Exercise in panic disorder: Implications for disorder maintenance, treatment and physical health

Abstract

According to cognitive behavioral models (CBT), panic attacks (PA) arise from distorted and catastrophic interpretations of bodily symptoms. As exercising involves exposure to physiological stimuli similar to those experienced during PAs, patients often experience anxiety and avoid exercising. Exercise avoidance and low levels of everyday physical activity turn out to promote a sedentary lifestyle as an indirect effect of Panic Disorder (PD), with deleterious health impacts. Interoceptive exposure techniques - the voluntary exposure of the patient to autonomic manifestations - have a therapeutic effect in the treatment of panic by promoting habituation to physiological cues contributing to break the hypervigilance- anxiety- panicavoidance cycle. Preliminary results indicating a potential positive role of aerobic exercise interventions designed to promote interoceptive habituation in the treatment of PD have been reported. The inclusion of an exercise protocol in the context of CBT interventions, may enhance motivation to participate and endure the discomfort and anxiety provoked by exercise using exposure therapy rationale. This chapter reviews and discusses the main results available in the literature of including exercise in the treatment of PD, as well as provides an unique cognitive behavioral perspective to the understanding of the relationship between panic disorder and exercise. We also provide specific recommendations for exercise testing, adherence promotion and particular issues that need to be addresses to successfully include PD patients in exercise protocols, based on authors experience.