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

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 and is most common during adolescence and mid-life. 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).

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
 * Low self-esteem
 * Mind control

Benefits of Exercise

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

Exercise Recommendations
Aerobic exercise is the recommended exercise modality, as it is more pleasurable and achievable for the patient, and therefore increases the likelihood of adherence. Brisk walking, jogging, cycling and swimming are best. 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.

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 sufferers of mental illness would be extremely beneficial in both prevention and treatment.