Regular physical activity is
anxiolytic in both healthy subjects and patients with
panic disorder. In contrast, acute exercise may induce acute
panic attacks or increase subjective anxiety in patients with
panic disorder more than in other people. The effects of quiet rest or an aerobic treadmill exercise (30 min at an intensity of 70% of the maximal
oxygen uptake, VO2max) on
cholecystokinin tetrapeptide (CCK-4) induced
panic attacks were studied in a crossover design in 12 patients with
panic disorder and 12 matched healthy subjects. The effects of
CCK-4 (25 microg in patients and 50 microg in control subjects) were measured with the Acute Panic Inventory (API) score, comparing
panic attack frequencies, total score, and subscores for anxiety and
somatic symptoms. CCK-4-induced
panic attacks were less frequent after prior exercise: they occurred in 15 (62.5%) subjects after rest (9 patients and 6 control subjects), but only 5 (20.8%) subjects after exercise (4 patients and 1 control subject). In both conditions,
CCK-4 administration induced a significant increase in the total API score and the anxiety and
somatic symptoms subsores. However, compared to prior rest, exercise resulted in a significantly reduced CCK-4-induced increase of the total API score and the anxiety subscore. In patients with
panic disorder exercise increased the total API score and the
somatic symptoms subscale but not the anxiety subscore. Patients with
panic disorder showed increased somatic but not anxiety symptoms after an acute bout of exercise. Severity of CCK-4-induced panic and anxiety, on the other hand was reduced by exercise. These findings suggest that in addition to exercise training an acute bout of exercise may be used to reduce anxiety and
panic attack frequency and intensity in
panic disorder patients.