Benefits of Resistance Exercise Training in Treatment of Anxiety and Depression

A new study by researchers at University of Limerick has demonstrated the impact resistance exercise training can have in the treatment of anxiety and depressive symptoms.

The new study provides evidence to support the benefits of resistance exercise training can have on anxiety and depression and offers an examination of possible underlying mechanisms.

The research, published in the Trends in Molecular Medicine journal, was carried out by Professor Matthew P Herring at University of Limerick and Professor Jacob D Meyer at Iowa State University.

The researchers said there was “exciting evidence” that resistance exercise training may be an accessible alternative therapy to improve anxiety and depression like more established therapies, while also improving other important aspects of health.

Dr Herring explained: “Anxiety and depressive symptoms and disorders are prevalent and debilitating public health burdens for which successful treatment is limited.

“The healthful benefits of resistance exercise training, or muscle-strengthening exercise involving exerting force against a load repeatedly for the purpose of generating a training response, are well-established,” said Dr Herring, Associate Professor in the Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences within the Faculty of Education and Health Sciences in UL.

“However, the potential impact of resistance exercise training in the treatment of anxiety and depressive symptoms and disorders remains relatively understudied. Moreover, the plausible psychobiological mechanisms, which help us to better understand how and why resistance exercise training may improve these mental health outcomes, are poorly understood.”

The researchers argue that, while the available studies in this area are focused on relatively small sample sizes, there is sufficient evidence from previous and ongoing research at UL and the National Institute of Health funded research with Dr Meyer and colleagues at Iowa State University, to suggest that resistance exercise training does improve anxiety and depressive symptoms and disorders – though disorders themselves are scarcely studied.

“There is a critical need for confirmatory, definitive trials that adequately address limitations, including small sample sizes, but the limited evidence available to us provides initial support for the beneficial effects of resistance exercise training on these mental health outcomes, including increased insulin-like growth factor 1, cerebrovascular adaptations, and potential neural adaptations influenced by controlled breathing inherent to resistance exercise,” Dr Herring explained.

“We are tremendously excited to have what we expect to be a highly cited snapshot of the promising available literature that supports resistance exercise training in improving anxiety and depression.

“Notwithstanding the limitations of the limited number of studies to date, there is exciting evidence, particularly from our previous and ongoing research of the available studies, that suggests that resistance exercise training may be an accessible alternative therapy to improve anxiety and depression.

“A more exciting aspect is that there is substantial promise in investigating the unknown mechanisms that may underlie these benefits to move us closer to maximizing benefits and to optimising the prescription of resistance exercise via precision medicine approaches,” Dr Herring added.

Professor Meyer, a co-author on the study, said: “The current research provides a foundation for testing if resistance training can be a key behavioural treatment approach for depression and anxiety.

“As resistance training likely works through both shared and distinct mechanisms to achieve its positive mood effects compared to aerobic exercise, it has the potential to be used in conjunction with aerobic exercise or as a standalone therapy for these debilitating conditions.

“Our research will use the platform established by current research as a springboard to comprehensively evaluate these potential benefits of resistance exercise in clinical populations while also identifying who would be the most likely to benefit from resistance exercise.”

Source: University of Limerick

 

 

 

 

Exercise May Reduce Heart Failure Risk for People with Depression or Anxiety

Thor Christensen wrote . . . . . . . . .

Physical activity may reduce the risk of heart failure among people with depression or anxiety more so than in people without the mental health conditions, according to new research.

Previous studies have shown that depression and anxiety are associated with unhealthy behaviors that can lead to heart disease, and that physical activity may help reduce heart failure – when the heart can’t pump blood properly – by lessening stress-related activity in the nervous system.

For the new study, researchers wanted to learn more about the impact of exercise on heart failure risk in people with depression, anxiety or both. They started with self-reported physical activity data from 48,673 participants in the Mass General Brigham Biobank, with a median age of 60. Then they looked at who developed heart failure over a 10-year period, and compared participants who had depression or anxiety with those who did not have either condition.

“We found that while physical activity very nicely reduces heart failure risk across the entire population, it had a substantially greater impact on heart failure risk among individuals with depression and anxiety, and this differential impact was relatively large,” said the study’s lead researcher, Dr. Abdulaziz Al-Hamam, a cardiovascular research fellow at Massachusetts General Hospital in Boston. Unpublished data shows the effect ranged from about 33% to 50% greater risk reduction, he said, “which was somewhat surprising.”

The findings were presented earlier this week at the American Heart Association’s Scientific Sessions in Philadelphia. They are considered preliminary until full results are published in a peer-reviewed journal.

Al-Hamam said the results underscore the link between physical and mental health and serve as a reminder that cardiologists should work more closely with mental health professionals. Health care systems should establish interdisciplinary clinics, he said. Medical professionals also should be more proactive and speak with their patients about the importance of exercise, and support efforts to stay physically active.

“Patients should prioritize regular physical activity, even if it’s simply walking, since the sum of one’s physical activity adds up to support heart and brain health,” Al-Hamam said. “They need to keep an open line of communication with health care providers about their mental and heart health. Regular checkups and effective stress management play vital roles in maintaining overall well-being and preventing heart failure, particularly for patients with depression and anxiety.”

Al-Haman said the research was limited by its reliance on self-reported data and its observational nature, which can’t prove cause and effect. Future studies, he said, should look at the ideal type, length and intensity of exercise as well as other lifestyle factors, like sleep and diet, to reduce heart failure risk among people with depression or anxiety.

Dr. Georges Chahoud, a cardiologist with St. Louis Cardiology Consultants and regional director of the Heart Failure Clinical Program at SSM Health in Missouri, called the new research “significant” because it highlights that more physical activity would help people with depression and anxiety who are at higher risk of heart failure.

“Medical professionals should implement counseling about the importance of physical activity, especially in this group of patients who are more vulnerable,” said Chahoud, who was not involved with the research.

Chahoud also said more research is needed, including studies to see if similar benefits are observed in people with atherosclerosis, a buildup of plaque in artery walls that can lead to a heart attack or stroke.

Source: American Heart Association

 

 

 

 

The Brain Science Behind Anxiety

The seat of worry is the amygdala, an almond-shaped structure beside the hippocampus that is associated with emotional responses such as fear and anxiety. “It’s the heart and soul of the [nervous] system—it detects a dangerous situation and causes you to react,” says Joseph LeDoux, PhD, an endowed professor of science at NYU, who has spent most of his career studying anxiety and the brain.

Two areas of the amygdala generate reactions. The lateral nucleus processes the sensory information associated with anxiety—hearing a strange sound, say, or not being able to see clearly—and the central nucleus (upon being activated by the stimulus) sends a signal to the motor system to “freeze.” It also triggers the release of stress hormones, affecting the autonomic nervous system, which regulates breathing, heart rate, and blood pressure. The result of all this activity is to feel anxious, says Dr. LeDoux, who is also director of the Emotional Brain Institute at NYU.

Some people get stuck in “freeze” mode, so anytime they encounter the same stimulus, they panic. “We saw that in animal studies. Most rats, when given an electric shock, react by moving elsewhere,” he says. “But some rats just took the shock over and over. They were frozen, or stuck.” Dr. LeDoux was ultimately able to alter the animals’ reaction by removing a part of their central nuclei.

Anti-anxiety drugs, says Dr. LeDoux, are a Band-Aid solution. “Drugs make people less responsive, which doesn’t really solve the problem,” he says. He compares it to dining at a restaurant where the music is too loud. “Medications can make you less reactive to the volume, but they won’t change the fact that it’s just too noisy.”

A better way to treat anxiety might be to reduce the overall state of arousal in the amygdala and the resulting behavioral reactions, says Dr. LeDoux. “One method for doing this is to flash a light in a person’s eye so fast they don’t even realize it’s there,” he explains. “This stimulus goes into the amygdala and activates it unconsciously. If you repeat it over and over, you train the amygdala to not react in the same way.”

Several studies have been conducted on the association between light and the amygdala, including one published in Frontiers in Psychology in 2021 that found the flash technique to be effective in reducing the vividness of and emotional reaction to disturbing memories. If the reaction of the amygdala can be tweaked, Dr. LeDoux says, people may be able to take the first steps toward conquering anxiety.

Source : Brain&Life

Effective Strategies for Managing Anxiety

Hallie Lwvine wrote . . . . . . . . .

Norman Dill, 69, never thought he was the anxious type. But when he was diagnosed in 2019 with posterior cortical atrophy (PCA)—a neurologic condition in which the posterior cortex, the area of the brain involved with visual processing, is damaged—anxiety became part of his life. In the early stages of the disease, people may experience problems seeing and recognizing faces and objects. “I began to have trouble driving,” says Dill, who lives in Charlottesville, VA. “I’d turn into the wrong lane or hit a curb. When my grandchildren came to visit me that Thanksgiving, I realized I didn’t feel comfortable driving with them in the car.”

His anxiety only deepened over the next few years as the disease increasingly affected his life. When PCA advances, people tend to develop symptoms of dementia, such as memory loss and confusion. Dill forgot the names of his employees at the natural food store he’d owned for more than 30 years. He struggled to read the labels of the food items that he stocked on his shelves. He had stopped driving, but taking public transportation confused him. “It’s a free-floating anxiety,” says Dill. “I feel a sense of frustration that things aren’t right, and I want to get back to how things were before.”

Research suggests that about half of people with PCA or Alzheimer’s disease report symptoms of anxiety, and it’s common in many other neurologic diseases, too. But “it’s always hard to tell if the anxiety is a manifestation of the condition or if the anxiety is related to living with the disease,” says Danny Bega, MD, associate professor of neurology at Northwestern University in Chicago.

In some cases, it may be a little of both. Denise Glassner, 47, has had migraine attacks for most of her life, and by 2016 they had worsened to the point that she had to quit her job as a veterinary technician and even stop driving. “I’ve always had anxiety, but this really brought it to the next level,” says Glassner, who lives in Boca Raton, FL. “I’m often at home alone. That’s when the little demons come out. With nothing to distract me, I spend a lot of time worrying, which only makes my migraine worse.”

There’s no doubt that anxiety is on the rise in general. Global prevalence of anxiety and depression has increased by 25 percent since the start of the COVID-19 pandemic, according to research released last year by the World Health Organization. But anxiety can be particularly challenging to detect in people with neurologic disease, says Dr. Bega, since symptoms of anxiety overlap with symptoms of some neurologic conditions, such as Parkinson’s disease. In addition, patients themselves may not bring it up. “They may expect that feeling anxious is ‘normal’ for the condition and thus don’t raise their concerns with their providers,” says Zahra Goodarzi, MD, assistant professor of geriatrics at the University of Calgary.

This may start to change with recent guidelines advocating for increased screening. Last October, the U.S. Preventive Services Task Force (a panel of medical professionals that advises Congress on disease prevention) issued a draft recommendation that adults younger than age 65 be screened for anxiety by their primary care providers. While the recommendation didn’t specify screening tools, most doctors use the generalized anxiety disorder scale and the geriatric anxiety scale. Other questionnaires include the hospital anxiety and depression scale and the PHQ-4 scale, both of which measure symptoms of anxiety and depression and can be filled out in the doctor’s office. “A lot of interventions are available to treat anxiety, so it’s important that patients be evaluated and diagnosed appropriately,” says Dr. Goodarzi.

Understanding the Emotion

Anxiety—defined as a feeling of fear, dread, or uneasiness—is a normal reaction to stress. There are three types of anxiety disorders: generalized anxiety disorder (worrying excessively about health, money, work, or family), panic disorder (having panic attacks), and phobia (an intense fear of something, such as spiders or flying).

Most of the time, people with neurologic conditions experience generalized anxiety disorder, says Dr. Goodarzi. They may also develop phobias, but with good reason: “A person with Parkinson’s disease may have a very real fear of falling, which leads them to avoid activity,” she explains. “This in turn causes more muscle loss, which makes them even more likely to fall and reinforces their fear. It’s a vicious cycle.”

Isolation also can exacerbate anxiety. “Family, friends, co-workers—they all can buffer some of the impact of anxiety because you can talk to them,” says Indu Subramanian, MD, a movement disorder specialist at UCLA Health. “But if you have limited mobility and spend most of your time at home alone, it’s easy to fixate on the uncertainty of your future and feelings of lack of control.”

Some neurologic diseases can amplify these emotions. “We know with migraine, for example, certain areas of the brain are dysregulated even in the absence of an actual migraine attack,” says Katherine T. Hamilton, MD, a neurologist at MedStar Georgetown University Hospital in Washington, D.C. “We think the migraine brain in general is more hypersensitive and hyperexcitable, and this may also make people more predisposed to anxiety.”

That is how Jill Feinstein describes her experience with migraine. “It’s both physical and emotional,” says the 65-year-old, who lives in Stamford, CT. “My body is hypersensitive to touch, and I get upset easily. If someone looks at me the wrong way, I’m a mess.” Her migraine attacks have always been triggered by stress. When she was 10, she was hospitalized for two weeks with an abdominal migraine, a type of migraine that causes not just headache but intense abdominal pain, nausea, and vomiting. “I’d switched elementary schools and was stressed about being the new girl,” she says.

High levels of stress and anxiety may increase vulnerability to neurologic disease. A 2021 study published in Frontiers in Neurology found that people diagnosed with post-traumatic stress disorder were more likely to develop seizures, and a 2022 study in Neurology found that people who reported increased stress at home or at work or who had experienced recent stressful events such as a divorce had an increased risk of stroke.

Medication and Meditation

Christine Morrisey, 53, cared for her mother, Jean, who had PCA, for three years before her death in 2020. “She was always a slightly anxious person, but her condition heightened it,” recalls Morrisey, who lives in Scituate, MA. “She was seeing things that weren’t there, like people and small animals. She’d recognize my voice but not know who I was. We’d sit and watch TV together, and I’d peek over at her and see her sobbing because she didn’t understand what was happening to her.”

Toward the end of her mother’s life, Morrisey and her sisters could calm her down only with medication. “She was intensely paranoid and confused. When my siblings came to take care of her, she thought they were nurses there to steal from her,” Morrisey says. Doctors prescribed a high dose of the antidepressant escitalopram (Lexapro) and, as needed, alprazolam (Valium). “We’d give her 5 mg of alprazolam, which is a very large dose, and within 15 to 20 minutes we’d see a noticeable difference where she’d level out,” Morrisey says. “Eventually she began to request it when she’d get worked up about something, because she recognized that it helped her stop feeling so anxious.”

Some people can manage their anxiety using relaxation techniques like meditation and yoga, says Dr. Subramanian. A study published last year in JAMA Psychiatry found that for adults with anxiety disorder, eight weeks of yoga was just as effective a treatment as eight weeks on escitalopram. “In the past, doctors often considered yoga a tool to help improve motor ability among patients with neurologic diseases such as Parkinson’s, studying it to see if it helped improve balance or reduce stiffness or tremor,” says Dr. Subramanian. “But we know it can be incredibly effective in relieving anxiety as well, and, unlike medication, it doesn’t cause side effects.”

Dill says he’s turned to meditation to manage his anxiety. He also attends Buddhist retreats with his wife and does mindfulness exercises such as deep breathing every day. “It’s not a formal practice—it’s just part of my life,” he says. “I get on the bus and practice awareness, focusing on what’s going on around me—the sounds and the smells. I just try to be present and not let myself get consumed with worries.”

Therapy and Exercise

Cognitive behavioral therapy (CBT), which teaches people a variety of ways to think and behave, is used sometimes to combat anxiety. People who have specific phobias, for example, can be encouraged to confront their fears, which may help them realize that the phobias aren’t as overwhelming as they thought. CBT helped reduce anxiety among people with dementia who had mild cognitive impairment, according to a study published in Alzheimer Disease & Associated Disorders in 2021.

Exercise, including yoga, also has been found to tamp down anxiety. According to a study in the Journal of Affective Disorders in 2021, people with anxiety who exercised moderately or strenuously for 60 minutes three days a week for 12 weeks saw a significant decrease in anxiety symptoms compared with a control group. A study published in Annals of Behavioral Medicine in October 2022 looked at almost 140 people with Parkinson’s disease who were randomized to eight weeks of either yoga or stretching. Yoga not only relieved depression and anxiety but also eased some symptoms, such as trouble walking, tremors, and rigidity. “Any activity like yoga that affects the autonomic nervous system—the part of your body that regulates your heart rate, blood pressure, and breathing—will help relieve anxiety,” says Dr. Subramanian.

Identifying what can and cannot be controlled is another way to manage anxiety. This helped Maureen Foster, 72, of Lafayette, CO. She had to quit her job as a payroll clerk in 2016 because of her PCA diagnosis, and her anxiety escalated in the ensuing years as she burned through all her savings. Her feelings of dread eased after she confided in her son about her financial worries and he offered to take over her mortgage payments. She then sat down and figured out how to get around town without driving. “I walk everywhere now or take the bus,” she says. Friends pick her up several times a week to go out for coffee and provide social support. Her son comes once a week to take her to lunch and grocery shopping. “It was hard to adjust at first, but now I look on the bright side,” says Foster. “I eat lunch and dinner when I want and cook and clean when I want. I don’t have pressure to be somewhere. That helps relieve anxiety too.”

When Feinstein feels stressed and her attacks intensify, she tries to focus on what makes her feel good: her five children, her 6-month-old grandchild, and her relaxing hobbies, like watching Audrey Hepburn movies. Recently, she went on a family vacation to Anguilla and was pleasantly surprised not to experience a single headache during the weeklong trip. “Being surrounded by so much love helped alleviate my stress,” she says. Another source of support: her French bulldog. “Remy is my life,” she says. “I cook for him and design halters and collars for him. It’s good to have such a sense of purpose.”

Source: Brain&Life

 

 

 

 

Men Who Worry More May Develop Heart Disease and Diabetes Risk Factors at Younger Ages

Middle-aged men who are anxious and worry more may be at greater biological risk for developing heart disease, stroke and type 2 diabetes, also called cardiometabolic disease, as they get older, according to new research published in the Journal of the American Heart Association, an open access journal of the American Heart Association.

“While the participants were primarily white men, our findings indicate higher levels of anxiousness or worry among men are linked to biological processes that may give rise to heart disease and metabolic conditions, and these associations may be present much earlier in life than is commonly appreciated – potentially during childhood or young adulthood,” said Lewina Lee, Ph.D., lead author of the study, an assistant professor of psychiatry at Boston University School of Medicine, and an investigator and clinical psychologist at the National Center for Posttraumatic Stress Disorder at the U.S. Department of Veterans Affairs, both in Boston.

To track the relationship between anxiety and cardiometabolic disease risk factors over time, the investigators analyzed data on participants in the Normative Aging Study, which is a longitudinal study of aging processes in men, founded at the U.S. Veterans Affairs outpatient clinic in Boston in 1961. The study includes both veterans and non-veterans. This analysis included 1,561 men (97% white), who were an average age of 53 years in 1975. The men completed baseline assessments of neuroticism and worry and did not have cardiovascular disease or cancer at that time. A personality inventory assessed neuroticism on a scale of 0–9. In addition, a worry assessment tool asked how often they worried about each of 20 items, with 0 meaning never and 4 meaning all the time.

“Neuroticism is a personality trait characterized by a tendency to interpret situations as threatening, stressful and/or overwhelming. Individuals with high levels of neuroticism are prone to experience negative emotions – such as fear, anxiety, sadness and anger – more intensely and more frequently,” said Lee. “Worry refers to our attempts at problem-solving around an issue whose future outcome is uncertain and potentially positive or negative. Worry can be adaptive, for example, when it leads us to constructive solutions. However, worry can also be unhealthy, especially when it becomes uncontrollable and interferes with our day-to-day functioning.”

After their baseline assessment, the men had physical exams and blood tests every 3-5 years until they either died or dropped out of the study. The research team used follow-up data through 2015. During follow-up visits, seven cardiometabolic risk factors were measured: systolic (top number) blood pressure; diastolic (bottom number) blood pressure; total cholesterol; triglycerides; obesity (assessed by body mass index); fasting blood sugar levels; and the erythrocyte sedimentation rate (ESR), a marker of inflammation.

A risk factor for cardiometabolic disease was considered in the high-risk range if the test results for the risk factor was higher than the cut-point established by national guidelines, or if the participant was taking any medicines to manage that risk factor (such as cholesterol-lowering medications). Cut points for ESR as a risk factor are not standardized, so the participant was ranked as high-risk if they were in the top 25% of those tested. Each participant was assigned a risk factor count score, one point for each of the seven risk factors classified as high-risk. The men were then stratified based on whether they did or did not develop six or more high-risk factors during the follow-up period.

“Having six or more high-risk cardiometabolic markers suggests that an individual is very likely to develop or has already developed cardiometabolic disease,” said Lee.

The researchers found:

• Between ages 33 to 65, the average number of cardiometabolic high-risk factors increased by about one per decade, averaging 3.8 risk-factors by age 65, followed by a slower increase per decade after age 65.
• At all ages, participants with higher levels of neuroticism had a greater number of high-risk cardiometabolic factors.
• Higher neuroticism was associated with a 13% higher likelihood of having six or more cardiometabolic disease risk factors, after adjusting for demographic characteristics (such as income and education) and family history of heart disease.
• Higher worry levels were associated with a 10% higher likelihood of having six or more cardiometabolic disease risk factors after adjusting for demographic characteristics.

“We found that cardiometabolic disease risk increased as men aged, from their 30s into their 80s, irrespective of anxiety levels, while men who had higher levels of anxiety and worry consistently had a higher likelihood of developing cardiometabolic disease over time than those with lower levels of anxiety or worry,” Lee said.

The researchers did not have data on whether participants had been diagnosed with an anxiety disorder. Standard evidence-based treatment for anxiety disorders includes psychotherapy or medication, or a combination of the two.

“While we do not know whether treatment of anxiety and worry may lower one’s cardiometabolic risk, anxious and worry-prone individuals should pay greater attention to their cardiometabolic health. For example, by having routine health check-ups and being proactive in managing their cardiometabolic disease risk levels (such as taking medications for high blood pressure and maintaining a healthy weight), they may be able to decrease their likelihood of developing cardiometabolic disease,” said Lee.

It is unclear to what extent the results of this analysis are generalizable to the public since the study participants were all male and nearly all white. In addition, although participants were followed for four decades, they were middle-aged when the study began.

“It would be important for future studies to evaluate if these associations exist among women, people from diverse racial and ethnic groups, and in more socioeconomically varying samples, and to consider how anxiety may relate to the development of cardiometabolic risk in much younger individuals than those in our study,” Lee said.

Source: American Heart Association