575-582. [PMID: 28505303 DOI: 10.1093/ntr/ntx104] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 05/10/2017] [Indexed: 11/14/2022]
Abstract
Introduction Aerobic exercise may improve smoking abstinence via reductions in craving and negative affect and increases in positive moods. Acute changes in craving and affect before and after structured exercise sessions have not been examined during the weeks prior to and following quit attempts nor has smoking status been examined in relation to these effects. Given that regular cigarette smoking can be perceived as affect enhancing and craving reducing, it is not known whether exercise could contribute additional affective benefit beyond these effects. Method Participants (N = 57; 68.4% women) were low-active daily smokers randomized to cessation treatments plus either group-based aerobic exercise (AE) or a health-education control (HEC). Mood, anxiety, and craving were assessed before and after each intervention session for each of the 12 weeks. Carbon monoxide (CO) breath samples ≤ 5ppm indicated smoking abstinence. Results During the prequit sessions, significantly greater decreases in anxiety following AE sessions relative to HEC sessions were observed. Changes in mood and craving were similar after AE and HEC sessions prior to quitting. Postquit attempt, significant reductions in craving and anxiety were observed after AE sessions but not following HEC. During the postquit period, positive mood increased following AE sessions relative to HEC only among individuals who were abstinence on that day. Conclusions AE may be effective in acutely reducing anxiety prior to a quit attempt and both anxiety and craving following the quit attempt regardless of abstinence status. The mood-enhancing effects of AE may occur only in the context of smoking abstinence. Implications The current findings underscore the importance of examining the acute effects of aerobic exercise prior to and after a cessation attempt and as a function of smoking status. Given the equivocal results from previous studies on the efficacy of exercise for smoking cessation, increasing our understanding of how aerobic exercise produces its reinforcing benefits for smokers attempting to quit could potentially inform the refinement (e.g., timing/sequencing) of exercise interventions within smoking cessation programs.
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Affiliation(s)
- Ana M Abrantes
- Butler Hospital, Providence, RI.,Alpert Medical School of Brown University, Providence, RI
| | - Samantha G Farris
- Butler Hospital, Providence, RI.,Alpert Medical School of Brown University, Providence, RI.,Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, RI
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Hallgren M, Nguyen TTD, Herring MP, McDowell CP, Gordon BR, Stubbs B, Bellocco R, Lagerros YT. Associations of physical activity with anxiety symptoms and disorders: Findings from the Swedish National March Cohort. Gen Hosp Psychiatry 2019; 58:45-50. [PMID: 30884441 DOI: 10.1016/j.genhosppsych.2019.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/28/2019] [Accepted: 03/09/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Regular physical activity (PA) is associated with less self-reported anxiety, but prospective studies linked to clinician diagnoses of anxiety disorder remain scarce. We examined whether the PA levels recommended for general health are related to anxiety symptoms and disorders. METHOD In total, 43,863 Swedish adults were surveyed in 1997 and responses linked to medical registers until 2010. Weekly durations of habitual moderate and vigorous leisure time PA were self-reported. Cross-sectional and prospective relationships between the total duration (minutes) of PA, 0-149 ('below'), 150-299 ('achieve'), and ≥300 min ('exceed') with self-reported anxiety symptoms and incident anxiety disorder were explored. Associations were explored using logistic and Cox proportional hazard regression models. RESULTS Of 27,053 participants with complete data (mean age = 49.0 years, SD = 15.9, 66% female), 76% met the recommended duration of PA (≥150 min), and 38% exceeded this duration. At baseline, 2573 participants (9.5%) reported elevated anxiety symptoms. In cross-sectional analyses, engaging in ≥150 min of MVPA/week was associated with 24% (OR = 0.76, 95% CI = 0.68-0.86) lower odds of anxiety symptoms. Exceeding the weekly duration was associated with 36% (OR = 0.64, 95% CI = 0.57-0.72) lower odds. During the 13-year follow-up, 198 incident cases of anxiety disorder (0.8%) were identified. No significant prospective relationships were found. CONCLUSIONS Engaging in leisure time PA at levels recommended for general health may reduce the risk of elevated anxiety symptoms. As the incidence of anxiety disorder was likely under-estimated, further prospective studies are needed to determine the relationship between PA and incident anxiety disorder.
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Affiliation(s)
- Mats Hallgren
- Department of Public Health Sciences, Karolinska Institutet, Solna 171 77, Sweden.
| | - Thi-Thuy-Dung Nguyen
- Department of Public Health Sciences, Karolinska Institutet, Solna 171 77, Sweden
| | - Matthew P Herring
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Cillian P McDowell
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Brett R Gordon
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
| | - Rino Bellocco
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden; Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy
| | - Ylva Trolle Lagerros
- Department of Medicine, Clinic of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, 171 77 Solna, Sweden
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Examining a training effect on the state anxiety response to an acute bout of exercise in low and high anxious individuals. J Affect Disord 2019; 247:29-35. [PMID: 30640027 DOI: 10.1016/j.jad.2018.12.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 11/21/2018] [Accepted: 12/20/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND An acute bout of exercise temporarily reduces state anxiety. The current study examined whether these benefits are greater for those with higher levels of anxiety, and whether these benefits are augmented with exercise training. METHODS Young adults were randomized to either a nine-week moderate-intensity exercise group or an inactive control group. We assessed changes in state anxiety in response to an acute bout of exercise each week. RESULTS State anxiety reductions following acute exercise increased in the exercise subgroup with high anxiety at baseline as training progressed (p = .029). No training effects were observed for the exercise subgroup with low baseline anxiety (p = .27). LIMITATIONS A predominantly female sample, a single state anxiety measure post exercise and a non-exercise control group should be addressed in future research. CONCLUSIONS The results support the use of regular physical activity as a method for managing state anxiety in young adults. In particular, regular physical activity may be especially beneficial for those experiencing higher levels of anxiety.
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12
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Abrantes AM, Farris SG, Brown RA, Greenberg BD, Strong DR, McLaughlin NC, Riebe D. Acute effects of aerobic exercise on negative affect and obsessions and compulsions in individuals with obsessive-compulsive disorder. J Affect Disord 2019; 245:991-997. [PMID: 30699885 PMCID: PMC7037579 DOI: 10.1016/j.jad.2018.11.074] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/17/2018] [Accepted: 11/11/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND The acute effects of aerobic exercise on improved mood and anxiety reduction have been demonstrated across clinical and nonclinical populations. Limited work has evaluated the acute effects of aerobic exercise on negative affect, obsessions, and compulsions in patients with Obsessive Compulsive Disorder (OCD). METHOD Fifty-five patients (64% female) with treatment-resistant OCD were randomized to either 12 weeks of aerobic exercise (AE) or health education contact (HEC) control. Participants rated negative affect (i.e., mood and anxiety), obsessions and compulsions before and after each weekly AE or HEC session. Multilevel models were constructed to evaluate the effect of intervention condition, treatment week (time), and their interaction in terms of acute change in affect, obsession, and compulsions. RESULTS Results reflected a main effect of condition, such that AE resulted in significantly larger increases in positive mood, and reductions in anxiety and compulsions, as compared to HEC. There was also a main effect of time in predicting acute anxiety reduction, such that linear reductions in anxiety over the course of treatment were observed. No significant effects were observed for acute changes in obsessions. LIMITATIONS The sample was small and was limited in demographic heterogeneity. Bouts of aerobic exercise were not standardized in terms of duration and mode, which could impact affective response to exercise, and acute affective OCD effects were exclusively self-reported. DISCUSSION The current findings may help elucidate potential mechanisms of action of exercise on OCD outcomes. In addition, these results point toward the potential of designing exercise interventions that can teach patients to utilize individual bouts of physical activity, "in-the-moment" to improve mood and reduce anxiety and compulsions.
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Affiliation(s)
- Ana M Abrantes
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI USA; Butler Hospital, Behavioral Medicine and Addictions Research, Providence, RI USA.
| | - Samantha G Farris
- Rutgers, the State University of New Jersey, Department of Psychology, New Brunswick, NJ USA
| | - Richard A Brown
- The University of Texas at Austin, Department of Nursing, Austin TX USA
| | - Benjamin D Greenberg
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI USA; Butler Hospital, Behavioral Medicine and Addictions Research, Providence, RI USA; Veterans Affairs Medical Center of Providence, Providence, RI USA
| | - David R Strong
- University of California San Diego, Family Medicine and Public Health, La Jolla, CA USA
| | - Nicole C McLaughlin
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI USA; Butler Hospital, Behavioral Medicine and Addictions Research, Providence, RI USA
| | - Deborah Riebe
- University of Rhode Island, Department of Kinesiology, Kingston, RI USA
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13
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Fontenelle LF, Zeni-Graiff M, Quintas JN, Yücel M. Is There A Role For Lifestyle Interventions In Obsessive-Compulsive And Related Disorders? Curr Med Chem 2019; 25:5698-5711. [DOI: 10.2174/0929867325666180104150854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 12/01/2017] [Accepted: 12/08/2017] [Indexed: 01/12/2023]
Abstract
Many of the currently available treatments for obsessive-compulsive and related
disorders (OCRDs) such as pharmacotherapy augmentation strategies, partial hospitalization
programs, deep brain stimulation, and neurosurgery are efficacious for individuals
suffering from more severe forms of these conditions. Unfortunately, the application
of these treatments in milder forms of illness and subclinical samples, which affect a
substantial portion of the population, is not justifiable by their costs (e.g. cognitivebehavioral
therapy) and/or potential for side effects (serotonin-reuptake inhibitors associated
sexual side effects). As such, there is an urgent need to develop simple yet effective
treatments, such as modifiable lifestyle interventions, that can be employed on a broader
scale. Here, we review the current state of evidence that supports or refutes the efficacy of
lifestyle approaches for OCRDs. We focus on dimensions of lifestyle that are deemed important
for cardiovascular diseases; namely, physical activity, stress, sleep, diet and eating
behaviors, alcohol consumption, and smoking. Despite the relative scarcity of welldesigned
randomized controlled trials targeting unhealthy life styles in OCRDs, we found
meditation-based therapies and interventions focusing on eliminating sedentarism to be
promising approaches. In the future, these strategies may represent valid alternative for
subjects with subthreshold symptoms or at risk for OCRDs or other “compulsive” disorders.
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Affiliation(s)
- Leonardo F. Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program. Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Maiara Zeni-Graiff
- Obsessive, Compulsive, and Anxiety Spectrum Research Program. Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Julliana N. Quintas
- Obsessive, Compulsive, and Anxiety Spectrum Research Program. Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Murat Yücel
- Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Victoria, Australia
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Abrantes AM, Farris SG, Garnaat SL, Minto A, Brown RA, Price LH, Uebelacker LA. The Role of Physical Activity Enjoyment on the Acute Mood Experience of Exercise among Smokers with Elevated Depressive Symptoms. Ment Health Phys Act 2017; 12:37-43. [PMID: 28989344 PMCID: PMC5625337 DOI: 10.1016/j.mhpa.2017.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PROBLEM Depressive symptoms are consistently shown to be related to poor smoking cessation outcomes. Aerobic exercise is a potential treatment augmentation that, given its antidepressant and mood enhancing effect, may bolster cessation outcomes for smokers with elevated depressive symptoms. Lower enjoyment of physical activity may inhibit the acute mood enhancing effects of aerobic exercise. The current study investigated the associations between depressive symptoms, physical activity enjoyment and the acute mood experience from exercise among low-active smokers with elevated depressive symptoms. METHOD Daily smokers with elevated depressive symptoms (N=159; Mage = 45.1, SD = 10.79; 69.8% female) were recruited for a randomized controlled exercise-based smoking cessation trial. Participants self-reported levels of depressive symptoms, physical activity enjoyment, and rated their mood experience (assessed as "mood" and "anxiety") before and after a standardized aerobic exercise test. RESULTS Hierarchical regression analysis revealed that depressive symptom severity accounted for significant unique variance in physical activity enjoyment (R2 =.041, t = -2.61, p = .010), beyond the non-significant effects of gender and level of tobacco dependence. Additionally, physical activity enjoyment was a significant mediator of the association between depressive symptom severity and acute mood experience ("mood" and "anxiety") following the exercise test. CONCLUSIONS Physical activity enjoyment may explain, at least in part, how depressive symptom severity is linked to the acute mood experience following a bout of activity. Interventions that target increasing physical activity enjoyment may ultimately assist in enhancing the mood experience from exercise, and therefore improve smoking cessation likelihood, especially for smokers with elevated depressive symptoms.
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Affiliation(s)
- Ana M. Abrantes
- Butler Hospital, Providence, Rhode Island
- Alpert Medical School of Brown University, Providence, Rhode
Island
| | - Samantha G. Farris
- Butler Hospital, Providence, Rhode Island
- Alpert Medical School of Brown University, Providence, Rhode
Island
- The Miriam Hospital, Providence, Rhode Island
| | - Sarah L. Garnaat
- Butler Hospital, Providence, Rhode Island
- Alpert Medical School of Brown University, Providence, Rhode
Island
| | | | - Richard A. Brown
- Alpert Medical School of Brown University, Providence, Rhode
Island
- University of Texas at Austin, Austin, Texas
| | - Lawrence H. Price
- Butler Hospital, Providence, Rhode Island
- Alpert Medical School of Brown University, Providence, Rhode
Island
| | - Lisa A. Uebelacker
- Butler Hospital, Providence, Rhode Island
- Alpert Medical School of Brown University, Providence, Rhode
Island
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15
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Brown RA, Prince MA, Minami H, Abrantes AM. An exploratory analysis of changes in mood, anxiety and craving from pre- to post-single sessions of exercise, over 12 weeks, among patients with alcohol dependence. Ment Health Phys Act 2016; 11:1-6. [PMID: 29606975 PMCID: PMC5878084 DOI: 10.1016/j.mhpa.2016.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aerobic exercise is currently being studied as a relapse prevention strategy for individuals with alcohol use disorders. Negative affect and cravings predict relapse. The acute effects of moderate-intensity exercise have been shown to improve mood and reduce craving. The current study examined the acute effects of exercise on changes in mood, anxiety, and craving from pre- to post-exercise at each week of a 12-week moderate intensity exercise intervention with sedentary alcohol dependent adults. Twenty-six participants in the exercise condition of a larger randomized clinical trial (Brown et al., 2014) exercised in small groups at moderate intensity for 20 to 40 minutes per session. Participants rated mood, anxiety, and cravings in the present moment before and after each exercise session over the course of the 12-week intervention. Data analyses focused on effect size and interval estimation. Joinpoint analysis was used to model longitudinal trends. Increases in mood and decreases in anxiety and craving were apparent at every session. Effect size estimates revealed that average change from pre- to post-exercise was in the small to medium range with some individual sessions reaching the large range. Joinpoint analyses revealed that the pre-post exercise changes in mood increased, anxiety remained stable, and craving diminished across the 12 weeks. This study provides provisional support for a change in mood, anxiety and alcohol cravings for the role of exercise in the early recovery period for alcohol dependence. Acute single bouts of moderate-intensity exercise may help individuals with alcohol dependence manage mood, anxiety, and craving thereby reducing relapse risk, but further research is needed with a more rigorous study design.
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Affiliation(s)
| | - Mark A Prince
- Butler Hospital/Alpert Medical School of Brown University
| | - Haruka Minami
- Butler Hospital/Alpert Medical School of Brown University
| | - Ana M Abrantes
- Butler Hospital/Alpert Medical School of Brown University
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16
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Rodriguez CI, Wheaton M, Zwerling J, Steinman SA, Sonnenfeld D, Galfalvy H, Simpson HB. Can exposure-based CBT extend the effects of intravenous ketamine in obsessive-compulsive disorder? an open-label trial. J Clin Psychiatry 2016; 77:408-9. [PMID: 27046314 PMCID: PMC5544939 DOI: 10.4088/jcp.15l10138] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Carolyn I. Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Michael Wheaton
- New York State Psychiatric Institute, New York, NY,Columbia University, Department of Psychiatry, College of Physicians and Surgeons, New York, NY
| | - Jordana Zwerling
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | | | | | - Hanga Galfalvy
- Columbia University, Department of Biostatistics, College of Physicians and Surgeons, New York, NY
| | - Helen Blair Simpson
- New York State Psychiatric Institute, New York, NY,Columbia University, Department of Psychiatry, College of Physicians and Surgeons, New York, NY
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Rodriguez CI, Kegeles LS, Levinson A, Ogden RT, Mao X, Milak MS, Vermes D, Xie S, Hunter L, Flood P, Moore H, Shungu DC, Simpson HB. In vivo effects of ketamine on glutamate-glutamine and gamma-aminobutyric acid in obsessive-compulsive disorder: Proof of concept. Psychiatry Res 2015; 233:141-7. [PMID: 26104826 PMCID: PMC4715460 DOI: 10.1016/j.pscychresns.2015.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 04/18/2015] [Accepted: 06/01/2015] [Indexed: 12/21/2022]
Abstract
We previously reported the rapid and robust clinical effects of ketamine versus saline infusions in a proof-of-concept crossover trial in unmedicated adults with obsessive-compulsive disorder (OCD). This study examined the concurrent neurochemical effects of ketamine versus saline infusions using proton magnetic resonance spectroscopy ((1)H MRS) during the clinical proof-of-concept crossover trial. Levels of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and the excitatory neurochemicals glutamate+glutamine (Glx) were acquired in the medial prefrontal cortex (MPFC), a region implicated in OCD pathology. Seventeen unmedicated OCD adults received two intravenous infusions at least 1 week apart, one of saline and one of ketamine, while lying supine in a 3.0 T GE MR scanner. The order of each infusion pair was randomized. Levels of GABA and Glx were measured in the MPFC before, during, and after each infusion and normalized to water (W). A mixed effects model found that MPFC GABA/W significantly increased over time in the ketamine compared with the saline infusion. In contrast, there were no significant differences in Glx/W between the ketamine and saline infusions. Together with earlier evidence of low cortical GABA in OCD, our findings suggest that models of OCD pathology should consider the role of GABAergic abnormalities in OCD symptomatology.
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Affiliation(s)
- Carolyn I Rodriguez
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA; Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA.
| | - Lawrence S Kegeles
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA; Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA; Department of Radiology, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Amanda Levinson
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - R Todd Ogden
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA; Department of Biostatistics, Columbia University, Mailman School of Public Health, New York, NY 10032, USA
| | - Xiangling Mao
- Department of Radiology, Weill Medical College of Cornell University, NY 10021, USA
| | - Matthew S Milak
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA; Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Donna Vermes
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA; Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Shan Xie
- Analytical Psychopharmacology Laboratory, the Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA
| | - Liane Hunter
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Pamela Flood
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, Palo Alto, CA 94305, USA
| | - Holly Moore
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA; Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Dikoma C Shungu
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA; Department of Radiology, Weill Medical College of Cornell University, NY 10021, USA
| | - Helen B Simpson
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA; Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA
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Rector NA, Richter MA, Lerman B, Regev R. A Pilot Test of the Additive Benefits of Physical Exercise to CBT for OCD. Cogn Behav Ther 2015; 44:328-40. [PMID: 25738234 DOI: 10.1080/16506073.2015.1016448] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The majority of "responders" to first-line cognitive-behavioural therapy (CBT) and pharmacological treatments for obsessive-compulsive disorder (OCD) are left with residual symptoms that are clinically relevant and disabling. Therefore, there is pressing need for widely accessible efficacious alternative and/or adjunctive treatments for OCD. Accumulating evidence suggests that physical exercise may be one such intervention in the mood and anxiety disorders broadly, although we are aware of only two positive small-scale pilot studies that have tested its clinical benefits in OCD. This pilot study aimed to test the feasibility and preliminary efficacy of adding a structured physical exercise programme to CBT for OCD. A standard CBT group was delivered concurrently with a 12-week customized exercise programme to 11 participants. The exercise regimen was individualized for each participant based on peak heart rate measured using an incremental maximal exercise test. Reports of exercise adherence across the 12-week regimen exceeded 80%. A paired-samples t-test indicated very large treatment effects in Yale-Brown Obsessive-Compulsive Scale scores from pre- to post-treatment in CBT group cohorts led by expert CBT OCD specialists (d = 2.55) and junior CBT clinician non-OCD specialists (d = 2.12). These treatment effects are very large and exceed effects typically observed with individual and group-based CBT for OCD based on leading meta-analytic reviews, as well as previously obtained treatment effects for CBT using the same recruitment protocol without exercise. As such, this pilot work demonstrates the feasibility and significant potential clinical utility of a 12-week aerobic exercise programme delivered in conjunction with CBT for OCD.
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Affiliation(s)
- Neil A Rector
- a Sunnybrook Health Sciences Centre , 2075 Bayview Ave., Toronto , Ontario , Canada M4N 3M5
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Linke SE, Ussher M. Exercise-based treatments for substance use disorders: evidence, theory, and practicality. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:7-15. [PMID: 25397661 PMCID: PMC4831948 DOI: 10.3109/00952990.2014.976708] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Epidemiological studies reveal that individuals who report risky substance use are generally less likely to meet physical activity guidelines (with the exception of certain population segments, such as adolescents and athletes). A growing body of evidence suggests that individuals with substance use disorders (SUDs) are interested in exercising and that they may derive benefits from regular exercise, in terms of both general health/fitness and SUD recovery. OBJECTIVES The aims of this paper were to: (i) summarize the research examining the effects of exercise-based treatments for SUDs; (ii) discuss the theoretical mechanisms and practical reasons for investigating this topic; (iii) identify the outstanding relevant research questions that warrant further inquiry; and (iv) describe potential implications for practice. METHODS The following databases were searched for peer-reviewed original and review papers on the topic of substance use and exercise: PubMed Central, MEDLINE, EMBASE, PsycINFO, and CINAHL Plus. Reference lists of these publications were subsequently searched for any missed but relevant manuscripts. Identified papers were reviewed and summarized by both authors. RESULTS The limited research conducted suggests that exercise may be an effective adjunctive treatment for SUDs. In contrast to the scarce intervention trials to date, a relative abundance of literature on the theoretical and practical reasons supporting the investigation of this topic has been published. CONCLUSIONS Definitive conclusions are difficult to draw due to diverse study protocols and low adherence to exercise programs, among other problems. Despite the currently limited and inconsistent evidence, numerous theoretical and practical reasons support exercise-based treatments for SUDs, including psychological, behavioral, neurobiological, nearly universal safety profile, and overall positive health effects.
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Affiliation(s)
- Sarah E. Linke
- Department of Family & Preventive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Michael Ussher
- Division of Population Health Sciences and Education, St George’s, University of London, London, UK
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Stanton R, Rosenbaum S, Kalucy M, Reaburn P, Happell B. A call to action: exercise as treatment for patients with mental illness. Aust J Prim Health 2015; 21:120-5. [DOI: 10.1071/py14054] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/01/2014] [Indexed: 12/17/2022]
Abstract
Mental illness affects the lives of a significant number of Australians. In addition to pharmacological and psychological interventions, exercise has demonstrated benefits for people with mental illness including symptom reduction, improved cardiovascular risk profile and improved physical capacity. Unfortunately, evidence shows that clinician-delivered exercise advice is not routinely offered. This is despite patient acceptability for exercise. This article summarises the recent evidence supporting the prescription of exercise for people with mental illness and offers a model incorporating basic exercise prescription, and referral pathways for specialised advice. Current exercise prescription patterns for people with mental illness may not meet patient expectations; therefore, clinicians should consider exercise referral schemes to increase the accessibility of interventions for people with a mental illness.
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21
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Fetzner MG, Asmundson GJG. Aerobic Exercise Reduces Symptoms of Posttraumatic Stress Disorder: A Randomized Controlled Trial. Cogn Behav Ther 2014; 44:301-13. [PMID: 24911173 DOI: 10.1080/16506073.2014.916745] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Evidence suggests aerobic exercise has anxiolytic effects; yet, the treatment potential for posttraumatic stress disorder (PTSD) and responsible anxiolytic mechanisms have received little attention. Emerging evidence indicates that attentional focus during exercise may dictate the extent of therapeutic benefit. Whether benefits are a function of attentional focus toward or away from somatic arousal during exercise remains untested. Thirty-three PTSD-affected participants completed two weeks of stationary biking aerobic exercise (six sessions). To assess the effect of attentional focus, participants were randomized into three exercise groups: group 1 (attention to somatic arousal) received prompts directing their attention to the interoceptive effects of exercise, group 2 (distraction from somatic arousal) watched a nature documentary, and group 3 exercised with no distractions or interoceptive prompts. Hierarchal linear modeling showed all groups reported reduced PTSD and anxiety sensitivity (AS; i.e., fear of arousal-related somatic sensations) during treatment. Interaction effects between group and time were found for PTSD hyperarousal and AS physical and social scores, wherein group 1, receiving interoceptive prompts, experienced significantly less symptom reduction than other groups. Most participants (89%) reported clinically significant reductions in PTSD severity after the two-week intervention. Findings suggest, regardless of attentional focus, aerobic exercise reduces PTSD symptoms.
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Affiliation(s)
- Mathew G Fetzner
- a Department of Psychology , University of Regina , Regina , Canada
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22
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Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, Christmas DM, Davies S, Fineberg N, Lidbetter N, Malizia A, McCrone P, Nabarro D, O'Neill C, Scott J, van der Wee N, Wittchen HU. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol 2014; 28:403-39. [PMID: 24713617 DOI: 10.1177/0269881114525674] [Citation(s) in RCA: 375] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.
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Affiliation(s)
- David S Baldwin
- 1Faculty of Medicine, University of Southampton, Southampton, UK
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23
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Mooney LJ, Cooper C, London ED, Chudzynski J, Dolezal B, Dickerson D, Brecht ML, Peñate J, Rawson RA. Exercise for methamphetamine dependence: rationale, design, and methodology. Contemp Clin Trials 2013; 37:139-47. [PMID: 24291456 DOI: 10.1016/j.cct.2013.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/14/2013] [Accepted: 11/19/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Effective pharmacotherapies to treat methamphetamine (MA) dependence have not been identified, and behavioral therapies are marginally effective. Based on behavioral studies demonstrating the potential efficacy of aerobic exercise for improving depressive symptoms, anxiety, cognitive deficits, and substance use outcomes, the study described here is examining exercise as a potential treatment for MA-dependent individuals. METHODS This study is randomizing 150 participants with MA dependence at a residential treatment facility for addictive disorders to receive either a thrice-weekly structured aerobic and resistance exercise intervention or a health education condition. Recruitment commenced in March, 2010. Enrollment and follow-up phases are ongoing, and recruitment is exceeding targeted enrollment rates. CONCLUSIONS Seeking evidence for a possibly effective adjunct to traditional behavioral approaches for treatment of MA dependence, this study is assessing the ability of an 8-week aerobic and resistance exercise protocol to reduce relapse to MA use during a 12-week follow-up period after discharge from residential-based treatment. The study also is evaluating improvements in health and functional outcomes during and after the protocol. This paper describes the design and methods of the study.
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Affiliation(s)
- Larissa J Mooney
- Integrated Substance Abuse Programs, Semel Institute, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Los Angeles, CA 90025, United States.
| | - Christopher Cooper
- Exercise Physiology Research Laboratory, Division of Pulmonary Medicine, David Geffen School of Medicine, 10833 Le Conte 37-131 CHS, University of California, Los Angeles, Los Angeles, CA 90095, United States.
| | - Edythe D London
- Semel Institute, David Geffen School of Medicine, University of California, 760 Westwood Plaza, Room C8-831, Los Angeles, CA 90024, United States.
| | - Joy Chudzynski
- Integrated Substance Abuse Programs, Semel Institute, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Los Angeles, CA 90025, United States.
| | - Brett Dolezal
- Exercise Physiology Research Laboratory, Division of Pulmonary Medicine, David Geffen School of Medicine, 10833 Le Conte 37-131 CHS, University of California, Los Angeles, Los Angeles, CA 90095, United States.
| | - Daniel Dickerson
- Integrated Substance Abuse Programs, Semel Institute, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Los Angeles, CA 90025, United States.
| | - Mary-Lynn Brecht
- Integrated Substance Abuse Programs, Semel Institute, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Los Angeles, CA 90025, United States.
| | - Jose Peñate
- Integrated Substance Abuse Programs, Semel Institute, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Los Angeles, CA 90025, United States.
| | - Richard A Rawson
- Integrated Substance Abuse Programs, Semel Institute, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Los Angeles, CA 90025, United States.
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Fiorilli G, Iuliano E, Aquino G, Battaglia C, Giombini A, Calcagno G, di Cagno A. Mental health and social participation skills of wheelchair basketball players: a controlled study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3679-3685. [PMID: 24012595 DOI: 10.1016/j.ridd.2013.08.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/11/2013] [Accepted: 08/14/2013] [Indexed: 06/02/2023]
Abstract
The aim of this study was to assess differences in psychological well-being, symptomatic psychological disorders and social participation, between competitive wheelchair basketball participants and those non-participants. Forty-six wheelchair participants, 24 Basketball players (aged 35.60 ± 7.56) and 22 non-players (aged 36.20 ± 6.23), completed three validated self-report questionnaires: Participation Scale (PS), Psychological Well-Being Scale [PWBS] and Symptom Checklist 90 R [SCL-90-R]. ANOVA showed significant overall differences between the two groups. The social restriction score, evaluated by PS, was significantly higher in the non-basketball participants (p=0.00001) than the basketball participants. The PWB Scale showed significant differences in all 6 dimensions: positive relations with others, environmental mastery, personal growth, purpose in life and self-acceptance (p<0.01), and autonomy (p<0.05), with better scores in the basketball participants. The SCL-90-R scores were significantly lower for the basketball group in the following 6 symptomatic dimensions: depression, phobic anxiety, and sleep disorder (p<0.01), somatization, interpersonal sensitivity and psychoticism (with p<0.05). It was concluded that competitive wheelchair basketball participants showed better psychological well-being and social skills than those non-participants.
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Affiliation(s)
- Giovanni Fiorilli
- Department of Medicine and Health Science, University of Molise, 86100 Campobasso, Italy.
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25
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Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: proof-of-concept. Neuropsychopharmacology 2013; 38:2475-83. [PMID: 23783065 PMCID: PMC3799067 DOI: 10.1038/npp.2013.150] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 06/08/2013] [Accepted: 06/10/2013] [Indexed: 12/18/2022]
Abstract
Serotonin reuptake inhibitors (SRIs), the first-line pharmacological treatment for obsessive-compulsive disorder (OCD), have two limitations: incomplete symptom relief and 2-3 months lag time before clinically meaningful improvement. New medications with faster onset are needed. As converging evidence suggests a role for the glutamate system in the pathophysiology of OCD, we tested whether a single dose of ketamine, a non-competitive N-methyl-D-aspartate (NMDA) glutamate receptor antagonist, could achieve rapid anti-obsessional effects. In a randomized, double-blind, placebo-controlled, crossover design, drug-free OCD adults (n=15) with near-constant obsessions received two 40-min intravenous infusions, one of saline and one of ketamine (0.5 mg/kg), spaced at least 1-week apart. The OCD visual analog scale (OCD-VAS) and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) were used to assess OCD symptoms. Unexpectedly, ketamine's effects within the crossover design showed significant (p<0.005) carryover effects (ie, lasting longer than 1 week). As a result, only the first-phase data were used in additional analyses. Specifically, those receiving ketamine (n=8) reported significant improvement in obsessions (measured by OCD-VAS) during the infusion compared with subjects receiving placebo (n=7). One-week post-infusion, 50% of those receiving ketamine (n=8) met criteria for treatment response (≥35% Y-BOCS reduction) vs 0% of those receiving placebo (n=7). Rapid anti-OCD effects from a single intravenous dose of ketamine can persist for at least 1 week in some OCD patients with constant intrusive thoughts. This is the first randomized, controlled trial to demonstrate that a drug affecting glutamate neurotransmission can reduce OCD symptoms without the presence of an SRI and is consistent with a glutamatergic hypothesis of OCD.
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Persistence on a stress-challenge task before initiating buprenorphine treatment was associated with successful transition from opioid use to early abstinence. J Addict Med 2013; 6:219-25. [PMID: 22864399 DOI: 10.1097/adm.0b013e31825d927f] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Lapse to opiate use after initiation of buprenorphine treatment is common and is a strong predictor of poor treatment retention and increased risk of long-term opiate use. Drug cues and situations or events associated with distress are known to provoke craving and increase risk for lapse. This study evaluated the predictive validity of a behavioral index of persistence during a stress challenge among opiate users identified as affectively vulnerable to lapse risk due to elevated depressive symptoms. METHODS Patients from an ongoing clinical trial (n = 48) completed a stress-challenge task before receiving their first dose of buprenorphine. RESULTS After controlling for levels of craving on their induction day, persistence on the stress-challenge task before initiating buprenorphine treatment was associated with successful transition to early abstinence, and lower rates of opiate use during the initial 3 months of buprenorphine treatment across antidepressant and placebo groups. CONCLUSIONS Results from this preliminary study suggest the promise of laboratory-based behavioral paradigms in facilitating an understanding of important mechanisms of early lapse. Identifying individual behavioral responses to drug and stress cues before attempts at abstinence may facilitate delivery of adjunctive behavioral treatments to prevent early lapse.
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Di Cagno A, Iuliano E, Aquino G, Fiorilli G, Battaglia C, Giombini A, Calcagno G. Psychological well-being and social participation assessment in visually impaired subjects playing Torball: a controlled study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1204-1209. [PMID: 23396197 DOI: 10.1016/j.ridd.2012.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/14/2012] [Accepted: 11/14/2012] [Indexed: 06/01/2023]
Abstract
The aim of this study was to evaluate the differences in psychological well-being, symptomatic psychological disorders and social participation, between blind Torball players and non-players. Thirty blind male participants were recruited, 17 Torball players (aged 36.27±3.46) and 13 non-players (aged 34.80±2.53), and evaluated for social participation level, psychological well-being and symptomatic psychological disorders, using three validated self-report questionnaires: Participation Scale (PS), Psychological Well-Being Scale (PWBS) and Symptom Checklist 90 R (SCL-90-R) respectively. ANOVA showed significant overall differences between the two groups. The social restriction score in the non-player group was significantly higher (p<0.01) than the player group. The Torball player group showed significant better scores than non-player group in 5 of the 6 dimensions of the PWB Scale (p<0.01) and in 8 of the 10 dimensions of the SCL-90-R (7 dimensions p<0.01; 1 dimension p<0.05) and in the three global scores of the SCL-90-R (p<0.01). The results of this study showed a relationship between psychological well-being and social skills of visually impaired people and their Torball practice.
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Affiliation(s)
- A Di Cagno
- Department of Medicine and Health Sciences, University of Molise, Via F. De Sanctis, 86100 Campobasso, Italy.
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Fedewa AL, Candelaria A, Erwin HE, Clark TP. Incorporating physical activity into the schools using a 3-tiered approach. THE JOURNAL OF SCHOOL HEALTH 2013; 83:290-297. [PMID: 23488890 DOI: 10.1111/josh.12029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 04/23/2012] [Accepted: 03/21/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Public health models have been used to address a number of school-based concerns, notably in the identification and treatment of students at-risk for academic or behavioral deficits. Significant benefits are associated with this model as, compared to a traditional approach, the focus is shifted from remediation to prevention, and from student pathology to student strengths. METHODS Although this model has been applied to multiple populations and used across a variety of settings, it has yet to be conceptualized as a framework for the integration of school-based physical activity (PA). RESULTS This article first reviews the public health service delivery model as well as the benefits of PA on children's physical health, mental health, and cognitive outcomes. Second, suggestions for incorporating PA into the schools using a 3-tiered system and as barriers to success are discussed. CONCLUSION School-based PA is a promising tool-and yet an overlooked and undervalued intervention-for a number of concerns applicable to children's academic achievement and overall mental health.
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Affiliation(s)
- Alicia L Fedewa
- Department of Educational, School, and Counseling Psychology, University of Kentucky, 236 Dickey Hall, Lexington, KY 40506-0219, USA.
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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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Moylan S, Eyre HA, Maes M, Baune BT, Jacka FN, Berk M. Exercising the worry away: how inflammation, oxidative and nitrogen stress mediates the beneficial effect of physical activity on anxiety disorder symptoms and behaviours. Neurosci Biobehav Rev 2013; 37:573-84. [PMID: 23415701 DOI: 10.1016/j.neubiorev.2013.02.003] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 11/27/2012] [Accepted: 02/05/2013] [Indexed: 12/11/2022]
Abstract
Regular physical activity exerts positive effects on anxiety disorder symptoms, although the biological mechanisms underpinning this effect are incompletely understood. Numerous lines of evidence support inflammation and oxidative and nitrogen stress (O&NS) as important in the pathogenesis of mood and anxiety disorders, and physical activity is known to influence these same pathways. This paper reviews the inter-relationships between anxiety disorders, physical activity and inflammation and O&NS, to explore whether modulation of inflammation and O&NS may in part underpin the positive effect of physical activity on anxiety disorders. Numerous studies support the notion that physical activity operates as an anti-inflammatory and anti-O&NS agent which potentially exerts positive effects on neuroplasticity, the expression of neurotrophins and normal neuronal functions. These effects may therefore influence the expression and evolution of anxiety disorders. Further exploration of this area may elicit a deeper understanding of the pathogenesis of anxiety disorders, and inform the development of integrated programmes including PA specifically suited to the treatment and prevention of anxiety disorders and symptoms.
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Affiliation(s)
- S Moylan
- School of Medicine, Deakin University, Melbourne, Australia.
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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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Abrantes AM, McLaughlin N, Greenberg BD, Strong DR, Riebe D, Mancebo M, Rasmussen S, Desaulniers J, Brown RA. Design and Rationale for a Randomized Controlled Trial Testing the Efficacy of Aerobic Exercise for Patients with Obsessive-Compulsive Disorder. Ment Health Phys Act 2012; 5:155-165. [PMID: 23189089 PMCID: PMC3505448 DOI: 10.1016/j.mhpa.2012.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND: Over the last two decades very few advances have been made in the development of new treatments for obsessive-compulsive disorder (OCD). While patients with OCD improve with available treatments (pharmacotherapy and/or cognitive-behavioral therapy), moderate levels of OCD symptoms often persist even with adequate doses and durations of these treatments. Building on the growing body of evidence for the efficacy of exercise in the treatment of other psychiatric disorders, interventions to increase aerobic exercise in patients with OCD represent a potentially useful yet relatively unexplored strategy in OCD. METHODS/DESIGN: One hundred and two (102) patients with clinically significant OCD symptoms despite current engagement in recommended treatments (pharmacotherapy and/or CBT) will be randomly assigned to receive either a 12-week moderate intensity aerobic exercise (AE) intervention or a health education control (HEC) intervention. Follow-up interviews will be conducted at the end of treatment and at 3-, 6- and 12-months post-intervention. They will assess OCD severity, nonspecific anxiety, depression, quality of life, cardiorespiratory fitness and cognition (executive function). DISCUSSION: If efficacy is established, patients with OCD who have clinically significant residual symptoms despite current pharmacotherapy or CBT would gain a valuable and practical treatment augmentation option.
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Affiliation(s)
- Ana M. Abrantes
- Butler Hospital, Providence, RI 02906, United States
- Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Nicole McLaughlin
- Butler Hospital, Providence, RI 02906, United States
- Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Benjamin D. Greenberg
- Butler Hospital, Providence, RI 02906, United States
- Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - David R. Strong
- Alpert Medical School of Brown University, Providence, RI 02906, United States
- University of California, San Diego, La Jolla, CA 92093, United States
| | - Deborah Riebe
- University of Rhode Island, Kingston, RI 02881, United States
| | - Maria Mancebo
- Butler Hospital, Providence, RI 02906, United States
- Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Steven Rasmussen
- Butler Hospital, Providence, RI 02906, United States
- Alpert Medical School of Brown University, Providence, RI 02906, United States
| | | | - Richard A. Brown
- Butler Hospital, Providence, RI 02906, United States
- Alpert Medical School of Brown University, Providence, RI 02906, United States
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Complementary medicine, exercise, meditation, diet, and lifestyle modification for anxiety disorders: a review of current evidence. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:809653. [PMID: 22969831 PMCID: PMC3434451 DOI: 10.1155/2012/809653] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/01/2012] [Indexed: 12/11/2022]
Abstract
Use of complementary medicines and therapies (CAM) and modification of lifestyle factors such as physical activity, exercise, and diet are being increasingly considered as potential therapeutic options for anxiety disorders. The objective of this metareview was to examine evidence across a broad range of CAM and lifestyle interventions in the treatment of anxiety disorders. In early 2012 we conducted a literature search of PubMed, Scopus, CINAHL, Web of Science, PsycInfo, and the Cochrane Library, for key studies, systematic reviews, and metaanalyses in the area. Our paper found that in respect to treatment of generalized anxiety or specific disorders, CAM evidence revealed current support for the herbal medicine Kava. One isolated study shows benefit for naturopathic medicine, whereas acupuncture, yoga, and Tai chi have tentative supportive evidence, which is hampered by overall poor methodology. The breadth of evidence does not support homeopathy for treating anxiety. Strong support exists for lifestyle modifications including adoption of moderate exercise and mindfulness meditation, whereas dietary improvement, avoidance of caffeine, alcohol, and nicotine offer encouraging preliminary data. In conclusion, certain lifestyle modifications and some CAMs may provide a beneficial role in the treatment of anxiety disorders.
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Carraro A, Gobbi E. Effects of an exercise programme on anxiety in adults with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1221-1226. [PMID: 22502848 DOI: 10.1016/j.ridd.2012.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 02/14/2012] [Accepted: 02/15/2012] [Indexed: 05/31/2023]
Abstract
Although high anxiety is common in people with intellectual disabilities (ID) and the anxiolytic effects of exercise have been systematically recognised in clinical and non-clinical populations, research is scant concerning the role played by exercise on anxiety in people with ID. The purpose of this study was to investigate the effects of a 12-week exercise programme on anxiety states in a group of adults with ID. Twenty-seven individuals with mild to moderate ID were randomly assigned to an exercise group or a control group. The Zung Self-Rating Anxiety Scale adapted for individuals with ID and the State-Trait Anxiety Inventory form Y were used to assess trait and state anxiety. In comparison with the control group, the anxiety scores of people in the exercise group decreased significantly over time.
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Affiliation(s)
- Attilio Carraro
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padua, Italy.
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Sarris J, Camfield D, Berk M. Complementary medicine, self-help, and lifestyle interventions for obsessive compulsive disorder (OCD) and the OCD spectrum: a systematic review. J Affect Disord 2012; 138:213-21. [PMID: 21620478 DOI: 10.1016/j.jad.2011.04.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 04/28/2011] [Accepted: 04/28/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND In Obsessive Compulsive Disorder (OCD) current standard pharmacotherapies may be of limited efficacy. Non-conventional interventions such as Complementary and Alternative Medicine (CAM), self-help techniques, and lifestyle interventions are commonly used by sufferers of OCD, however to date no systematic review of this specific area exists. METHODS We conducted a systematic review of studies using CAM, self-help, and lifestyle interventions for treatment of OCD and trichotillomania (TTM). PubMed, PsycINFO, China Academic Journals Full-text Database, The Cochrane Library and CINAHL were searched (up to Jan 11th 2011), for controlled clinical trials using non-conventional interventions for OCD. A quality analysis using a purpose-designed scale and an estimation of effect sizes (Cohen's d) where data was available, were also calculated. RESULTS The literature search revealed 14 studies that met inclusion criteria. Methodological quality of nutraceutical studies (nutrients and herbal medicines) were rated as high (mean 8.6/10), whereas mind-body or self-help studies were poorer (mean 6.1/10). In OCD, tentative evidentiary support from methodologically weak studies was found for mindfulness meditation (d=0.63), electroacupuncture (d=1.16), and kundalini yoga (d=1.61). Better designed studies using the nutrient glycine (d=1.10), and traditional herbal medicines milk thistle (insufficient data for calculating d) and borage (d=1.67) also revealed positive results. A rigorous study showed that N-acetylcysteine (d=1.31) was effective in TTM, while self-help technique "movement decoupling" also demonstrated efficacy (d=0.94). Mixed evidence was found for myo-inositol (mean d=0.98). Controlled studies suggest that St John's wort, EPA, and meridian-tapping are ineffective in treating OCD. CONCLUSIONS While several studies were positive, these were un-replicated and commonly used small samples. This precludes firm confidence in the strength of clinical effect. Preliminary evidence however is encouraging, and more rigorous research of some of the more hypothesis-based interventions in the treatment of OCD and TTM may be indicated.
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Affiliation(s)
- Jerome Sarris
- The University of Melbourne, Faculty of Medicine, Department of Psychiatry, Richmond, Victoria, Australia.
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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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Rodriguez CI, Kegeles LS, Flood P, Simpson HB. Rapid resolution of obsessions after an infusion of intravenous ketamine in a patient with treatment-resistant obsessive-compulsive disorder. J Clin Psychiatry 2011; 72:567-9. [PMID: 21527129 PMCID: PMC3727240 DOI: 10.4088/jcp.10l06653] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Carolyn I. Rodriguez
- New York State Psychiatric Institute, New York, NY 10032,Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032
| | - Lawrence S. Kegeles
- New York State Psychiatric Institute, New York, NY 10032,Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032
| | - Pamela Flood
- Department of Anesthesia, Columbia University, College of Physicians and Surgeons, New York, NY 10032
| | - Helen Blair Simpson
- New York State Psychiatric Institute, New York, NY 10032,Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032
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Park S, Cho MJ, Cho SJ, Bae JN, Lee JY, Park JI, Kim JY, Lee DW, Hong JP. Relationship Between Physical Activity and Mental Health in a Nationwide Sample of Korean Adults. PSYCHOSOMATICS 2011; 52:65-73. [DOI: 10.1016/j.psym.2010.11.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 04/10/2009] [Accepted: 04/14/2009] [Indexed: 11/16/2022]
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