Brief bouts of high-intensity exercise reduced panic disorder (PD) symptom severity more than relaxation therapy.

Results of a randomized trial revealed that after 12 weeks of a sprint-based exercise program, patients with PD experienced fewer, less intense panic attacks and fewer depressive symptoms than those undergoing relaxation therapy.

Individuals in the exercise group also enjoyed the exercise program more than those assigned to the relaxation therapy group, potentially indicating stronger engagement with exercise therapy, the investigators suggested.

“Healthcare professionals can adopt brief intermittent intense exercise as a natural and low-cost interoceptive exposure strategy. It doesn’t need to take place in a clinical setting, so that exposure to the symptoms of a panic attack is brought closer to the patient’s daily life,” study investigator Ricardo William Muotri, PhD and postdoctoral fellow at the Anxiety Disorders Program of the University of São Paulo Medical School in São Paulo, Brazil, said in a news release.

The study was published online on February 8 in Frontiers in Psychiatry.

A More Tolerable Treatment?

Characterized by frequent, unexpected panic attacks, PD affects roughly 5% of US adults over their lifetime. Cognitive behavioral therapy (CBT) remains the gold-standard treatment for these patients.

A core element of CBT is interoceptive exposure, which involves deliberately provoking the physical sensations of a panic attack — such as dizziness or breathlessness (eg, by having patients spin in a chair) and teaching them how to manage these symptoms.

The investigators hypothesized that brief bouts of exercise, such as sprinting, might offer an effective and less aversive method of interoceptive exposure, an approach not previously studied as a stand-alone treatment for PD.

The study included 72 sedentary adults (34 men; mean age, 33 years) with a diagnosis of PD.

Of these, 37 received 12 weeks of brief, intensive exercise, and a control group of 35 received 12 weeks of Jacobson Progressive Muscular relaxation therapy. There were no sociodemographic or clinical differences between the groups.

Individuals were excluded from the study if they exercised regularly, were at risk for cardiovascular disease, had a history of substance use, were pregnant or breastfeeding, or reported suicidal ideation.

Each exercise session consisted of a 5-minute warm-up, followed by a 15-minute walk, 30-second sprint, and then another 15-minute walk. The number of sprints increased biweekly throughout the training period, culminating with six sprints per session by the end.

Participants in the control group completed three weekly 45-minute sessions that included deep-breathing exercises and progressive muscle tensing and relaxation.

All patients received a placebo pill. Outcomes were assessed by a psychiatrist blinded to treatment allocation at baseline, weeks 6 and 12, and again at week 24.

The primary outcome was decreased PD severity assessed with the Panic Agoraphobia Scale (PAS). Secondary outcomes included the frequency and intensity of panic attacks, severity of anxiety symptoms measured by the Hamilton Anxiety Rating Scale and severity of depressive symptoms using the Hamilton Depression Rating Scale.

A two-way repeated-measures analysis of variance evaluated changes within and between groups over time. Although PD severity decreased in both groups, the exercise group experienced significantly greater overall reductions.

A Low-Cost, Enjoyable Option

At week 12, PAS scores were significantly lower in the exercise group vs control group (14.9 vs 23.1; P < .001), and this difference persisted at the 24-week follow-up (14.2 vs 24.7; P < .001).

In addition, the frequency and intensity of panic attacks declined in both groups during the intervention. Although attacks increased in both groups after the intervention ended, participants in the exercise group vs control group reported fewer panic attacks at follow-up (0.7 vs 1.5; P = .003).

Symptoms of anxiety and depression declined in both groups, with significant group-by-time interactions. At follow-up, depression scores were significantly lower in the exercise group vs control group (13.3 vs 16.4; P = .013).

Treatment adherence was high compared to previous PD trials, the investigators noted, suggesting that health benefits from the exercise might have played a role.

“This treatment option is low-cost, health-promoting, and can enhance patient engagement by providing an interoceptive exposure program that is experienced as more enjoyable than traditional office-based procedure,” the investigators noted.

The study’s limitations included its potential limited generalizability to PD patients who already engage in regular exercise and the lack of a second independent clinical evaluation.

The authors declared having no conflicts of interest. This study was supported by the São Paulo Research Foundation.