Background: Exercise training may be especially helpful for patients with generalized anxiety disorder (GAD). We conducted a randomized controlled trial to quantify the effects of 6 weeks of resistance (RET) or aerobic exercise training (AET) on remission and worry symptoms among sedentary patients with GAD. Methods: Thirty sedentary women aged 18–37 years, diagnosed by clinicians blinded to treatment allocation with a primary DSM-IV diagnosis of GAD and not engaged in any treatment other than pharmacotherapy, were randomly allocated to RET, AET, or a wait list (WL). RET involved 2 weekly sessions of lower-body weightlifting. AET involved 2 weekly sessions of leg cycling matched with RET for body region, positive work, time actively engaged in exercise, and load progression. Remission was measured by the number needed to treat (NNT). Worry symptoms were measured by the Penn State Worry Questionnaire. Results: There were no adverse events. Remission rates were 60%, 40%, and 30% for RET, AET, and WL, respectively. The NNT was 3 (95% CI 2 to 56) for RET and 10 (95% CI –7 to 3) for AET. A significant condition-by-time interaction was found for worry symptoms. A follow-up contrast showed significant reductions in worry symptoms for combined exercise conditions versus the WL. Conclusions: Exercise training, including RET, is a feasible, low-risk treatment that can potentially reduce worry symptoms among GAD patients and may be an effective adjuvant, short-term treatment or augmentation for GAD. Preliminary findings warrant further investigation.

1.
Broocks A, Bandelow B, Pekrun G, George A, Meyer T, Bartmann U, Hillmer-Vogel U, Ruther E: Comparison of aerobic exercise, clomipramine, and placebo in the treatment of panic disorder. Am J Psychiatry 1998;155:603–609.
2.
Merom D, Phongsavan P, Wagner R, Chey T, Marnane C, Steel Z, Silove D, Bauman A: Promoting walking as an adjunct intervention to group cognitive behavioral therapy for anxiety disorders – a pilot group randomized trial. J Anxiety Disord 2008;22:959–968.
3.
Goodwin RD: Association between physical activity and mental disorders among adults in the United States. Prev Med 2003;36:698–703.
4.
Herring MP, O’Connor PJ, Dishman RK: Exercise training reduces anxiety symptoms among patients: a systematic review. Arch Intern Med 2010;170:321–331.
5.
Kendler KS, Neale MC, Kessler RC, Heath AC, Eaves LJ: Generalized anxiety disorder in women: a population-based twin study. Arch Gen Psychiatry 1992;49:267–272.
6.
Puetz TW, O’Connor PJ, Dishman RK: Effects of chronic exercise on feelings of energy and fatigue: a quantitative synthesis. Psychol Bull 2006;132:866–876.
7.
Colcombe S, Kramer AF: Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci 2003;14:125–130.
8.
Martinsen EW, Hoffart A, Solberg OV: Aerobic and non-aerobic forms of exercise in the treatment of anxiety disorders. Stress Med 1989;5:115–120.
9.
Brown T, Di Nardo P, Barlow DH: Anxiety Disorders Interview Schedule Adult Version (ADIS-IV): Client Interview Schedule. Albany, Graywind Publications, 1994.
10.
Zimmerman M, Mattia, JI: A self-report scale to help make psychiatric diagnoses: the Psychiatric Diagnostic Screening Questionnaire. Arch Gen Psychiatry 2001;58:787–794.
11.
Meyer TJ, Miller ML, Metzger RL, Borkovec TD: Development and validation of the Penn State Worry Questionnaire. Behav Res Ther 1990;28:487–495.
12.
Blair S, Haskell W, Ho P, Paffenbarger RS, Vranizan KM, Farquhar JW, Wood PD: Assessment of habitual physical activity by a seven-day recall in a community survey and controlled experiments. Am J Epidemiol 1985;122:794–804.
13.
Borg G: Borg’s Perceived Exertion and Pain Scales. Champaign, Human Kinetics, 1983.
14.
Cook D, O’Connor P, Eubanks S, Smith J, Lee M: Naturally occurring muscle pain during exercise: assessment and experimental evidence. Med Sci Sports Exerc 1997;29:999–1012.
15.
Brown TA, Di Nardo PA, Lehman CL, Campbell LA: Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders. J Abnorm Psychol 2001;110:49–58.
16.
Brown TA, Antony MM, Barlow DH: Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample. Behav Res Ther 1992;30:33–37.
17.
Beck AT, Steer RA, Brown GK: Manual for the Beck Depression Inventory- II. San Antonio, Psychological Corporation, 1992.
18.
Cook RJ, Sackett DL: The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995;310:452–454.
19.
Hedges LV, Olkin I: Statistical Methods for Meta-Analysis. New York, Academic Press, 1985.
20.
McCrone P, Ridsdale L, Darbishire L, Seed P: Cost-effectiveness of cognitive behavioral therapy, graded exercise and usual care for patients with chronic fatigue in primary care. Psychol Med 2004;34:991–999.
21.
Heuzenroeder L, Donnelly M, Haby MM, Mihalopoulos C, Rossell R, Carter R, Andrews G, Vos T: Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder. Aust N Z J Psychiatry 2004;38:602–612.
22.
Wittchen H-U, Zhao S, Kessler R, Eaton WW: DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:355–364.
23.
Hackett D, Haudiquet V, Salinas E: A method for controlling for a high placebo response rate in a comparison of venlafaxine XR and diazepam in the short-term treatment of patients with generalised anxiety disorder. Eur Psychiatry 2003;18:182–187.
24.
Chessick CA, Allen MH, Thase M, Batista Miralha da Cunha AB, Kapczinski FF, de Lima MS, dos Santos Souza JJ: Azapirones for generalized anxiety disorder. Cochrane Database Syst Rev 2006;3:CD006115.
25.
Singh NA, Stavrinos TM, Scarbek Y, Galambos G, Liber C, Singh MAF: A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults. J Gerontol A Biol Sci Med Sci 2005;60:768–776.
26.
Gould RA, Safren SA, Washington DO, Otto MW: A meta-analytic review of cognitive behavioral treatments; in Heimber R, Turk CL, Mennin DS (eds): Generalized Anxiety Disorder: Advances in Research and Practice. New York, Guilford Press, 2005, pp 248–264.
27.
Hofmann SG, Sawyer AT, Witt AA, Oh D: The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol 2010;78:169–183.
28.
Dishman RK, Berthoud HR, Booth FW, Cotman CW, Edgerton VR, Fleshner MR, Gandevia SC, Gomez-Pinilla F, Greenwood BN, Hillman CH, Kramer AF, Levin BE, Moran TH, Russo-Neustadt AA, Salamone JD, Van Hoomissen JD, Wade CE, York DA, Zigmond MJ: Neurobiology of exercise. Obesity 2006;14:345–356.
29.
Sylvia LG, Ametrano RM, Neirenberg AA: Exercise treatment for bipolar disorder: potential mechanisms of action mediated through increased neurogenesis and decreased allostatic load. Psychother Psychosom 2010;79:87–96.
30.
Trivedi MH, Greer TL, Grannemann BD, Church TS, Galper DI, Sunderajan P, Wisniewski SR, Chambliss HO, Jordan AN, Finley C, Carmody TJ: TREAD: TReatment with Exercise Augmentation for Depression: study rationale and design. Clin Trials 2006;3:291–305.
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