Panic disorder and exercise avoidance

Abstract

Objectives: 1) To identify whether patients with panic disorder in general and those with the respiratory subtype in particular actively avoid exercise; 2) to investigate physiological differences in cardiopulmonary function parameters in patients with panic disorder in general, patients with the respiratory subtype of panic disorder, and healthy controls upon exercise challenge. Methods: Patients with panic disorder were classified as having either the respiratory or the nonrespiratory subtype. Both groups were compared to controls in terms of exercise avoidance patterns and performance on cardiopulmonary exercise testing. Results: Patients with panic disorder exhibited higher exercise avoidance scores and worse performance on cardiopulmonary exercise testing as compared with controls. No differences were found between patients with the respiratory and non-respiratory subtypes. Conclusions: Exercise avoidance is present in panic disorder and is associated with poorer performance on cardiopulmonary exercise testing. These findings are not limited to patients with the respiratory subtype of the disorder.

A New CBT Model of Panic Attack Treatment in Comorbid Heart Diseases (PATCHD): How to Calm an Anxious Heart and Mind

“…Behavioral avoidances of stimuli or situations that could trigger benign cardiac alterations may include caffeine ingestion, daily activities that involve physical effort, sexual intercourse (Muotri & Bernik, 2014;Ramos et al, 2014), and also cardiac rehabilitation or exercise (Yohannes et al, 2007). Cognitive avoidances can include thought-suppression and disassociation surrounding stimuli such as medical appointments, discussions about health, stressful situations, and interpersonal conflicts.…”

“…Anticipatory anxiety is important to identify and remedy considering that exercise avoidance is common in panic disorder (Muotri & Bernik, 2014). Of course, a graded exercise program is routinely recommended and rarely contraindicated, and this requires careful explanation (e.g., "the heart, like all muscles, requires exercise to get stronger").…”

Misinterpretation of the Borg’s Rating of Perceived Exertion Scale by patients with panic disorder during ergospirometry challenge

“…The most widely used instrument to measure perceived exertion or exercise intensity is the Borg's Rating of Perceived Exertion (RPE) Scale (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). 1 Objective measures of effort, such as heart rate (HR) and oxygen uptake, have be used in conjunction with RPE scores in clinical settings such as cardiac rehabilitation [2][3][4][5] and with patients receiving b-blocker therapy.…”

“…18 Consequently, avoidance of physical exercise, which share with fear activation the same arousal bodily sensations, has been previously reported (eg, Muotri and Bernik), and was observed in this sample. 19 Putatively, catastrophic interpretation of exerciseinduced bodily sensations can alter the perception of current state of fatigue. Fatigue compromises exercise performance and is determined by central and peripheral mechanisms.…”

Aerobic exercise reduces anxiety symptoms and improves fitness in patients with panic disorder

“…In addition, physical exercise may induce panic attacks, 18,19 causing an increase in exercise avoidance by these PD patients. 20 Thus, the aim of this study was to investigate the effects of continuous AE on anxiety and VO 2max in PD patients. We hypothesized that in the end of the training period there would be a significant improvement of anxiety and of VO 2max .…”