Anxiety disorders are among the most prevalent, disabling, persistent and costly psychiatric disorders. However, they are often underdiagnosed and individuals with anxiety disorders are not treated properly. Anxiety disorders are highly prevalent, with global estimates ranging from 3.8 to 25% across countries, while data for people with chronic conditions report prevalence rates as high as 70%. Over the last years there have been significant advances in understanding and treating the symptoms of anxiety disorders with innovative non-pharmaceutical interventions, such as exercise, having gained much popularity. In fact, the field of anxiety disorders is one of the most exciting areas of modern medicine.
In terms of symptoms anxiety disorders are usually characterized by hyperarousal, excessive fear and sleep interruptions. They are associated with increased feelings of anxiety, which escalate rapidly and have high intensity, and have a debilitating impact on people’s daily functioning, quality of life and well-being. The subtypes of anxiety disorders can manifest with different symptoms and include:
- generalized anxiety disorder (GAD)
- social anxiety disorder
- panic disorder
- post-traumatic stress disorder (PTSD)
- specific phobias
- agoraphobia
- separation anxiety disorder
- Obsessive Compulsive Disorders
In addition, findings associating disorders with increased risk factors of the cardiovascular system1,3, such as high blood pressure, a higher rate of cardiovascular disease and premature mortality, are quite alarming. People suffering from anxiety disorder have been shown to be up to 52% more likely to develop cardiovascular disease than the general population1.
Anxiety disorders are usually treated using antidepressant medications, cognitive behavioral therapy (CBT) psychotherapeutic interventions, or a combination of treatment options.
These traditional approaches may be effective in reducing anxiety disorder symptoms, yet up to one in 3 patients do not seem to respond to treatment1,3, which can lead to treatment discontinuation and dramatic effects on overall functioning. There are also financial barriers to effectively providing these types of treatment, particularly in low- and middle-income countries1.
Exercise can be an alternative or adjunctive solution for people with anxiety disorders and should be considered an evidence-based option and effective intervention in improving the symptoms of chronic struggles, as it works through a number of different physiological and psychological mechanisms which include:
- regulation of stress responses through the hypothalamic-pituitary-adrenal axis or glucocorticoid circulation
- strengthening neurogenic processes that are important for the proper functioning of the brain
- improving the function of the hippocampus, an area of the brain involved in the regulation of stress responses. It has been shown that exercise can improve the volume of the left hippocampus1.
- improving stress tolerance and better symptom management through sparing the normal physical stimulation brought about by exercise (eg tachycardia).
- increasing self-esteem and moving away from negative self-perception concerns
New therapeutic approaches call for a greater focus on the role of lifestyle interventions such as physical activity, sleep and nutrition in the treatment of mental disorders (Firth et al., 2020). At the same time, they improve the health of the cardiovascular system and the overall physical health of people with anxiety disorders, which is often burdened and neglected.
Research results have shown a significant reduction in symptoms in patients with panic disorder who follow structured exercise, specifically running.
The improvement was attributed to the stimulating effect of running, which exposes patients to palpitations, sweating, rapid breathing, and other similar effects4. Thus the patient becomes familiar with and de-escalates physical symptoms caused by exercise that simulate the symptoms of the disorder from which he suffers.
Regarding aerobic and anaerobic exercise, both aerobic and anaerobic physical activities that have been studied achieve similar and significant reductions in uncontrolled stress4.
In addition, for patients with anxiety disorders, it is recommended to “prescribe” exercise with a printed plan, while written or electronic messages of motivation and encouragement can be helpful, which are more effective than face-to-face, verbal motivation to exercise4.
Although the anxiolytic effects of exercise appear to be less than those of antidepressant medications for clinical anxiety disorders, exercise may be beneficial as an adjunctive therapy. Future research is still needed to investigate the factors that influence the degree of effectiveness of exercise, such as frequency, intensity, duration of sessions and type of exercise, and patient characteristics3.
- Kandola A, Vancampfort D, Herring M, Rebar A, Hallgren M, Firth J, Stubbs B. Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Curr Psychiatry Rep. 2018 Jul 24;20(8):63. doi: 10.1007/s11920-018-0923-x. PMID: 30043270; PMCID: PMC6061211.
- Stubbs B, Vancampfort D, Rosenbaum S, Firth J, Cosco T, Veronese N, Salum GA, Schuch FB. An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry Res. 2017 Mar;249:102-108. doi: 10.1016/j.psychres.2016.12.020. Epub 2017 Jan 6. PMID: 28088704.
- Ramos-Sanchez CP, Schuch FB, Seedat S, Louw QA, Stubbs B, Rosenbaum S, Firth J, van Winkel R, Vancampfort D. The anxiolytic effects of exercise for people with anxiety and related disorders: An update of the available meta-analytic evidence. Psychiatry Res. 2021 Aug;302:114046. doi: 10.1016/j.psychres.2021.114046. Epub 2021 Jun 11. PMID: 34126464.
- Jayakody K, Gunadasa S, Hosker C. Exercise for anxiety disorders: systematic review. Br J Sports Med. 2014 Feb;48(3):187-96. doi: 10.1136/bjsports-2012-091287. Epub 2013 Jan 7. PMID: 23299048.
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