Treinamento físico intervalado como ferramenta na terapia cognitivo-comportamental do transtorno de pânico

Physical exercise as an add-on treatment to cognitive behavioural therapy for anxiety: a systematic review

BACKGROUND

Cognitive behavioural therapy (CBT) is currently the treatment of choice for most anxiety disorders. Yet, with recovery rates of approximately 50%, many patients fail to achieve complete remission. This has led to increased efforts to enhance treatment efficacy. Physical exercise (PE) has in recent years been advocated as means to augment the effects of CBT for anxiety disorders. PE appears to reduce anxiety through other mechanisms than CBT, some of which might also have the potential to augment the effects of psychological treatment.

AIMS

The current review aimed to summarize and discuss the current research status on CBT augmented with PE for anxiety.

METHOD

A systematic literature search was conducted in the databases PsychInfo, Medline and Web of Science to evaluate the potential augmentative effect of combining PE with CBT for anxiety disorders. These effects were intended to be evaluated in a meta-analysis, but findings from the few and diverse studies were better summarized in a systematic review.

RESULTS

Eight articles were included in this review, of which two had no control group, while six had from two to four experimental arms. Six of the studies concluded in favour of benefits of add-on PE, while two studies found no added benefits of the combined interventions.

CONCLUSIONS

The combination of PE and CBT appears feasible. Add-on PE seems to be more beneficial for clinical populations, when administered regularly several times per week, across several weeks. Future studies should investigate further how and for whom to best combine PE and CBT.

Misinterpretation of the Borg's Rating of Perceived Exertion Scale by patients with panic disorder during ergospirometry challenge

INTRODUCTION

The most widely used instrument to measure perceived exertion or exercise intensity is the Borg's Rating of Perceived Exertion (RPE) Scale. Panic attacks are aversive experiences that may be triggered by bodily sensations such as palpitations, breathlessness or dizziness due to increasing autonomic distress, prior sensitisation to panic and fear conditioning. The consequence is catastrophic interpretation of bodily sensations of arousal in general, which can lead to misinterpretation of exertion or exercise intensity.

PURPOSE

To verify the effectiveness of the Borg's RPE Scale as a measure of perceived effort in panic disorder subjects.

METHODS

The study enrolled 72 subjects: the control group (C, healthy sedentary subjects, n=30) and patients with panic disorder (PD, n=42). All subjects were submitted to an ergospirometry challenge. Perceived exertion RPE scores and heart rate at 90% VO2max were compared between groups.

RESULTS

Patients with PD showed lower levels of maximal oxygen consumption, when compared with C group [VO₂max (mL/kg/min): PD=29.42±6.50xC=34.51±5.35; Student's t-test=-3.51; p <0.05]. Furthermore, among PD subjects, the maximum heart rate during ergospirometry challenge was lower than expected [predict max HR (bpm)=200.85±6.33xheart rate test (bpm)=178.86±7.28; Z=-5.64; p<0.05]. Perceived exertion, as measured by RPE, was also overestimated in relation to heart rate at 90% of maximum oxygen consumption compared with controls (RPE90%VO₂max: PD=18.93±0.55xC=16.67±0.60; U=8.00; Z=7.42; p<0.05).

CONCLUSIONS

The present study findings suggest that the Borg's RPE Scale may not be an appropriate measure of subjective exertion among subjects with panic disorder performing a cardiopulmonary exercise test.