# Exercise as it relates to Disease/Exercise in OCD: a little less obsessed?

The purpose of this fact sheet is to explore the practical use of the article “Acute changes in obsessions and compulsions following moderate-intensity aerobic exercise among patients with obsessive-compulsive disorder” by Abrantes et al. (2009).

## What is the background of the research?

Obsessive compulsive disorder (OCD) is a chronic anxiety disorder. It is a serious disease that is quite disabling among sufferers and is among the top ten disabling illnesses as identified by the World Health Organisation. Despite having medications and other therapies, those that experience OCD may still suffer symptoms on a daily basis which can impact on their quality of life. Physical activity has been shown to be effective in anxiety disorders for relief of symptoms and has been theorised to improve executive brain functioning.

## Where is the research from?

15 patients who suffer OCD were enrolled into the study from Butler Hospital OCD specialty clinic in Rhode Island. The lead author, Ana M. Abrantes is an Associate Professor of Psychiatry and Human Behaviour (research) at Brown Medical School. (Butler Hospital Biography/Brown University Biography)

## What kind of research is this?

This article is a clinical case series, meaning that it looks at a clinical sample (patients with OCD) and exposes them to treatment (the exercise) to see if there are any changes from the treatment. The study uses results from the initial pilot-study.

## What did the research involve?

The research involved taking 15 sedentary patients with OCD through a 12-week exercise program. The average age of the patients was 41.9 years (±11.2). The patients who were enrolled in the study must have had treatment for >3 months and meet specific criteria for OCD. All patients enrolled were required to be medically safe and able to exercise, and were excluded if pregnant, suffered an eating disorder, were suicidal or homicidal, or had a drug use/addiction. The exercise sessions consisted of 20 minute, progressing to 40 minute, sessions at 55-69% of age predicted heart rate maximum. Patients had the choice of moderate-aerobic exercise on a treadmill, bicycle, and elliptical. Patients were monitored throughout the session for heart rate, blood pressure and perceived exertion. Measurements were taken before and after exercising and consisted of:
* National Institute of Mental Health self-rating 0-10 point scale measuring;
** Mood
** Anxiety
** Obsessions
** Compulsions
* Weekly log of exercise done during the week as ‘homework’

## What were the basic results?

The article measured the immediate exercise effect on the participants’ mood, anxiety, obsessions and compulsions. Results within the study were poorly reported and only the effect sizes were mentioned. What they found:
* Overall after exercising, instant significant improvement in mood and anxiety symptoms AND obsessions and compulsions.
* Consistent improvement in anxiety and mood measures after exercise.
* The improvements got smaller for obsession and compulsion measures toward the end of the study but a trend of decreasing pre-exercise levels of obsessions and compulsions over the 12 weeks.

## What are the strengths and weaknesses of the study?

Strengths and weaknesses of the article are listed in the tables below.
| STRENGTHS | What this means |
| Patients underwent medical screening | Ensures safety of the participants within the study. |
| Exercise physiologist guided exercise | Ensures that the exercise program was correctly implemented. |
| Validated measurement used | Results reflect what is being measured and the scales have been tested and developed prior to this experiment. |
| WEAKNESSES | What this means |
| No control/comparison group | Without a control group (a group that does no exercise), the authors cannot definitively conclude that the change in symptoms measured were due to the addition of exercise. |
| Small sample size | Only 15 people enrolled in the study: the smaller the sample size, the less certainty in the effects of the results. |
| Bias | Patients may have recorded lower results after exercising to please the assessors. |
| Poorly described results | Without raw data/means and confidence intervals it is difficult to draw concrete conclusions. |

## What conclusions can we take from this research?

Before making conclusions, it is important to consider the limitations/weaknesses in the article.
* Without a control group to compare to, we don’t conclusively know if the improvements in symptoms were due to the exercise intervention
* The study was done in a sedentary population, so can really only be applied to a sedentary population
* There is no commentary on whether the results are clinically significant - that is, does the patient feel the difference in symptoms after exercising?
Considering the above, however, what we could draw from this article is that those with OCD MIGHT benefit from aerobic exercise to ease symptoms – using exercise as a coping strategy, but further study with better methodology (such as a randomised controlled trial) in this field is required.

## Practical advice

As long as it is SAFE to do so, exercise and physical activity is very important in reducing risk for mortality (death) and morbidity (disease) and has been shown to improve mental health. If you’re unsure if it is safe to exercise, see your medical health professional for some advice!
READY...SET....EXERCISE

## Further information/resources

OCD is a serious condition. The following provides some useful links to sites that provide support and information about OCD:
* Australian Government Department of Health Exercise Guidelines
* Beyond Blue - OCD
* National Institute of Mental Health
* Mental Health Australia

## References

* 1 2 3 4 5 6 Abrantes AM, Strong DR, Cohn A, Cameron AY, Greenberg BD, Mancebo MC, Brown RA. Acute changes in obsessions and compulsions following moderate-intensity aerobic exercise among patients with obsessive-compulsive disorder. J Anxiety Disord. 2009 Oct;27(3):923-7.
* 1 2 Bobes J, González MP, Bascarán MT, Arango C, Sáiz PA, Bousoño M. Quality of life and disability in patients with obsessive compulsive disorder. Eur Psychiatry. 2001 Jun;16(4):239-45.
* 1 2 Sarris J, Camfeild D, Berk M. Complimentary medicine, self-help, and lifestyle interventions for Obsessive Compulsive Disorder (OCD) and the OCD spectrum: A systematic review. J Affect Disord. 2012 May;138(3):213-21.
* 1 2 Moylan S, Eyre HA, Maes M, Baune BT, Jacka FN, Berk M. Exercising the worry away: How imflamation, oxidative and nitrogen stress mediates the beneficial effect of physical activity on anxiety disorder symptoms and behaviours. Neurosci Biobehav Rev. 2013 May;37(4):573-84.
* ↑ Hoffman T, Bennet S, Del Mar C. Evidence-based practice: Across the health professions. 2nd ed. Sydney: Elsevier; 2013.
* ↑ Brown RA, Abrantes AM, Strong DR, Mancebo MC, Menard J, Rasmussen SA, Greenberg BD. A Pilot study of moderate- intensity aerobic exercise for obsessive compulsive disorder. J Nerv Ment Dis. 2007 Jun;195(6):514-20.
* ↑ Soo Kim Y, Soo Park Y, Allegrante JP, Marks R, Ok H, Ok Cho K, Ewing Garber C. Relationship between physical activity and general mental health. Prev Med. 2012 Nov;55(5):458-63.