Brief Intermittent Intense Exercise as Interoceptive Exposure Strategy in the Treatment of Patients with Panic Disorder: A Randomised Controlled  Trial

Introduction: Physiological symptoms of arousal in a panic attack are accompanied by an aversive sensation of intense fear. Over time, this aversive conditioning leads to a heightened awareness and avoidance of these bodily arousal symptoms. Interoceptive exposure to bodily arousal symptoms is considered a core feature of diverse cognitive-behavioural therapy (CBT) protocols for the treatment of panic disorder (PD). However, office-based interoceptive exposure is considered aversive and tedious, possibly hindering the patient engagement. The use of physical exercise to elicit bodily arousal symptoms may be an effective and pleasurable alternative. Objective: To investigate the feasibility and effectiveness of a PD treatment protocol based on brief intermittent intense exercise as interoceptive exposure therapy. Methods: In total, 121 patients with PD were evaluated, and 72 were enrolled in the study. The participants were randomly allocated to a 12-week program of either brief intermittent intense exercise (BIE, n = 37) or relaxation training (RT, n = 35). The primary outcome measure was the Panic Agoraphobia Scale (PAS) score, evaluated at baseline, 6, 12, and 24 weeks by a blinded investigator. Results: The patients in the BIE group were much less symptomatic at the endpoint week 12 (BIE: M = 14.9, SD = ±5.3; RT: M = 23.1, SD = ±9.4; t = -4,72; p < 0.001) and at the 24-week follow-up re-evaluation (BIE: M = 14.2, SD = ±5.5; RT: M = 24.7, SD = ±8.5; t = -6.07; p < 0.001). They also experienced fewer episodes of panic at the follow-up evaluation  (t = -3.785, p = 0.003). The patients undergoing BIE were also less symptomatic at week 12 on both the Hamilton Rating Scale for Anxiety (HAM-A) (F = 5.041; p = 0.005) and Hamilton Rating Scale for Depression (HAM-D) (F = 13.967; p < 0.001). Conclusions: In this trial, Brief intermittent intense exercise was  a more effective treatment for PD than relaxation training, a common  treatment for anxiety disorders.