title: Aerobic exercise training facilitates the effectiveness of cognitive behavioral therapy in panic disorder.
abstract: BACKGROUND
  Physical activity has been discussed as a therapeutic alternative or add-on for the treatment of anxiety disorders. We studied whether aerobic exercise compared to physical activity with low impact can improve the effect of cognitive behavioral therapy (CBT) in patients with panic disorder (PD) with/without agoraphobia.
  
  
  METHODS
  Forty-seven patients received group CBT treatment over 1 month, which was augmented with an 8-week protocol of either aerobic exercise (three times/week, 30 min, 70% VO(2) max; n = 24) or a training program including exercises with very low intensity (n = 23) in a randomized controlled double-blind design. The primary outcome measure was the total score on the Hamilton Anxiety Scale (Ham-A). A 2 × 3 analysis of covariance (ANCOVA) with baseline value as a covariate was conducted for data analysis.
  
  
  RESULTS
  Time × group interaction for the Ham-A revealed a significant effect (P = .047, η(2) p = .072), which represented the significant group difference at a 7-month follow-up. For the other clinical outcome measures no statistical significance emerged, although improvement was more sustained in the exercise group.
  
  
  CONCLUSIONS
  For patients with PD, regular aerobic exercise adds an additional benefit to CBT. This supports previous results and provides evidence about the intensity of exercise that needs to be performed.
authors.affiliation: Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - University Medicine Berlin, Berlin, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Gaudlitz
authors.forename: Jens
authors.initials: J
authors.lastname: Plag
authors.forename: Fernando
authors.initials: F
authors.lastname: Dimeo
authors.forename: Andreas
authors.initials: A
authors.lastname: Ströhle
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D004311:Double-Blind Method; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
keywords: CBT/cognitive behavioral therapy; agoraphobia; anxiety/anxiety disorders; clinical trials; exercise; panic attacks/agoraphobia; phobia/phobic disorders