This is the second article in 4-part series focusing on Depression, Postpartum Depression, Anxiety, Attention Deficit Disorder (ADD/ADHD), Obsessive Compulsive Disorder (OCD) and Panic Disorder, and how exercise can be effective in their treatment. 

This is the second article in 4-part series focusing on Depression, Postpartum Depression, Anxiety, Attention Deficit Disorder (ADD/ADHD), Obsessive Compulsive Disorder (OCD) and Panic Disorder, and how exercise can be effective in their treatment.

Anxiety

Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components.[2] The root meaning of the word anxiety is ‘to vex or trouble’; in present or absent of psychological stress, anxiety can create feelings of fear, worry, uneasiness and dread.[3] Anxiety is considered to be a normal reaction to a stressor. It may help someone to deal with a difficult situation by prompting them to cope with it. When anxiety becomes excessive, it may fall under the classification of an anxiety disorder.  In the United States today, slightly more than 18% of the population suffers from all types of anxiety, and 25% of teenagers between the ages of 13-18 have various forms of anxiety during those years. 

Generalized Anxiety Disorder (GAD) is characterized by excessive, uncontrollable and often irrational worry about everyday things that is disproportionate to the actual source of worry. This excessive worry often interferes with daily functioning, as individuals suffering GAD typically anticipate disaster, and are overly concerned about everyday matters such as health issues, money, death, family problems, friend and  relationship problems or work difficulties. Individuals often exhibit a variety of physical symptoms including fatigue, fidgeting, headaches, nausea, numbness in the  hands and feet, muscle tension, muscle aches, difficulty swallowing, bouts of difficulty breathing,  trembling, twitching, irritability, agitation, sweating, restlessness difficulty concentrating, insomnia, hot flashes and rashes. These symptoms must be consistent and ongoing, persisting for at least six months, in order for a formal diagnosis of GAD to be introduced. Approximately 6.8 million American adults experience GAD, and 2% of adult Europeans, in any given year, experience GAD.

The common treatment for Anxiety and Anxiety Disorder is Cognitive Behavioral Therapy (CBT) coupled with relaxation techniques that incorporate learning how to calm down quickly.  Cognitive behavioral therapy (CBT) is a psychotherapeutic approach: a talking therapy. CBT aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure in the present. It deals directly with your thoughts, emotions and behaviors and aims at changing the thought process.  It generally works in a short amount of time compared to other types of therapy.  Drug therapy for anxiety includes antidepressants, Buspirone (BuSpar) and Benzodiazepines.  But here also, exercise can play a very important role. 

Three researchers from the Department of Kinesiology at the University of Georgia – Ramsey Center assessed whether exercise training would help improve anxiety symptoms. They estimated the exercise training effects on anxiety and also explored important variables that could moderate the effect. They performed a meta-analysis of 40 English-language articles publishes from January 1995 to December 2008 in scholarly journals involving sedentary adults with chronic illness and found that, compared with no treatment conditions, exercise training significantly reduced anxiety symptoms. The largest anxiety improvements resulted from exercise programs lasting no more than 12 weeks, using session durations of at least 30 minutes and an anxiety report time frame greater than the past week. Their conclusion was that exercise training reduces anxiety symptoms among sedentary patients who have a chronic illness.

ADD/ADHD – Attention Deficit Disorder

Attention Deficit Hyperactivity Disorder (ADHD or AD/HD or ADD) is a developmental disorder.  It is primarily characterized by “the co-existence of attention problems and hyperactivity, with each behavior occurring infrequently alone” and symptoms starting before seven years of age.

ADHD is the most commonly studied and diagnosed psychiatric disorder in children, affecting about 3-5% of children globally. It is diagnosed in approximately 2-16 % of school-aged children. It is a chronic disorder with 30-50% of those individuals diagnosed in childhood continuing to have symptoms into adulthood. It is estimated that 4.7% of American adults live with ADHD. 

The evidence is strong for the effectiveness of behavioral treatments in ADHD. It is recommended first-line in those who have mild symptoms, and in preschool-aged children. Psychological therapies include psychoeducational input, behavior therapy, Cognitive Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT), family therapy, school-based interventions, social skills training and parent management training. Parent training and education have been found to have short-term benefits. Family therapy has shown to be of little use in the treatment of ADHD; however, several ADHD-specific support groups exist as informational sources and to help families cope with challenges associated with dealing with ADHD.

Stimulant medications are the medical treatment of choice.  There are a number of non-stimulant medications, such as atomoxetine, that may be used as alternatives.  There are no conclusive studies to date of comparative effectiveness between various medications, and there is a lack of evidence on their effects on academic performance and social behaviors. While stimulants and atomoxetine are generally safe, there are side effects and contraindications to their use. Medications are not recommended for preschool children, as their long-term effects in such young people are unknown. There is very little data on the long-term adverse effects or benefits of stimulants for ADHD.  Guidelines on when to use medications vary internationally, with the UK’s National Institute of Clinical Excellence, for example, only recommending use in severe cases, while most United States guidelines recommend medications in nearly all cases.
John J. Ratey, M.D., advocates that exercise should be included in the treatment regimen, and that exercise can even reduce or eliminate the need for medication. An Associate Clinical Professor of Psychiatry at Harvard Medical School, Cambridge, Massachusetts, Dr. Ratey is author of the book Spark: The Revolutionary New Science of Exercise and the Brain.  In an interview with Medscape, he stated the following in regard to using exercise in the treatment of ADD:  There are 2 basic ways of thinking about ADD in relation to exercise: One is about the neurotransmitters norepinephrine and dopamine, both believed to be drivers of the attention system. Exercise increases the concentration of both dopamine and norepinephrine, as well as other brain chemicals. I have always said that a dose of exercise is like taking a bit of methylphenidate (Ritalin®) or amphetamine/dextroamphetamine (Adderall®); it’s similar to taking a stimulant. Second, over time, exercise helps build up the machinery to increase the amount of neurotransmitters in the brain as well as their postsynaptic receptors. Chronic exercise eventually causes growth of the system. The more fit that you are, the better the system works.”

Dr. Ratey continues: “People are just beginning to pay attention to this. It was only 2 years ago that the American Medical Association (AMA) president, in his inaugural address, said that “Exercise is medicine.” He said that every physician, no matter their specialty, should ask every patient at every meeting about their exercise regimen and encourage them to pursue this. Neurology is paying more attention to exercise, with whole conferences looking specifically at exercise and Parkinson’s disease, for instance. If exercise can help protect against some of the symptoms in Parkinson’s disease, then it should also affect ADD, because the diseases have overlapping features.”

Dr. Ratey also says that “the effects of exercise on self-efficacy are huge. Although exercise helps balance brain chemistry, there are helpful incidental effects, such as self-efficacy.” It is well-known that many ADHD children and adults experience low self-esteem because of the inability to perform well in school or the work place.  So for them, exercise can have this wonderful secondary effect; they see progress in all areas of exercise, which brings tremendous self-efficacy and confidence.  This new ability to believe in one’s self goes a long way to elevate the mood and overall attitude in both children and adults. 

Part III in this series will explore the effect of exercise Obsessive Compulsive Disorder. 

ALAN FREISHTAT is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 15 years of professional experience. He is the Co-Director of the Jerusalem-based weight loss and stress management center Lose It! along with Linda Holtz M.Sc. They are available for private consultations, assessments and personalized workout programs. They have begun working with Dr. Michael Bunzel, M.D., a psychiatrist in Bnei Brak, Israel on incorporating exercise as a therapy for several mental health disorders.  Alan can be reached at 02-651-8502 or 050-555-7175, or by email at [email protected]. You can also visit the Lose It! website at www.loseit.co.il 

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