Exercise as it relates to Disease/Improvements in General Anxiety Disorder Symptoms with Exercise

Generalised anxiety disorder (GAD) is a form of anxiety disorder in which sufferers experience excessive and unnecessary anxiety and worry about regular occurrences in everyday life. In Australia, GAD affects approximately 3-6% of the population. GAD is most common during late teens to early twenties, and also in the elderly - as we have an ageing population, the number of people living with disorder may increase over time. GAD is also more common in people of lower socio-economic status due to increased uncontrollable stressors. [1]The onset of GAD can either be genetic, caused by prolonged stress, a traumatic experience or distorted beliefs.

Symptoms
Symptoms of anxiety can be classified as either mental (affecting the psyche) or somatic (affecting the body but excluding the psyche). Mental symptoms can be categorised as apprehension and vigilance, whilst somatic symptoms can be categorised as either motor-based or exaggerated physiological responses.

In order to meet diagnostic criteria for GAD, patients must suffer from persistent and uncontrollable apprehension, and the consequential somatic responses, for at least six months.

Comorbidities
GAD has a high comorbidity rate as many symptoms of GAD overlap with those of other psychiatric illnesses, including depression, bipolar and other forms of anxiety (namely social phobia and panic disorder). As a result, 75-90% of GAD sufferers will also be diagnosed with one of the aforementioned psychiatric illnesses. [1]

Common Treatments
Common treatments for GAD include:
 * Pharmacotherapy
 * Cognitive behaviour therapy
 * Hypnotherapy
 * Dietary modifications (elimination of caffeine and alcohol)

Exercise can be used in conjunction with these treatments to help minimise the symptoms of GAD.

Barriers to Exercise or Physical Activity
There are several factors that dictate the likelihood of a GAD patient adhering to an exercise regime:
 * Interest in the activity
 * Perception of physical activity and exercise (i.e. incidental physical activity)
 * Motivation
 * Fatigue
 * Self-esteem
 * Mind control

Benefits of Exercise in GAD Patients

 * Endorphin release which masks pain, and produces feelings of euphoria and well-being
 * Stress relief and clearing and calming of the mind
 * Lowers resting heart rate - elevated heart rate is a symptom of GAD and exercise works to regulate this
 * Lowers airway resistance which improves the breathing difficulties experienced by GAD sufferers
 * Aids in alleviating muscle tension associated with GAD
 * Improves concentration
 * Provides a sense of self-mastery and changes in self-concept

Exercise Recommendations
Moderate-intensity aerobic exercise, such as brisk walking, jogging, cycling or swimming, are recommended as they are more successful than vigorous intensity-based programs. [10]Exercising in social situations (for example, social tennis or dancing) is beneficial in two ways; the body undergoes the physiological adaptations associated with exercise, whilst also relieving emotional tension and improving self-value. Constantly elevated heart rate is a complication associated with GAD, however aerobic exercise improves the efficiency of the heart, thus lowering resting heart rate and helping to alleviate this symptom. [9] Yoga is recommended, and, whilst is it not seen as an aerobic exercise, it calms the body, regulates breathing, and alleviates stress, whilst also stretching the muscles and strengthening the body.

It is recommended that patients partake in aerobic exercise 3-4 times per week, with a duration of 20 – 30 minutes per bout. The exercise program should continue for 8 –14 weeks to see overall improvements in their condition, but should be maintained for life. As well as exercise, incidental physical activity should be encouraged (for example, cleaning the house or climbing stairs) [10]

Further Research, Reading and Support
It is well-documented that there is a positive link between exercise and its role in preventing or lessening the burden of mental illness, however the clinical recommendations for exercise prescription are very general and limited. Future studies into standardising an exercise regime for GAD sufferers would be extremely beneficial in both prevention and treatment. [10]

Further reading and support:
 * http://au.reachout.com/Generalised-Anxiety-Disorder
 * http://www.patient.co.uk/health/Anxiety-Generalised-Anxiety-Disorder.htm **
 * http://www.anxietyonline.org.au/
 * Life line: 131114
 * Lifeline online: https://www.lifeline.org.au/Get-Help/Online-Services/crisis-chat


 * Beyond Blue: 1300 22 4636
 * Beyond blue online http://www.beyondblue.org.au/index.aspx?link_id=103.883