# Exercise as it relates to Disease/Resistance and Aerobic Interventions for Generalised Anxiety Disorder

Main Paper: Herring, M. P., Jacob, M. L., Suveg, Cynthia., O’Connor, P. J. (2011). Effects of short-term exercise on training signs and symtpms of generalized anxiety disorder. Mental Health and Physical Ancivity, Science Direct, 4, 71-77.

## What is the background to this research?

A new study has revealed that Exercise greatly reduces the symptoms associated with Generalized Anxiety Disorder (GAD). In the promising study conducted on 30 women diagnosed with GAD, it was revealed that both short term Resistance training and Aerobic training over a 6 week period, provoked improvements in a range of signs and symptoms that characterize GAD patients including anxiety, irritability, pain and fatigue.
Generalized Anxiety Disorder is a stress-related condition characterized by excessive and persistent worry about everyday activities on most days over a 6 month period. Patients feel worry, tense and anxious about the smallest of matters relating to aspects of everyday life, including work, family, health and financial issues.
The most common signs and symptoms of GAD include patents feeling anxious, tired, irritable, fatigued, have difficulty concentrating and have problems falling asleep and staying asleep. Physical symptoms such as headaches, muscle tension and stomach pains are also very common. GAD can also be closely related to other major physical and psychological disorders such as heart disease, irritable bowel syndrome, panic disorder and even depression.
Previous studies have shown that that both resistance and aerobic training has positive effects on GAD signs and symptoms. These include
* Depression
* Fatigue
* Anxiety
* Muscle Tension
Despite this, there are certain factors such as the psychological consequences of exercise training and the link between irritability and exercise which have limited research. No other randomized control study has quantified and compared exercise interventions with this many signs and symptoms of GAD.

## Where is the research from?

The research was conducted by Matthew Herring, PhD, from the University of South Carolina, USA along with colleagues from the University of Georgia, Athens, USA.

## What kind of research was this?

The study was a randomized controlled trial using exercise interventions to determine if exercise is an effective treatment option for the signs and symptoms that characterize GAD patients.

## What did the research involve?

The study’s propulsion size of 30 sedentary women (18-37 y.o), diagnosed with a primary diagnosis of GAD who were not involved in any other treatment other than pharmacotherapy, were split into 3 groups. These consisted of two exercise groups of a Resistance program and aerobic program with a third group that was used as a baseline with no exercise intervention or lifestyle change. The hedges d equation was used to calculate the magnitude of the improvements compared to the baselines (Week 0) of the 3 groups.
The following table summarizes the Exercise training format.
| Both Exercise Programs | Resistance | Aerobic |
| 2*16 min sessions/ week, 6 weeks | Leg Press, Leg Curl, Leg Extensions | Leg Cycling |
| HR and RPE taken at end of each exercise/session | Week 1: 50% 1RM, Then 5% load progression weekly | Week 1: Unknown starting load. Then 5% progression weekly |
The signs and symptoms measured included.
* Trait Anxiety Symptoms
* Feelings of Anxiety-Tension, Vigor, Fatigue and Confusion
* Intensity and frequency of Irritability
* Depression Symptoms
* Concentration
* Reaction Time and ratio of errors/ valid responses
* Physiological Tremor (muscle tension)
* Pain intensity/ location

## What were the basic results?

The results of the study revealed positive improvements of the 12 associated signs and symptoms of GAD. In fact, between the resistance and aerobic exercise programs, 11 out of the 12 outcomes were improved, with the exception of pain locations which increased by week 6. Resistance exercise showed large improvements in anxiety tension, frequency and intensity of irritability, and muscle tension, while showing smaller improvements in trait-anxiety, depression, vigor, concentration and pain intensity. Aerobic exercise resulted in large improvements in pain intensity and mean reaction time, while showing small improvements in trait anxiety, concentration, fatigue, vigor, irritability and muscle tension. Overall, Resistance exercise showed greater improvements in 9 of the 12 outcomes, however, the improvements were for most, only slightly better than Aerobic exercise effects.

## How did the researchers interpret the results?

Herring and colleagues hypothesized that both exercise interventions would bring positive results and but didn’t predict the shear dominance of the resistance intervention. They think this could be due to the fact that the perceived intensity (perceived exertion and HR) of resistance treatment was higher than the aerobic across the trial.

## What conclusions should be taken away from this research?

The Study’s findings show that exercise is an extremely viable short-term treatment option for GAD patients with most associated signs and symptoms improving, as well as providing added benefits such as it’s low cost, limited risk and lack of negative side affects. The results not only support the work of previous research on the more important signs and symptoms associated with GAD such as Depression, Anxiety and Muscle tension, but add to the field's overall knowledge with it’s positive exercise effect results on Irritability.
Herring’s positive findings on Irritability are important as it could be seen as the most vital symptom among GAD patients. Its association with a handful of other disorders such as major depressive disorder and dysthymia as well as it’s role in exacerbating the other symptoms of GAD patients, links to disability and the development of heart disease show why exercise is so important for improving Irritability symptoms.
Despite this, one thing the study didn’t show comprehensively was a clear differentiation between the exercise effect for those taking or not taking medication during the trial. With it’s negative side effects and limited effectiveness, medication needs to looked at more closely in future research to determine if exercise can be used as a stand alone treatment. Future research could also show the exercise effect on females with pre-reported high levels of GAD, the effect on males, younger populations, especially young women, and with most improvements really coming to fruition in week 6, a longer study to show what happens in week 8, 16, etc, to see if bigger improvements can occur. Stonerock's 2015 Systematic review on Exercise as Treatment for Anxiety mentioned the fact that most Anxiety/ GAD studies don't pre-select patients with high anxiety levels like Herring's study didn't do.

## What are the implications of this research?

Herring has shown that Exercise is an effective, easy and simple treatment option not only for GAD patients but patients of other mental disorders. He has set the platform for future research to get rid of the use of other treatment options which are expensive and bring negative side effects.

## FurtherReadings

* http://resources.beyondblue.org.au/prism/file?token=BL/0505 - Beyond Blue: Generalised Anxiety Disorder
* WebMD – GAD General Information

### References

* ↑ Herring, M. P., Jacob, M. L., Suveg, Cynthia., O’Connor, P. J. (2011). Effects of short-term exercise on training signs and symtpms of generalized anxiety disorder. Mental Health and Physical Ancivity, Science Direct, 4, 71-77.
* ↑ Generalised Anxiety Disorder, (Fact Sheet), Beyond Blue (2008). http://resources.beyondblue.org.au/prism/file?token=BL/0505 First Accessed 7 September 201
* 1 2 Blumenthal, J. A., Babyak, M. A., Moore, K. A., Craighead, W. E., Herman, S., Khatri, P., et al,(1999). Effects of exercise training on older patients with depression. Archives of Internal Medicine, 159, 2349-2356.
* ↑ Puetz, T. W., O’Connor, P. J., & Dishman, R. K. (2006). Effects of chronic exercise on feelings of energy and fatigue: a quantitative synthesis. Psychological Bulletin, 132, 866-876.
* 1 2 Broocks, A., Bandelow, B., Pekrun, G., George, A., Meyer, T., Bartmann, U., et al. (1998). Comparison of aerobic exercise, clomipramine, and placebo in the treatment of panic disorder. American Journal Psychiatry, 155, 603-609.
* 1 2 Smith, J. C., O’Connor, P. J., Crabbe, J., & Dishman, R. K. (2002). Emotional responsiveness after low- and moderate-intensity exercise and seated rest. Medicine and Science in Sports and Exercise, 34, 1158-1167.
* ↑ Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. New York: Academic Press.
* ↑ Stonerock, G. L., et al (2015). Exercise as Treatment for Anxiety: Systematic Review and Analysis. Annals of Behavioural Medicine. 49 (4), 542-556