# Exercise as it relates to Disease/Aerobic exercise helps patients with panic disorder

This Wikibooks page is a critical appraisal of the journal article “Aerobic Exercise Reduces Anxiety Symptoms and Improves Fitness in Patients with Panic Disorder” by Lamego et al. 2016.

## What is the background to this research?

In Australia 2.3 million people aged 16–85 years have an Anxiety Disorder (AD). Panic Disorder (PD) is an AD that affects 1-2 % of the Australian and New Zealand population every year. PD consists of recurrent unanticipated panic attacks to an individual. Individuals with PD experience panic attacks which are brief episodes of intense anxiety causing psychical sensations of fear. Panic attacks usually last around half an hour in duration and occur several times a day or may happen only once every few years.
Treatments options for PD patients are using pharmaceutical drugs or Cognitive Behavioural Therapy (CBT). Pharmaceutical drugs such as benzodiazepines or antidepressants are commonly prescribed to patients but have side effects such as cognitive dysfunction, cardiovascular implications and becoming medication dependent. Researchers in the field of anxiety disorders are shifting toward other treatment options for patients such as Aerobic Exercise (AE). AE is increasingly becoming a more accepted therapeutic treatment option for individuals suffering from anxiety disorders due to positive health benefits exercise has on physical and mental health. However, researchers are still debating to whether AE is an effective treatment option for AD. The aim of this study was to examine the effects of continuous AE on PD patients.

## Where is the research from?

This journal article was undertaken in Rio de Janeiro, Brazil. The article was published by Medical Express in 2016 which is a non-profit organisation that is free from unilateral influence of professional society or research institution. The lead author Murilo Lamego is a respected researcher from Veiga de Almeida University (UVA). Despite the research being conducted in South America, the research findings are still valid for Australians.

## What kind of research was this?

This research was an intervention study, as researchers implemented an AE program to see the effects it had on the participants. To be eligible for the study, participants had to meet the following criteria: patients had to be diagnosed with PD, display negative responses to a physical activity readiness questionnaire and finally, patients did not partake in AE in the last 6 months.
Limitations
It is important to identify the limitations of this research study when interpreting results:
* The research study had one sample group with no controlled group
* This was not a randomised control trial (RCT)or double blind study due to one sample group
* The sample of participants was not enough to draw any convincing conclusions
* The sample had only female participants and no male representation
* The researchers in this study failed to perform a follow-up assessment and failed to retest body weight and body fat percentage after the 12-week AE intervention
Despite the limitation in this research study, the findings can be a reference for future research.

## What did the research involve?

The research study consisted of a sample size of ten inactive female subjects. Individuals in this study were invited to participate and agreed to join the study on a voluntary basis. This research study was 12-weeks in duration with individuals performing AE on a treadmill 3 times per week, accumulating 36 sessions in total. Researchers composed the study into three phases: (1) baseline assessment, (2) experimental procedure and (3) reassessment.
AE was performed at 70-75% of participants VO2 max, which was established before exercise commenced. Participants VO2 max was then reassessed at the end of week 12 to see any change in aerobic fitness levels. Before AE started, participants had their anxiety symptoms examined during baseline. The tests used to assess anxiety symptoms were: Trait Anxiety Inventory (STAI-T) and State Anxiety Inventory (STAI-S), and the Subjective Units of Distress Scale. Anxiety symptoms were them reassessed during weeks 6 and 12, to identify any changes.

## What were the basic results?

The study found the following key findings:
* Significant reductions were found across all three anxiety symptom tests
* STAI-T displayed significant reductions across all three testing protocols throughout the study
* STAI-S and SUDS displayed significant reductions but only across baseline testing and week 12
* Participants VO2 max improve over the 12-week intervention (Baseline: 22.5 ± 8.8 ml.kg-1.min-1 vs. Post-training: 24.2 ± 9.2 ml.kg-1.min-1)
| | Baseline | Week 6 | Week 12 |
| STAI-T | 57.3 ± 8.7 | 51.7 ± 10.2 | 44.2 ± 10.2 |
| STAI-S | 34.4 ± 5.8 | N/A | 12.0 ± 16.0 |
| SUDS | 42.0 ± 9.0 | N/A | 27.0 ± 16 |

## What conclusions can we take from this research?

In summary, the 12-week AE protocol found positive benefits in cardiorespiratory fitness and anxiety levels in PD patients. AE may be a suitable non-pharmacological treatment option to reduce anxiety symptoms in PD patients. AE should be continued to be researched in this population as AE has many positive health benefits, which may aid recovery in patients. However, further studies are required to determine if AE is a valid treatment option for PD and other anxiety disorders. Research recommendations include:
* Larger sample sizes with both male and female participants, which will allow for a RCT study
* Different exercise protocols to determine the most suitable aerobic exercise program for PD patients.
* Perform a follow-up assessment to investigate the biological and lifestyle changes that occur from following a regular exercise program
Overall, this research study found PD patients improved their anxiety levels and cardiorespiratory fitness levels by following a 12-week AE training program.

## Practical advice?

If you are currently diagnosed with an AD such as PD, AE may be a suitable non-pharmacological treatment option to reduce anxiety symptoms. Performing AE at 70-75% of VO2 max on a treadmill can reduce anxiety symptoms and improve cardiovascular fitness levels and overall health in individuals. Make sure you speak with your doctor, psychologist and health professionals before commencing any exercise program protocol.

## Further information/resources

If you are interested in further information, please see the links below:
* Beyond Blue
* Better Health Channel
* The Department of Health
* Beyond Blue National Help lines and Websites

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Lamego, M., Lattari, E., Sá Filho, A., Paes, F., Mascarenhas Jr., J., Maranhão Neto, G., & Machado, S. (2016). Aerobic exercise reduces anxiety symptoms and improves fitness in patients with panic disorder. Medical Express, 3(3).
* ↑ ABS (2008). National Survey of Mental Health and Wellbeing: Summary of Results, 2007, p 27. Retrieved from Australian Bureau of Statistics: https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4326.0Main+Features32007?OpenDocument
* ↑ The Department of Health. (2005). What is panic disorder and agoraphobia? Retrieved from The department of Health: https://www1.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-p-panic-toc~mental-pubs-p-panic-wha
* ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
* ↑ Better Health Channel. (2018). Panic Attack. Retrieved from Better Health Channel: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/panic-attack
* ↑ Beyond Blue. (2019). Panic Disorder. Retrieved from Beyond Blue: https://www.beyondblue.org.au/the-facts/anxiety/types-of-anxiety/panic-disorder
* ↑ Colman, I., Zeng, Y., Ataullahjan, A., Senthilselvan, A., & Patten, S. (2011). The association between antidepressant use and depression eight years later: A national cohort study. Journal of Psychiatric Research. 45(8),1012–1018.
* 1 2 De Sa Filho, A., De Souza Moura, A., Lamego, M., Ferreira Rocha, N., Paes, F., & Oliveira A. (2015). Potential Therapeutic Effects of Physical Exercise for Bipolar Disorder. CNS Neurol Disord Drug Targets, 14(10):1255-9
* 1 2 De Souza Moura, A., Lamego, M., Paes, F., Ferreira Rocha N., Simoes- Silva, V., & Rocha S. (2015). Effects of Aerobic Exercise on Anxiety Disorders: A Systematic Review. CNS Neurol Disord Drug Targets, 14(9):1184-93
* ↑ Bartley, C., Hay, M., & Bloch, M. (2013). Meta-analysis: Aerobic exercise for the treatment of anxiety disorders. Progress in Neuropsychopharmacology & Biological Psychiatry, 45, 34–39
* ↑ Medical Express. (2019). About Us. Retrieved from Medical Express: http://www.medicalexpress.net.br/about-us
* ↑ Lamego, M. (2019). Research Gate. Retrieved from Research Gate: https://www.researchgate.net/profile/Murilo_Lamego
* 1 2 3 Ströhle, A., Graetz, B., Scheel, M., Wittmann, A., Feller, C., Heinz, A., & Dimeo, F. (2009). The acute antipanic and anxiolytic activity of aerobic exercise in patients with panic disorder and healthy control subjects. Journal of Psychiatric Research, 43(12), 1013–1017