Can Cognitive Behavioural Techniques Reduce Exercise Anxiety and Improve Adherence to a Resistance Training Program for People with Anxiety-Related Disorders?

Abstract

Anxiety-related disorders (ARDs) are highly prevalent and associated with substantial functional impairment, including poor health outcomes and economic burden. Exercise is a cost-efficient alternative to other treatments for ARDs (e.g., psychotherapy, pharmaceutical) that is also associated with health benefits. Several exercise modalities, including resistance training (RT), have demonstrated efficacy at reducing symptoms of ARDs; however, there are challenges associated with effectively implementing such protocols, most notably, exercise avoidance or early discontinuation. Researchers have identified exercise anxiety (i.e., exercise-related worries, fear of exercise-related physical sensations, and anxiety-driven exercise-related behaviours) as a contributor to exercise avoidance for people with ARDs. Consequently, exercise-based interventions for people with ARDs may need to include strategies for helping these individuals cope with exercise anxiety to facilitate long-term exercise engagement. Cognitive-behavioural techniques (CBT), such as cognitive restructuring and exposure, can alter maladaptive thinking and behavioural patterns associated with ARDs. Teaching people how to apply CBT techniques to manage their exercise anxiety could improve both the efficacy and effectiveness of exercise-based interventions; however, research has not been conducted to test this hypothesis. The primary purpose of this randomized controlled trial (RCT) was to examine the effects of combining select modules from a transdiagnostic iteration of CBT with a RT program for people with ARDs. Primary outcomes included changes in exercise anxiety, disorder-specific anxiety-symptoms, exercise behaviour, physical activity, and general psychological distress. This RCT also evaluated potential predictors of exercise frequency. A total of 59 physically inactive (i.e., not meeting Canada’s Physical Activity Guidelines) participants who met Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria for at least one anxiety disorder, obsessivecompulsive disorder, or posttraumatic stress disorder were recruited. Participants were randomized into either RT + CBT, RT, or waitlist (WL). Each condition consisted of a month-long active phase and a three-month-long follow-up phase. During the active phase, participants in both RT groups received and followed a program supported by a certified personal trainer. This program consisted of three weekly RT sessions. During the active phase, participants in the RT + CBT group also met weekly with a clinical psychology doctoral student to learn CBT techniques. Primary measures were assessed at baseline, weekly during active phase, and at 1-week, 1-month, and 3-month follow-ups. Multilevel modelling was used for all analyses. Findings showed that as compared to both WL and RT, RT + CBT was associated with significantly greater reductions in disorderspecific symptoms, increased exercise behaviour and vigorous physical activity, and improved exercise self-efficacy. Comparable improvements in exercise anxiety and exercise motivation were noted for both RT and RT + CBT participants. In addition, exercise anxiety was identified as the best predictor of exercise frequency. This RCT is the first to evaluate strategies for helping people with ARDs exercise. Findings indicate both RT and RT + CBT can reduce exercise anxiety; however, the addition of CBT techniques may help facilitate improvements in exercise self-efficacy, reductions in disorder-specific anxiety, and increases in long-term exercise behaviour and vigorous physical activity. These techniques may be useful for researchers and clinicians alike in supporting individuals with ARDs interested in using exercise to cope with anxiety. Keywords: randomized controlled trial, anxiety-related disorders, resistance training, cognitive behavioural techniques, Unified Protocol, exercise adherence, physical activity.