Anxiety disorders are one of the most prevalent of all mental disorders. Between 16% to 29% of the population will have experience it in their lifetimes(1). One of the biggest reasons why is that anxiety is associated with many other mental disorders like depression, post-traumatic stress disorder, obsessive compulsive disorder, attention deficit hyperactivity disorder, and bipolar disorder. The DSM-V classifies panic attacks as including four or more of the following symptoms in a sudden onset(2):
- Palpitations, pounding heart, or accelerated heart rate
- Nausea or abdominal distress
- Trembling or shaking
- Chills or heat sensations
- Sensations of shortness of breath or smothering
- Feeling of choking
- Feeling dizzy, unsteady, lightheaded, or faint
- Chest pain or discomfort
- Paresthesias (numbness or tingling sensations)
- Derealization (feelings of unreality) or depersonalization (being detached from oneself)
- Fear of losing control or going crazy
- Fear of dying
Which may last minutes or hours depending on the severity of the attack. Many times the symptoms act as a positive feedback loop where one or a few of the symptoms triggers the body to react and increase the severity of the attack. Before delving any deeper into the research on exercise and panic attacks I strongly recommend that you talk with your medical doctor or psychologist. All of the exercise research in mental disorders points towards the most effective approach of treatment as a combination of multiple treatment methodologies (i.e. psychology and psychiatry).
Although there is a genetic component to anxiety and panic attacks there is also a strong interrelationship with sedentary behaviour. With less than 15% of Canadians meeting the daily 150 minutes of moderate to vigorous physical activity(3) we are creating a perfect storm scenario for mental health issues and chronic health concerns (remember those blogs about cancer?). It is not to say that lack of movement and improper nutrition are the direct causes of these illnesses but that they add to the increased probability expressing them.
Exercise benefits anxiety and panic attacks from multiple fronts(4):
- Increases the threshold of stress that is required to create a panic attack
- Reduces the frequency and severity of anxious periods and panic attacks
- Strenuous physical activity improves the body’s ability to chemically handle stressful situations by:
- heating up from physical activity that is similar to anxiety related processes allowing the body to become tolerant
- production of endorphins and hormones that reduce anxiety
- down-regulating the sympathetic nervous system that is responsible for the fight or flight response
- Increases the production of brain-derived neurotrophic factors which help to rewire the brain to handle stressful situations
- Is a vehicle to learn deep breathing techniques
- Improves sleep
- Improves the learning of new skills and self-efficacy
- Improves the interpretation of emotions
- Reduces social withdrawal
Think of exercise as seeing a psychologist, and taking an anti-anxiety (anxiolytic), and an anti-depressant drug all at the same time.
Exercising induces a physiological response similar to a panic attack and, much like cognitive behavioural therapy, the person is forced to confront these feelings. The confrontation rewires the brain and allows it to learn that it doesn’t need to mount a large physiological response every time it is stressed. Exercise acts as an anxiolytic by producing similar hormones and chemicals in the brain that these drugs have. Furthermore, exercise is actually more powerful than drugs since it creates new neural pathways improving our coping mechanisms and doesn’t simply replace chemicals that are low in concentration.
Adherence to exercise is always an issue when looking at its use as a drug in panic attacks. Since the act of exercise actually induces anxiety and panic attacks, most people have a general reluctance in pursuing fitness for intensities and durations that would actually allow for the pharmacological effects to take effect. Qualified and supervised exercise regimens, at least for the first few times a person is exercising, is always recommended. This way the person can be brought back from the attack and encouraged to continue on.
Movement in general is beneficial to reduce anxiety and panic attacks. The type of exercise does make a difference in the following areas:
- Effect on a person currently experiencing a panic attack or anxiety: Yoga and Tai Chi are the most optimal in this situation(5).
- Reduced general day to day anxiety: Aerobic exercise is most optimal: between 60-90% of maximum heart rate, 3 or more times per week for 20-40 minutes(4).
- Reduced situational anxiety: resistance training is most optimal: three times per week and whole body workouts. Either at two sets 8-10 repetitions at 75 – 80% of a one repetition max, or two sets of 14-18 repetitions at 55-65% of a 1 repetition max(6).
Much like any health lifestyle, one fitness style should not be the only exercise form. Research points to using each one of the exercise modalities in complement with each other. They are drugs that can be used at varying stages of anxiety or panic attacks. Fitness is about enriching your environment with positive activities and both reduce stress and increase coping mechanism(7). The research infers that sticking to a regimen for a minimum of 10 weeks shows the best results in reducing anxiety and panic attacks. The most optimal results were shown after 16 weeks of exercise(4). The duration shows that, much like any other drug or treatment methodology, the dosage needs to be frequent and consistent. It’s not about taking one drug, one time, that cures an illness it’s about creating a proper lifestyle.
So the answer is no, exercise can’t cure panic attacks directly, but it can be part of the tools to reduce the frequency and severity of the panic attacks.
1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence
and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593-602.
2. Craske M. G., et al. (2010). Panic Disorder: A Review of DSM-IV Panic Disorder and Proposals for DSM-V. Depression & Anxiety. 2010;27: 93-112
3.Statistics Canada. Canadian Health Measures Survey: physical activity of youths and adults. Retrieved April 10 2014, http://www.statcan.gc.ca/pub/82-003-x/2011001/article/11396-eng.htm
4.Gordon J.G. et al. Let’s get physical: a contemporary review of the anxiolytic effects of exercise for anxiety and its disorders. Depression & Anxiety. 2013; 30:362-373
5. Field T, DiegoM, Hernandez-Relf M. Tai Chi/Yoga Effects on anxiety, heart rate, EEG and math computations. Comp Ther Clin Pract. 2010;16:235-238.
6. Bartholomew JB, Linder DE. State anxiety following resistance exercise: the role of gender and exercise intensity. J Behav Med. 1998;21:205–219.
7. Hendriksen H, Oliver B, Ronals O. From non-pharmacological treatments for post-traumatic stress disorder to novel therapeutic targets. European Journal of Pharmacology.2014.