اثرات تمرین ورزش های کوتاه مدت بر روی علائم و نشانه های اختلال اضطراب فراگیر

Background No randomized controlled trial has investigated exercise training effects on signs and symptoms that characterize patients with Generalized Anxiety Disorder (GAD). Objectives To quantify and compare the effects of six weeks of resistance (RET) and aerobic exercise training (AET) on signs and symptoms associated with GAD. Methods Thirty sedentary women, aged 18–37 years, diagnosed by blinded clinicians with a primary DSM-IV diagnosis of GAD, who were not engaged in treatment other than pharmacotherapy, were randomized to six weeks of RET, AET, or wait list (WL). RET involved two weekly sessions of lower-body weightlifting. AET involved two weekly sessions of leg cycling matched with RET on body region, positive work, exercise time, and load progression. Outcomes included concentration difficulty, trait anxiety, symptoms of depression, tension, low vigor, fatigue and confusion, irritability, muscle tension, and pain location and intensity. Hedges’ d effect sizes and 95% confidence intervals were calculated at weeks two, four, and six for each exercise condition compared to WL. Results RET significantly reduced feelings of anxiety-tension and the frequency and intensity of irritability. RET also resulted in six-week Hedges’ d effect sizes ≥0.36 for trait anxiety, concentration, symptoms of depression, fatigue and vigor, and pain intensity. AET resulted in comparable improvements in trait anxiety, concentration, irritability, muscle tension, and symptoms of fatigue and vigor. Effects for 9 of 12 outcomes were non-significantly larger for RET compared to AET. Conclusions Short-term RET and AET provoke comparable improvements in signs and symptoms associated with GAD, particularly irritability, anxiety, low vigor and pain. Findings warrant further investigation.

Findings from a recent randomized controlled trial indicated that short-term exercise training may be an effective adjuvant or augmentation treatment with minimal risk of adverse events to ameliorate worry symptoms, the hallmark symptoms of Generalized Anxiety Disorder (Herring, Jacob, Suveg, Dishman, & O’Connor, in press). In addition to pathological worry, patients with Generalized Anxiety Disorder (GAD) also are often characterized by an elevation in one or more associated signs and symptoms, including restlessness and feelings of anxiety, fatigue, difficulty concentrating, irritability, muscle tension (American Psychiatric Association, 2000), pain (Beesdo et al., 2010 and Wittchen et al., 2002) and depression (Watson, 2009). There has been limited success in treating the signs and symptoms associated with GAD. Although pharmacotherapy has shown some efficacy as a frequently employed first line treatment (Chessick et al., 2006 and Hackett et al., 2003), there have been notable drawbacks including well-established negative side effects such as nausea and sexual dysfunction (Corona et al. 2009). Because GAD symptoms are heterogeneous, pharmacotherapy may well attenuate one symptom but exacerbate another. For example, selective serotonin reuptake inhibitors have shown efficacy for GAD symptom improvement (Chessick et al., 2006 and Hackett et al., 2003), but they often exacerbate sleep disturbances (Schweitzer, 2005). Behavioral treatments also have demonstrated efficacy (Chambless et al., 1998), but there are logistical barriers associated with these treatments, including expense and the need for extensive specialized training among practitioners who provide therapy. Thus, there is a continued need to explore alternative or adjuvant treatments, including exercise training, for the associated signs and symptoms of GAD. Exercise training has positive effects on multiple signs and symptoms that characterize patients with GAD, including poor concentration (Colcombe & Kramer, 2003), depression (Blumenthal et al. 1999), fatigue (Puetz, O’Connor, & Dishman, 2006), feelings of anxiety (Broocks et al., 1998), muscle tension (Smith, O’Connor, Crabbe, & Dishman, 2002), and pain (Busch et al., 2002 and Hayden et al., 2005). In addition, the relation between exercise and irritability is of potential interest in part because of associations between negative moods related to irritability, including anger and hostility, and the development and progression of heart disease (Chida and Steptoe, 2009 and Kubzansky and Kawachi, 2000). No randomized controlled trial has investigated the effects of exercise training on the signs and symptoms that characterize patients with GAD.