# Exercise as it relates to Disease/Improvements in General Anxiety Disorder Symptoms with Exercise

Generalised anxiety disorder (GAD) is a form of anxiety disorder in which sufferers experience excessive and unnecessary anxiety and worry about regular occurrences in everyday life. In Australia, GAD affects approximately 3-6% of the population. GAD is most common during late teens to early twenties, and also in the elderly - as we have an ageing population, the number of people living with disorder may increase over time. GAD is also more common in people of lower socio-economic status due to increased uncontrollable stressors. $_$The onset of GAD can either be genetic, caused by prolonged stress, a traumatic experience or distorted beliefs.

## Symptoms

Symptoms of anxiety can be classified as either mental (affecting the psyche) or somatic (affecting the body but excluding the psyche). Mental symptoms can be categorised as apprehension and vigilance, whilst somatic symptoms can be categorised as either motor-based or exaggerated physiological responses.
| Category (Mental or Somatic) | Associated Symptoms |
| Mental: Apprehension | Excessive worry Fear Agitation |
| Mental: Vigilance | Difficulty concentrating Irritability Fidgeting |
| Somatic: Motor-based | Muscle tension Restlessness |
| Somatic: Exaggerated Physiological Responses | Accelerated heart and sweat rate Breathing difficulties Headaches Dizziness Fatigue Insomnia |
In order to meet diagnostic criteria for GAD, patients must suffer from persistent and uncontrollable apprehension, and the consequential somatic responses, for at least six months.

## Comorbidities

GAD has a high comorbidity rate as many symptoms of GAD overlap with those of other psychiatric illnesses, including depression, bipolar and other forms of anxiety (namely social phobia and panic disorder). As a result, 75-90% of GAD sufferers will also be diagnosed with one of the aforementioned psychiatric illnesses. $_{[1]}$

## Common Treatments

Common treatments for GAD include:
* Pharmacotherapy
* Cognitive behaviour therapy
* Hypnotherapy
* Dietary modifications (elimination of caffeine and alcohol)
Exercise can be used in conjunction with these treatments to help minimise the symptoms of GAD.

## Barriers to Exercise or Physical Activity

There are several factors that dictate the likelihood of a GAD patient adhering to an exercise regime:
* Interest in the activity
* Perception of physical activity and exercise (i.e. incidental physical activity)
* Motivation
* Fatigue
* Self-esteem
* Mind control

## Benefits of Exercise in GAD Patients

* Endorphin release which masks pain, and produces feelings of euphoria and well-being
* Stress relief and clearing and calming of the mind
* Lowers resting heart rate - elevated heart rate is a symptom of GAD and exercise works to regulate this
* Lowers airway resistance which improves the breathing difficulties experienced by GAD sufferers
* Aids in alleviating muscle tension associated with GAD
* Improves concentration
* Provides a sense of self-mastery and changes in self-concept

## Exercise Recommendations

Moderate-intensity aerobic exercise, such as brisk walking, jogging, cycling or swimming, are recommended as they are more successful than vigorous intensity-based programs. $_{[10]}$Exercising in social situations (for example, social tennis or dancing) is beneficial in two ways; the body undergoes the physiological adaptations associated with exercise, whilst also relieving emotional tension and improving self-value. Constantly elevated heart rate is a complication associated with GAD, however aerobic exercise improves the efficiency of the heart, thus lowering resting heart rate and helping to alleviate this symptom. $^{[9]}$ Yoga is recommended, and, whilst is it not seen as an aerobic exercise, it calms the body, regulates breathing, and alleviates stress, whilst also stretching the muscles and strengthening the body.
It is recommended that patients partake in aerobic exercise 3-4 times per week, with a duration of 20 – 30 minutes per bout. The exercise program should continue for 8 –14 weeks to see overall improvements in their condition, but should be maintained for life. As well as exercise, incidental physical activity should be encouraged (for example, cleaning the house or climbing stairs) $_{[10]}$

## Further Research, Reading and Support

It is well-documented that there is a positive link between exercise and its role in preventing or lessening the burden of mental illness, however the clinical recommendations for exercise prescription are very general and limited. Future studies into standardising an exercise regime for GAD sufferers would be extremely beneficial in both prevention and treatment. $_{[10]}$
Further reading and support:
* http://au.reachout.com/Generalised-Anxiety-Disorder
* http://www.patient.co.uk/health/Anxiety-Generalised-Anxiety-Disorder.htm **
* http://www.anxietyonline.org.au/
* Life line: 131114
    Lifeline online: https://www.lifeline.org.au/Get-Help/Online-Services/crisis-chat
* Beyond Blue: 1300 22 4636
    Beyond blue online http://www.beyondblue.org.au/index.aspx?link_id=103.883

## References

* ↑ "Generalised Anxiety Disorder" (PDF). Anxiety BC. Retrieved 23/10/2012. {{cite web}}: Check date values in: |accessdate= (help)
* ↑ Clark, D.M (1999). "Anxiety Disorders: Why They Persist and How to Treat Them". Journal of Behaviour Research and Therapy. 37: 5–27. {{cite journal}}: |access-date= requires |url= (help); Check date values in: |accessdate= (help)
* ↑ Brown, T.A. "Generalised Anxiety Disorder" (PDF). Clinical Handbook of Psychological Disorders, Third Edition: A Step-by-Step Treatment Manual. Retrieved 20/10/2012. {{cite web}}: Check date values in: |accessdate= (help)
* ↑ Kessler, R.C. "Patterns and Correlates of Generalised Anxiety Disorder in Community Samples" (PDF). Retrieved 20/10/2012. {{cite web}}: Check date values in: |accessdate= (help)
* ↑ Simon, N.M (2009). "Generalized Anxiety Disorder and Psychiatric Comorbidities such as Depression, Bipolar Disorder, and Substance Abuse". Journal of Clinical Psychiatry. 70: 10–14. doi:10.4088/JCP.s.7002.02. {{cite journal}}: |access-date= requires |url= (help); Check date values in: |accessdate= (help)
* ↑ Sharma, Renu (2011). Hypononsis: Psycho-philosophical Perspectives and Therapeutic Evidence. New Dehli: Concept Publishing Company. pp. 207–211. ISBN 13-978-81-8069-727-2. {{cite book}}: Check |isbn= value: length (help)
* ↑ Hughes, R.N (1996). "Drugs Which Induce Anxiety: Caffeine". New Zealand Journal of Psychology. 25 (1): 36–42. {{cite journal}}: |access-date= requires |url= (help); Check date values in: |accessdate= (help); Unknown parameter |month= ignored (help)
* ↑ Harbor, VJ. "Endorphins and Exercise". Journal of Sports Medicine. Retrieved 16/10/2013. {{cite web}}: Check date values in: |accessdate= (help)
* ↑ Rodriguez, Diana. "Anti-Anxiety Workout". Retrieved 22/10/2012. {{cite web}}: Check date values in: |accessdate= (help)
* ↑ Strohle, A (2009). "Physical Activity, Exercise, Depression and Anxiety Disorders" (PDF). Biological Psychiatry: 777–784. doi:10.1007/s00702-008-0092-x. Retrieved 22/10/2012. {{cite journal}}: Check date values in: |accessdate= (help)
* ↑ Nefer, B. "Exercises for General Anxiety Disorder". Live Strong. Retrieved 23/10/2012. {{cite web}}: Check date values in: |accessdate= (help)