The use of physical exercise in psychiatry: prescribing aerobic exercise in panic disorder

Abstract

Background Physical exercise plays an increasingly important part in the management of most psychiatric disorders. The precise mode of action of exercise therapy is unclear, but there is growing evidence that it does change cerebral functioning. In panic disorder, panic attacks result from the misfiring of the brain's asphyxiation alarm following increases of PCO2. Panic patients tend to chronically hyperventilate in the attempt to keep PCO2 low. Hyperventilation causes systemic alkalosis, cerebral vasoconstriction and cerebral hypoxia. Panic patients in the nonpanic state have been shown to have abnormal cerebral activity, probably as consequence of chronic hyperventilation secondary to panic attacks. As panic disorder is chronic, panic patients are exposed to long periods of cerebral hypoxia, which in turn may perpetuate anxiety and panic symptoms. By restoring physiological breathing patterns, aerobic exercise regularly may resolve cerebral dysfunction secondary to hyperventilation, thereby mitigating panic symptoms.