How Exercise Reduces Anxiety

The relationship between physical activity and anxiety is multi-factorial and includes both psychological and physiological components. Many hypotheses have been proposed to explain the anxiety-reducing benefits of regular exercise. Psychological theories include distraction, enhanced self-efficacy, mastery, and psychological benefits of regular social interaction. Physiological mechanisms include beneficial effects of regular exercise on the levels of several neurotransmitters that affect anxiety including serotonin, norepinephrine, dopamine, and endorphins.

Regular exercise alleviates chronic anxiety and may reduce the frequency and severity of panic attacks.

Individuals who report chronic anxiety frequently engage in strenuous physical activity in efforts to alleviate their symptoms. Open studies suggest that both aerobic exercise and strength training improve anxiety when done on a regular basis (Paluska 2000). The beneficial effects of exercise are similar to those of meditation and regular relaxation. Acute onset anxiety generally responds better to exercise than long-standing symptoms of anxiety.

A workout program consisting of at least 20 to 30 minutes of daily exercise can significantly reduce symptoms of generalized anxiety. Findings of a prospective 10-week study of exercise in individuals prone to panic attacks show that regular walking or jogging (4 miles three times a week) reduces the severity and frequency of panic attacks (Stevinson 1999).

Most studies on the effects of physical activity on anxiety have been done in healthy adults. Although some studies have been done in children, adolescents, and the elderly, more studies need to be done to determine the kind, intensity, frequency, and duration of physical activity that are most effective in reducing anxiety in these age groups.

In my own 20+ year clinical practice, I have observed that chronically anxious patients who follow a regular exercise program usually pay more attention to their health in general, and tend to respond more rapidly to both prescription medications and integrative treatments compared to patients who are not physically active.

Safety Issues: Individuals in good health can engage in vigorous exercise with few limitations. However, individuals with heart disease, chronic pain, or other serious medical problems should consult with their physician before starting an exercise program.

To learn more about non-medication treatments for anxiety, see my short e-book “Anxiety: The Integrative Mental Health Solution.”

I Suffer Panic Attacks at the Gym—Here’s What Helps Me Get Past the Anxiety

Research shows that exercise is one of the best remedies for anxiety. It’s actually been found to be nearly as effective as Prozac at calming sensory nervous systems, producing feel-good hormones, lowering resting heart rate, increasing confidence, and decreasing sensitivity to anxiety symptoms. But cruelly, working out can also be a major trigger. Shallow breathing, a racing pulse, chest pressure, sweating, even slight nausea—these are all natural consequences of exertion; and they’re also symptoms of panic attacks. For me and the 3.3 million Americans with panic disorder, the sensations of exercise can morph seamlessly into full-fledged terror.

I’ve loved gyms since I was a high-schooler, burning off SAT stress and social drama on the elliptical machines. Throughout my adult life, I’ve cardio-kickboxed my way out of break-ups, and strength-trained into a self-assured, self-advocating woman. But during periods when I’m experiencing heightened anxiety, a workout can go from liberating to horrifying within seconds.

The amygdala, an ancient structure in the middle brain, sends out hormones to speed up heart rate, release adrenaline, and ready large muscles for action. The amygdala and the adrenal system are designed to override cognition and respond faster than the logical frontal cortex—so the second I have an anxious thought or feeling, I am flooded with chemicals bracing my body to fight or flee.

My pupils dilate so I can better spot danger, which makes the gym’s fluorescent lights garish and the people around me appear unreal. Blood is diverted away from my extremities to my core (so if I get cut I won’t bleed to death) and to my large muscles (biceps, quads), preparing them for action.

This redistribution of blood in my body causes me to feel faint, as well as an eerie sense of unreality and sensory overwhelm. My fingers and toes buzz from lack of circulation, and my lips and face blanch. Seeing my face so white and drained in the floor-to-ceiling wall mirrors scares me. I feel an impending doom, a black cloud descending. Dizzy and shaking, my mouth parched, my stomach cramping, legs quivering, I grab my water bottle and keys and flee the gym.

My overactive nervous system would have given me a great advantage for survival in Paleolithic times. But now it leaves me breathless and terrified at a luxury gym, with nothing to battle but a series of my own reflections in a row of spotless mirrors.

When panic plagues me, I avoid the gym and working out for months or a year at a time. People with panic disorder often develop agoraphobia, fear and avoidance of activities and places that could trigger panic. In times of acute anxiety I’m not able to go to work, to the store, or drive. On the worst days, I can’t even get out of bed—just venturing to the kitchen could trigger a devastating attack. I’ve had to crawl, quivering, back to my room more than once.

RELATED: 12 Signs You May Have an Anxiety Disorder

How exercise affects an anxiety-prone brain

One of the most touted benefits of exercise is the release of endorphins—pain-reducing chemicals that can create feelings of euphoria and relaxation. What’s more, exercise raises levels of a protein called brain-derived neurotrophic factor, which repairs brain cells that stress and depression damage. Opiate-like endocannabinoids also increase.

But during a workout, the stress hormone cortisol can rise, because exertion activates the sympathetic nervous system. People who have panic disorder are hyper-attuned to any increase in stress hormones and sympathetic nervous system arousal. They actually interpret those shifts in the body as dangerous—leading to more cortisol, adrenaline, and nervous system arousal. This cycle of escalating arousal and stress hormones can lead very quickly to a panic attack.

Ironically, in the long-term, exercise is associated with lower cortisol levels and nervous system arousal overall. So if someone with panic can tolerate the temporary increase in anxiety symptoms during and just after exercise, over time she’ll experience a net reduction in stress hormones and nervous system arousal—and greater calm.

The National Institute of Mental Health (NIMH) has found that regular aerobic exercise decreases the reactivity of both the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis (another stress response system in the body). The NIMH also presents evidence that regular aerobic exercise has an effect on the brain similar to that of anti-anxiety meds like SSRIs. Exercise can also calm the amygdala, as well as stabilize sleep and appetite, and increase levels of GABA, a calming neurotransmitter, which is often naturally low in the brains of people with anxiety.

Because the normal side effects of exercise mimic the physical experience of panic, working out can also help desensitize sufferers to the physical symptoms of anxiety and panic. In other words, if you can tolerate the sweating, increased heart rate, muscle tension, and rapid breathing during exercise, you can also learn to bear those sensations when they arise due to anxiety. This is similar to exposure therapy, which incrementally exposes a person to what they fear in ways that do not seriously threaten them. Repeated exposures will eventually lead to better tolerance and less fear.

RELATED:These Are the Best Exercises for Anxiety and Depression

What I learned about panic at the gym

Easier said than done. Most people can hop on a treadmill and if their heart pounds, they recognize it as a sign they’re working hard. For the anxious and panic-prone, a racing heart and heavy breathing trigger worries, then images, then certainty of heart attacks, fainting, or dropping dead—and these scary thoughts trip off the adrenal system leading swiftly into a panic attack.

In exposure therapy, you confront what makes you anxious in small, simple steps, with a safety plan in place. I got back into exercise by raising my heart rate for short bouts. One day I walked vigorously around the block. The next I ran in place for five minutes in place in my backyard. When I ventured back to the gym, I did so for 10, then 15 minutes at a time, keeping my exertion level in check. When the anxiety became intense, I distracted myself with a comforting playlist, ice water, or a snack. If I felt on the verge of panic, I stepped outside, paced and breathed, and came back in, even if only for five more minutes.

I started going to Barre, which is strengthening and strenuous but not aerobic, so my heart rate stayed reassuringly low, and I could control how much strain I felt. My teacher reminded us that the exercises were supposed to feel uncomfortable, that’s how we’d get stronger. “Get comfortable with discomfort!” she cheered from the microphone clipped to her pink sports bra, while our legs quivered in squats and lunges.

This was great advice for us in class, and also for anyone with panic. I needed to learn to withstand the messages of terror and dread my body produced and that panic attacks, horrific as they are, were my body’s natural, if misguided, attempts at self-preservation. I needed to learn that the quaking of my body was a normal and expected outcome of exercise, not a sign of impending heart attack or mental collapse.

These feelings wouldn’t kill me. They wouldn’t cause insanity or permanent damage. They didn’t mean I actually needed to flee where I was. They would pass, like muscle fatigue when lifting, and rapid, gasping breathing when running or panicking.

Anxiety and panic have cost me so much—relationships, jobs, travel, sleep, salary, vacations, and more. At least now, to deal with that harsh reality, I can work it off at the gym.

Gila Lyons’ work has appeared in The New York Times, Cosmopolitan, Salon, Vox, The Huffington Post, GOOD Magazine, and more. She is at work on a memoir about seeking a natural cure for anxiety and panic disorder but falling prey to the underbelly of the alternative health movement.

How Exercise Eases Anxiety

Anxiety can be overwhelming and cause many physical and emotional side effects. When you can’t stop worrying, you can’t sleep and you may even feel sick to your stomach. While an anxiety disorder should be monitored and treated by a qualified professional, exercise can be part of an effective treatment plan to help manage your anxiety symptoms.

Exercise and Anxiety: What the Research Says

“Exercise won’t cure anxiety or depression, but the physical and psychological benefits can improve the symptoms,” explains Sally R. Connolly, LCSW, a therapist at the Couples Clinic of Louisville in Kentucky. “Research shows that at least 30 minutes of exercise three to five days a week can significantly make a difference.” Some studies have suggested that regular exercise can help alleviate anxiety as much as anxiety medications, and the anxiety-relieving effects of exercise may last longer than those of drugs.

Exercise and Anxiety: Who Benefits

While everyone can reap psychological benefits from exercise, research suggests that people who may see the biggest improvements in anxiety symptoms are those who:

  • Exercise consistently for at least several weeks
  • Are not already physically active
  • Have severe anxiety
  • Do aerobic exercise, such as jogging, swimming, or dancing

Exercise has also been shown to be effective in managing symptoms of depression, which frequently affects people with anxiety disorders.

Exercise and Anxiety: How Exercise Helps

“Anxiety is usually linked to an increased heart rate,” notes Connolly. “Exercise can be very helpful with calming people’s heart rate.”

During exercise, your heart rate shoots up, but over time, as your fitness level improves, your heart begins to work more efficiently. As a result, your resting heart rate between exercise sessions eventually becomes slower. Improved heart and lung function due to regular aerobic activity are often associated with a greater sense of overall well-being, which can help offset feelings of anxiety.

Even short bursts of exercise — just 10 to 15 minutes at a time — can improve your fitness and your mood. Connolly recommends that her patients get a total of 30 minutes of exercise a day, which can be broken into 10-minute blocks if necessary, between six and seven days a week.

Exercise can even help prevent anxiety disorders from beginning in the first place. One study showed that regular exercisers were at a 25 percent reduced risk of depression and anxiety disorders over a five-year period. Not surprisingly, exercise has also been found to improve mental clarity and concentration, both of which may be negatively affected by anxiety. Chemicals released in the brain during exercise may help improve the ability to focus and deal with stressful situations, thereby lessening the risk of anxiety and depression.

Exercise and Anxiety: Anti-Anxiety Workouts

Any exercise can help diminish anxiety, but Connolly says aerobic exercise that really gets your heart rate up will be the most beneficial. Some good aerobic exercises that can help manage anxiety are:

  • Swimming
  • Biking
  • Running
  • Brisk walking
  • Tennis
  • Dancing

“Dancing is a great exercise, and it has a lot of other side benefits. And it’s great when you dance with other people,” notes Connolly, since socializing can also boost your mood.

Though not aerobic, yoga can help offset anxiety symptoms. Yoga combines physical movement with meditation and deep breathing to help calm the mind and alleviate worry.

While weight training and other strengthening exercises are important for your overall health, they don’t seem to offer as much anxiety relief as activities that get your heart rate going.

We all know that exercise is good for the body, and now research shows that it’s also good for the mind. In addition to managing your anxiety with a doctor’s help, exercise is a powerful tool you can use to enhance your physical and mental health.

“My heart starts to race, I can’t breathe, I get all sweaty, and I feel very scared – like I am about to die.”
This is how one of my patients recently described her panic attacks. Her diagnosis is panic disorder. The cause of this condition is still not understood, but we have long known that the vulnerability to panic disorder is strongly genetic. Now, a recent study from the laboratory of John Wemmie at the University of Iowa may have revealed an important new clue to the underlying cause of recurring panic attacks: It may, in effect, be a problem of pH — of acidity at key junctures in the brain.
The amygdala, an almond-shaped structure deep in the brain, has a critical role in the circuits that control the experience of fear, both instinctive fear (like being afraid of snakes or large carnivores) and fear that is learned from life experiences. The Iowa study shows that a very basic metabolic factor, pH — acidity — also has an essential role in fear.
In general, the pH of our brain is carefully regulated. A large increase or decrease in brain acidity can seriously disrupt brain functioning. This new study indicates that pH can sometimes rise and fall in synapses, the points of communication between individual neurons in the brain. Some synapses include specialized proteins that “sense” acidity. These proteins (called “‘acid-sensing ion channels”, or ASICs) stimulate neurons when increased acid is detected.
The Iowa study shows that genetically modified mice lacking these acid-sensing proteins have a greatly reduced capacity to show either instinctive or learned fear. When the researchers restored the ASIC gene only in the amygdala of these genetically modified mice, they observed a normalization of fear behaviors. So their studies suggest that the ability to detect changes in synaptic pH in the amygdala is essential for normal fear behavior.
The Iowa paper also examined another element in the panic equation: Carbon dioxide. Carbon dioxide acts like an acid in the body and the brain. Several of the experiments described in the Iowa paper showed that inhaling elevated concentrations of carbon dioxide triggered strong fear reactions in normal mice, and that some of these fear reactions required the presence of the acid-sensing protein in the amygdala.
These experiments are especially relevant to understanding panic disorder. One of the most consistent findings in patients with panic disorder is that they are unusually sensitive to carbon dioxide inhalation and other laboratory procedures that increase brain acidity. Most patients with panic disorder will experience a panic attack when they inhale air containing 35% carbon dioxide, while most healthy volunteers will not.
Interestingly, the close relatives of panic patients will also panic during carbon dioxide inhalation, even if they have never suffered from an anxiety disorder. A hypersensitivity to acid in the brain appears to be part of the inherited vulnerability to panic attacks. The recent studies in mice lacking the ASIC protein add further credence to this understanding of why some people are more prone to having panic attacks.
The Iowa findings might help explain the significance of another curious observation: patients with panic disorder tend to generate excess lactic acid in their brains. Scientists have long hypothesized that an abnormality affecting basic cellular metabolism or pH lay at the heart of the genetic vulnerability to panic disorder. One of the products of glucose metabolism is lactic acid, or lactate. Lactate is constantly being produced and consumed during brain activity, but if it accumulates in the brain, it will make the brain more acidic. Recent studies have shown that patients with panic disorder consistently build up excess lactate in their brains during ordinary mental activities. The results of the Iowa studies suggest that one of the triggers for “spontaneous” panic attacks in patients with panic disorder might be lactic acid accumulating in acid-sensitive fear circuits.
Although there are several effective treatments available for people with panic disorder, current treatments do not work for all patients. It is unlikely that any of the current treatments specifically act on the underlying genetic vulnerability in panic disorder patients. The new studies show that brain pH changes are a crucial part of the mechanism of many fear behaviors. At present, no available medications affect the responses of acid-sensing ion channels in the brain. It may be possible to develop medications that inhibit these ASICs or otherwise modify the metabolic or neurochemical pathways involved in the regulation of fear and anxiety by brain acidity.
For example, one of the many beneficial effects of aerobic exercise training (like running or cycling) is that metabolically active tissues (including the brain) become more efficient at consuming — removing — lactic acid. There is growing evidence that exercise training has powerful anti-anxiety and anti-panic effects. This invites the speculation that exercise training may reduce anxiety in part by improving the brain’s ability to prevent excess acid accumulation in acid-sensitive brain regions involved in fear. If experiments support this idea, then specific exercise training regimens could be designed to take maximum advantage of this anti-anxiety mechanism.

This is just one example of what are sure to be many new ideas about treatment to arise from our growing understanding of the fundamental role of brain pH in fear. Already, even with those treatments still only on the horizon, people with panic disorder, like my patient, may find some comfort in the mounting evidence that what they experience is not just “in their head” — it is in their acid-sensing ion channels.

How Lactic Acid Causes Anxiety

Lactic acid has always had a bad rap in the exercise world, and now there are numerous studies stating how lactic acid causes anxiety .

Many people sized up lactic acid as pain in your muscles after an intense workout when actually lactic acid was created by other habits we were doing while we were working out. It is similar to things we do when we are anxious which makes someone much more likely to have a full blown panic attack. When lactic acid levels are high in someone who is anxious, the chances of a panic attack are well, high.

What exactly causes lactic acid, and is there a way to stop it from happening?

The answer is YES, and here are the three key steps how!

The Top 3 Ways Lactic Acid Causes Anxiety :

  • Hyperventilation: Slowing down our breathing patterns is very underrated. Sure it makes sense when we are in the middle of a panic attack, but what about before, the pregame. This is the most crucial time to set yourself up for success. Slowing down your breathe and engaging in 4×4 breathing patterns. Breathe in for 4 seconds, hold for 4 seconds, and breathe out for 4 seconds. Slow and in control, making this a regular ritual in your daily life is going to set you up for panic free days ahead.
  • B Vitamins: When our bodies are lacking in B Vitamins we will have an excess of lactic acid in our bodies. B Vitamins are water soluble so they come into our system quickly, and in turn leave quickly. It is crucial to keep optimal levels. When we are plagued with anxiety and stress we are using up our B vitamins at an even faster rate.
  • Blood Sugar Levels: Stabilizing our blood sugar is crucial during and after anxiety recovery. Having a high quality protein rich snack on hand between meals is the best way to set yourself up for success. It doesn’t have to be a lot. Just something to keep your blood sugar from dipping because it causes worse things than just hanger.

Shocking isn’t it?

When we focus on these 3 steps during anxiety, the recovery rate is high compared to those who decide to deal with a panic attack once it has already happened.

Write this list down and have it on your fridge, your desk at work, or your bed side table and put it into action! Set yourself up for success in the days ahead, Love to all.

Picture it: You’ve had a bad day, perhaps with panic attacks and overwhelming anxious dread, and the last thing you want to do is exercise after work. But if you force yourself to just get there, is that a potentially harmful situation? Or will the catharsis of a good sweat sesh make everything better?

It depends.

The relationship between working out and minimizing or even preventing feelings of depression and anxiety is one that’s been studied with impressive frequency. But in some situations, especially in regards to the latter, it’s possible that exercise can make anxiety worse and exacerbate your mental state.

Certain types of workouts can worsen how you’re feeling, says Kevin Gilliland, MD, CEO and executive director of Innovation 360, a team of therapists and health pros based in Dallas, Texas that specialize in mental health, addiction, and relationship counseling.

One example he gives is a group class, especially if you struggle with any sort of social anxiety. “Being stuck in a class and not comfortable leaving,” says Dr. Gilliland, can cause anxiety to increase and will take away from the physiological benefits of being active. When you’re working out alone, it’s much easier to call it a day. But when you’re doing downward dog, wedged in between people in a packed class, trying to figure out how to make your escape can add to your sense of dread, and potentially cause an internal panic.

Dr. Gilliland says people with anxiety issues should also be wary of intense cardiovascular exercise.

Dr. Gilliland says people with anxiety issues should also be wary of intense cardiovascular exercise. The physical symptoms that often accompany this type of workout—shortness of breath, light headedness, dry mouth—are similar to what you experience when you’re having a panic attack. The familiarity of the sensations and feelings might work as a trigger and cause you to have or think you’re having a panic attack.

That’s not to say you can never take another spin class or that having a fitfam won’t be in your future. It just means that if you’re prone to anxiety, it’s important to be mindful about your form of exercise depending on your mood. Overall Dr. Gilliland says moderate exercise is a positive thing for most people. But if you’re feeling really anxious, perhaps something simple, like a mindful walk or a quick grounding session, is the better bet.

Confused about whether you’re stressed or anxious? Here’s how to tell the difference. And if you struggle with social anxiety, here are tips on how to overcome it.

Exercise and Anxiety (guest blog)

Exercising when you have anxiety can be quite a challenge but it’s a great way to relieve stress and keep your mind as well as your body healthy. Jane has collated her best tips for Anxiety UK on how to keep your body active and healthy and in turn manage your anxiety.

Understand What Exercise Does To Your Body

When you exercise, you boost your blood circulation, heart rate, and breathing rate. These are normal symptoms that are actually good for you. For instance, an increased heart rate during exercise is good because when your heart beats faster, it’s sending more blood to the muscles that require it during exercise. Sweating, another anxiety symptom, is your body’s release of toxins during exercise. When you understand that these symptoms are happening for good reasons that can benefit your health, you can prevent yourself from giving them negative connotations associated with a panic attack.

Find A Distraction

If you concentrate on how anxious you feel, you’ll increase the horrible sensation. Often, anxiety attacks last longer than they should because we’re too focused on them. Exercise can therefore be a good distraction to the feeling of anxiety.

It also helps to do exercise outside, where there are things to see to further create distraction, such as beautiful flowers or trees. Listening to music can be a good distraction as popping in earphones will prevent you from hearing your beating heart.

Finally, make use of exercise equipment during your workout. This gives your mind something useful to focus on instead of the anxiety you feel, which will reduce your negative feelings. For instance, power towers help you create customised workouts that build your strength, while helping you concentrate on the exercise you’re doing.

Pace Yourself

If you were resting on your bed and then decided to do some running, the sudden change in activity will cause your heart rate to change dramatically really quickly – this can make you feel anxious. Thus, it’s better to start slowly and warm up before exercising so that you get used to the sensations. It’s also good to concentrate on exercises that don’t raise your heart rate too much, as these will give you a healthy workout without the stress or fear of having a panic attack. For instance, walking is a gentle exercise, especially if you’re not fit. As you get used to it, you can increase your speed.

Stick With The Exercise For A While

It can be tempting to stop your exercise routine when you start to notice your faster heartbeat and fear you’re having a panic attack. But research into anxiety and exercise has found that people in exercise groups showed a significant decrease in their anxiety. Regular exercise can help to decrease anxiety within a few days or weeks, while a short bout of exercise can put you in a more positive mood instantly thanks to the endorphins. This is great for tackling negative thoughts that commonly present with an anxiety attack.

A good tip is to continue exercising even when you feel anxious as the anxiety will usually pass. During this time, it can be helpful to remind yourself that your body’s doing what is normal during exercise, and it cannot harm you.

Feeling anxious during exercise can be a terrifying experience, but it doesn’t mean you should avoid exercise forever. Exercise can be beneficial to decreasing your anxiety levels, while helping to distract you during a panic attack.

Jane is a freelance writer and content editor, working across a wide variety of fields. Her main interest is exploring how people can improve their health and well being in their everyday life. And when she isn’t writing, Jane can often be found with her nose in a good book, at the gym or just spending quality time with her family.

The views expressed by the contributor are not necessarily those of Anxiety UK, nor can we guarantee the accuracy of the information provided. If you would like to write a blog for AUK please email [email protected] for more information

Image: iStock.

Earlier this year, Lena Dunham struck a chord when she spoke about the positive impact exercise had on her mental health.

“To those struggling with anxiety, OCD, depression: I know it’s mad annoying when people tell you to exercise, and it took me about 16 medicated years to listen … it has helped with my anxiety in ways I never dreamed possible,” the author wrote on Instagram.

RELATED: The first thing you should do if you’re depressed or anxious.

Dunham’s not alone here; research has established the value of regular physical activity for people living with mental illnesses.

Lena Dunham says exercise has helped her manage anxiety. (Image: Instagram)

People who exercise have been found to experience less depression and anxiety symptoms than those who don’t, while a study earlier this year found a link between a sedentary lifestyle and an increased risk of anxiety. Physical activity can improve sleep, increase energy levels, elevate mood and balance mood swings, decrease stress, and distract from worrying thoughts.

For some people, however, exercise can actually be a source of anxiety because its physiological processes — increased heart rate, spike in adrenalin, quicker breathing, sweating — can be disconcertingly similar to those of a panic attack.

RELATED: Emma Stone explains how she manages her panic attacks.

Blogger Summer Beretsky, who lives with anxiety, feels these affects so acutely she’s come to actually fear exercise.

“The rapid heart rate reminds me of my worst ohmygod-I-swear-this-is-a-heart-attack breed of panic attacks. I am always afraid that the quick breathing will make me pass out — even though I know the extra oxygen I’m inhaling is 100 per cent necessary, normal, and natural,” Beretsky writes on PsychCentral. (Post continues after gallery.)

AdeleAdele told The Rolling Stone in 2011 “I’m scared of audiences… I get shitty scared. One show in Amsterdam, I was so nervous I escaped out the fire exit. I’ve thrown up a couple of times. Once in Brussels, I projectile-vomited on someone. I just gotta bear it. But I don’t like touring. I have anxiety attacks a lot.” Kate Moss Oprah Winfrey Barbra Streisand Emma StoneEmma Stone has had a long history of panic attacks, and told USA Today “I just started meditating in January… It’s changing my life completely. I’m pretty into it. Once or twice a day, I meditate. That has been the best thing for my mind.” Kristen Stewart Selena GomezSelena Gomez sought help in January 2014 for her severe anxiety, telling fans in a statement: It has become clear to me and those close to me that after many years putting my work first, I need to spend some time on myself in order to be the best person I can be.” Kim BasingerHollywood Actress, Kim Basinger, has had a history of social anxiety, agoraphobia and panic disorder. Basinger has been open about her mental health issues, and in an interview with Charlie Rose stated: “Fear has been something I’ve lived with my entire life, the fear of being in public places – which led to anxiety or panic attacks… I stayed in my house and literally cried every day.” Olivia MunnActress Olivia Munn has been very public about her battle with anxiety, revealing to Marie Claire in 2013 that she is “trying to overcome my social anxiety. Its manifested in trichotillomania, a disorder that gives me the urge to pull out my eyelashes.”

Although anecdotally this phenomenon isn’t unheard of, research into it is fairly sparse. However, a 2010 study in the journal Hippocampus examined the effect of exercise on the emotional behaviour of adult mice, and found the mice exhibited some signs of stress and anxiety-like behaviours.

Joe Bonington, strength and conditioning trainer and founder of Sydney adventure gym Joe’s Basecamp, has witnessed this reaction in people who are predisposed to anxiety.

RELATED: “How I learned to deal with anxiety at work.”

One of his clients who took up running found her breathing would get “all over the place”, which in turn would make her anxious and prompt an attack. Another has an extreme fear of lifting objects above her head, including weights. Bonington says even a workout with a highly competitive atmosphere, like Crossfit, can be triggering for someone who has anxiety.

Yes, Workout-Induced Panic Attacks Are a Real Thing

There’s nothing more exhilarating than a good run when that boost of endorphins makes you feel like you’re on top of the world.

However, for some people, that workout high can feel dangerously high. Instead of a rush of wellbeing, feelings of intense anxiety can follow a strenuous workout, causing disorientating symptoms such as heart palpitations, dizziness, and an overwhelming sense of dread.

Yep, it’s a panic attack, and it can be completely debilitating, says Eva Ritvo, M.D., a Miami-based psychiatrist—so much so that people will even confuse these paralyzing symptoms with those of a heart attack.

Does this sound mildly familiar? Read on for more insight into why workout-induced panic attacks can happen, what they feel like, and what to do if you think you’re at risk.

Panic Attacks: The Basics

To understand how workout-induced panic attacks happen, it’s helpful to paint a picture of what happens in your body during a regular panic attack.

“A panic attack is a state of extreme arousal that doesn’t match the situation, and usually feels very unpleasant,” says Dr. Ritvo.

Panic attacks start inside part of the brain called the amygdala, which is referred to as the “fear center” and plays a critical role in your response to threatening situations, according to Ashwini Nadkarni, M.D., an associate psychiatrist at Harvard Medical School. “Any time you’re faced with some sort of fear-inducing stimulus, your brain will take the sensory information from that threat stimulus (for instance, could be visual, tactile, or in the case of exercise, bodily sensations) and convey it to the amygdala,” she says.

Once the amygdala is ignited, it sets off a cascade of events inside the body, says Dr. Nadkarni. This often activates the sympathetic nervous system (which induces the body’s fight or flight response) and triggers the release of large amounts of adrenaline. This, in turn, often produces the telltale symptoms of a panic attack: palpitations, pounding or accelerated heart rate, sweating, trembling or shaking, shortness of breath, chest pain, and more.

What Causes Exercise-Induced Panic Attacks?

There are a few different factors at play when you’re having an exercise-enduced panic attack vs. a regular panic attack.

For starters, an excess of lactic acid can be one of the major reasons behind an attack, says Dr. Ritvo. ICYDK, lactic acid is a compound your body creates during intense workouts. You might think of it as the reason behind your sore muscles, but that build-up of lactic acid affects your brain as well. Some people have more difficulty clearing lactic acid from their brain than others, says Dr. Ritvo. As this acid builds up, it can cause the amygdala to over-fire, ultimately leading to a panic attack.

“When you breathe really fast or hyperventilate, it causes changes in your levels of carbon dioxide and oxygen in your blood,” explains Dr. Nadkarni. “This, in turn, causes brain blood vessels to narrow and lactic acid build up in the brain. The amygdala’s sensitivity to this acidity (or ‘over-firing’) is part of what makes certain people more vulnerable to panic.”

Image zoom laflor/Getty Images

Also, elevated heart rate and breathing rate (which are both synonymous with exercise) both cause a release of cortisol, the body’s stress hormone, says Dr. Ritvo. For some people, it dials-in your workout performance; for others, that cortisol can lead to increased perspiration and limited focus, which can ignite feelings of hyperarousal and panic.

Dr. Nadkarni breaks it down:

“Among the symptoms of panic attacks are shallow breathing, a racing heart, sweating palms and the feeling that you’re having an out-of-body experience—and it also happens to be the case that when you exercise, your heart rate goes up, you breathe faster, and you sweat.

This, of course, is perfectly normal. But if you have anxiety or, on one random occasion, pay closer attention or too much attention to your body’s level of arousal, you might misinterpret your body’s normal reaction to exercise, and a panic attack can result. If you then experience fear of feeling this way again, the dread of future panic attacks is what comes together to define a panic disorder.”

– Ashwini Nadkarni, M.D.

Who’s at risk for exercise-induced panic attacks? It’s not likely for just anyone to panic in spin class; people who have an underlying anxiety or panic disorder (whether diagnosed or otherwise) are more prone to have a workout-induced panic attack, says Dr. Nadkarni. “Studies show that people with panic disorder are genetically more sensitive to inhaling carbon dioxide, which increases brain acidity,” she says. “Lactate is always produced and cleared in the brain —even if you’re not diagnosed with any sort of mood disorder—but a genetic tendency to generate it and accumulate it can increase both someone’s tendency to experience panic attacks in general and risk for panic attacks during workouts.”

Are Some Exercises More Triggering Than Others?

While a run or Zumba class may be stress-relieving for some people, aerobic exercises like these can often induce panic attacks in patients with panic disorder, says Dr. Nadkarni.

Aerobic (or cardio) exercise, by nature, uses a lot of oxygen. (The word “aerobic” itself means “requiring oxygen.”) Your body is forced to circulate blood faster in order to get oxygen to your muscles, which elevates your heart rate and mandates that you to take faster and deeper breaths. Because these two things increase cortisol in the body and trigger hyperarousal, aerobic exercise can be more likely to cause a panic attack than, say, a slow weight lifitng session or barre class, which don’t elevate your heart and breathing rate as much.

It’s worth noting, though, that the exercise itself isn’t to blame; it’s all about how your body is responding to the exercise.

“A certain heart rate is not what triggers panic, but rather, how a person interprets their normal bodily function during exercise.”

– Dr. Nadkarni

And, over time, engaging in regular cardio exercise can actually help. New research looked at the effects of aerobic exercise on anxiety symptoms in patients with panic disorder (PD), and found that aerobic exercise does cause an acute increase in anxiety—but that the gradual practice of aerobic exercises promotes a reduction in overall anxiety levels, according to a recent study published by the journal Clinical Practice & Epidemiology in Mental Health. Why? It comes back to that lactic acid build-up: “It’s hypothesized that exercise can reduce anxiety by improving the brain’s ability to prevent lactic acid accumulation,” says Dr. Nadkarni.

So if you properly ease your way into cardio exercise and do it regularly, it can help reduce overall anxiety (in addition to improving cardiovascular health and reducing symptoms of depression in some participants, according to the study). (Proof: How One Woman Used Fitness to Overcome Her Anxiety Disorder)

What to Do If You’re Working Out and Have a Panic Attack

If you’re having a panic attack while exercising, there a few things you can do to help calm yourself down, according to Dr. Ritvo:

  • Stop exercising and see if you can slow your heart rate down.
  • Try deep breathing exercises .
  • If you’re working out inside, get some fresh air (if possible).
  • Take a warm shower or bath, if you have one accessible.
  • Talking to or phoning a friend often relieves anxiety.
  • It may feel good to stretch or lay down until the anxiety decreases.

Try these two breathing exercises recommended by Dr. Ritvo to reduce anxiety:

4-7-8 breathing method: Inhale slowly for four counts, hold for seven counts, then exhale for eight counts.

Box breathing technique: Inhale for four counts, hold for four counts, exhale for four counts, then pause for four counts before inhaling again.

If you spiraled out of control during a recent workout, your best bet is (you guessed it!) to see your doctor. Dr. Ritvo advises talking with your physician about booking an appointment with a psychiatrist since these trained professionals can prescribe medications to help those suffering from debilitating anxietyor help you find ways to manage it. (P.S. Did you know there are tons of therapy apps now?)

How to Prevent Workout-Induced Panic Attacks

When you want to get back into the swing of things workout-wise, it’s helpful to get to know how much exercise your body can tolerate so you don’t trigger panic attacks, says Dr. Ritvo.

Workouts like Pilates or yoga can be really beneficial since they combine breath with movement and helps you focus on taking long, slow breaths. It also allows for moments of relaxation between active poses, which ultimately allows your heart and respiratory rates to slow down. (Related: The Case for Calmer, Less Intense Workouts)

But since exercising your heart is important, you can’t skip cardio forever. Dr. Ritvo suggests working your way back up to more aerobic exercises. Brisk walking is a great place to start, as you can easily slow down or stop if you feel your heart is racing too fast, she says. (Try this walking workout with a few butt exercises thrown in.)

Long term, engaging in certain practices (like stretching and doing breathing exercises) regularly can help keep panic at bay. “Panic attacks are overfilling of the sympathetic nervous system,” says Dr. Ritvo. “Anything you can do to strengthen the opposite side of your nervous system may be helpful in preventing future panic attacks.”

“Panic attacks are overfilling of the sympathetic nervous system. Anything you can do to strengthen the opposite side of your nervous system may be helpful in preventing future panic attacks.”

– Eva Ritvo, M.D.

Taking care of someone else, feeling connected to others, relaxing over a bite to eat, resting (which can be getting proper sleep each night, taking a nap, getting a massage, taking a warm bath or shower, etc.), taking a few slow deep breaths, meditating, and listening to a relaxation tape or soft music are all activites that help stimulate the parasympathetic side of the nervous system, says Dr. Ritvo.

“Do these things regularly so your nervous system comes back to a healthier balance,” she says. “Many of us are overstimulated and live in a constant state of anxiety. This makes us more prone to a panic attack from whatever our unique trigger may be.”

  • By Courtney Leiva

Exercise for Stress and Anxiety

The physical benefits of exercise — improving physical condition and fighting disease — have long been established, and physicians always encourage staying physically active.

Exercise is also considered vital for maintaining mental fitness, and it can reduce stress. Studies show that it is very effective at reducing fatigue, improving alertness and concentration, and at enhancing overall cognitive function. This can be especially helpful when stress has depleted your energy or ability to concentrate.

When stress affects the brain, with its many nerve connections, the rest of the body feels the impact as well. Or, if your body feels better, so does your mind. Exercise and other physical activity produce endorphins — chemicals in the brain that act as natural painkillers — and also improve the ability to sleep, which in turn reduces stress.

Scientists have found that regular participation in aerobic exercise has been shown to decrease overall levels of tension, elevate and stabilize mood, improve sleep, and improve self-esteem. About five minutes of aerobic exercise can begin to stimulate anti-anxiety effects.

Relationship of Exercise to Anxiety Disorders

Stress and anxiety are a normal part of life, but anxiety disorders, which affect 40 million adults, are the most common psychiatric illnesses in the U.S. The benefits of exercise may well extend beyond stress relief to improving anxiety and related disorders.

Psychologists studying how exercise relieves anxiety and depression suggest that a 10-minute walk may be just as good as a 45-minute workout. Some studies show that exercise can work quickly to elevate depressed mood in many people. Although the effects may be temporary, they demonstrate that a brisk walk or other simple activity can deliver several hours of relief, similar to taking an aspirin for a headache.

Science has also provided some evidence that physically active people have lower rates of anxiety and depression than sedentary people. Exercise may improve mental health by helping the brain cope better with stress. In one study, researchers found that those who got regular vigorous exercise were 25 percent less likely to develop depression or an anxiety disorder over the next five years.

Exercise as Part of Therapy

According to some studies, regular exercise works as well as medication for some people to reduce symptoms of anxiety and depression, and the effects can be long lasting. One vigorous exercise session can help alleviate symptoms for hours, and a regular schedule may significantly reduce them over time.

Although exercise has a positive effect for most people, some recent studies show that for some, exercise may not have a positive effect on anxiety or depression or may not make a strong impact on long-term mental health.

Like all forms of therapy, the effect can vary: Some people may respond positively, others may find it doesn’t improve their mood much, and some may experience only a modest short-term benefit. Nonetheless, researchers say that the beneficial effects of exercise on physical health are not in dispute, and people should be encouraged to stay physically active.

Read all about it: Exercise for Mood and Anxiety, Proven Strategies for Overcoming Depression and Enhancing Well-Being, by Michael W. Otto, PhD, and Jasper A.J. Smits, PhD (Oxford University Press, 2011)

Fitness Tips: Stay Healthy, Manage Stress

The most recent federal guidelines for adults recommend at least 2½ hours of moderate-intensity physical activity (e.g. brisk walking) each week, 1¼ hours of a vigorous-intensity activity (such as jogging or swimming laps), or a combination of the two.

If you have an exercise program already, keep up the good work. If not, here are tips to get you started.

  • 5 X 30: Jog, walk, bike, or dance three to five times a week for 30 minutes.
  • Set small daily goals and aim for daily consistency rather than perfect workouts. It’s better to walk every day for 15-20 minutes than to wait until the weekend for a three-hour fitness marathon. Lots of scientific data suggests that frequency is most important.
  • Find forms of exercise that are fun or enjoyable. Extroverted people often like classes and group activities. People who are more introverted often prefer solo pursuits.
  • Distract yourself with an iPod or other portable media player to download audiobooks, podcasts, or music. Many people find it’s more fun to exercise while listening to something they enjoy.
  • Recruit an “exercise buddy.” It’s often easier to stick to your exercise routine when you have to stay committed to a friend, partner, or colleague.
  • Be patient when you start a new exercise program. Most sedentary people require about four to eight weeks to feel coordinated and sufficiently in shape so that exercise feels easier.

Cold Weather Exercise

Learn more about exercising in cold weather.

  • Dress in layers. Exercise in layers that you can remove as you start to sweat and put back on as needed.
  • Protect your hands, feet, and ears. Make sure your extremities aren warm and wear gloves, socks, and headbands to prevent frostbite.
  • Pay attention to weather conditions and wind chill. Rain and wind can make you even more vulnerable to the effects of the cold. If the temperature is below zero degrees and the wind chill is extreme, consider taking a break or finding an indoor activity.
  • Choose appropriate gear. It gets dark earlier in the winter, so be sure to wear reflective clothing. Wear shoes with enough traction to prevent falls in snow or ice.
  • Remember sunscreen. It’s just as easy to get burned in the winter as in summer, so don’t forget the SPF.
  • Head into the wind. Plan your route so the wind is at your back toward the end of your workout to prevent getting a chill after working up a sweat.
  • Drink plenty of fluids. It can be harder to notice the symptoms of dehydration in cold weather, so drink fluids before, during, and after a workout, even if you’re not thirsty.
  • Know the signs of frostbite and hypothermia. Know the signs and get help immediately to prevent frostbite and hypothermia.

Learn more about anxiety at BetterHelp.com.

6 Reasons Anxious People Sometimes Avoid Exercising

Source: Unsplash

Most people know that exercise is extremely beneficial for anxiety and depression, but here’s a conundrum that no one talks about: Exercise can also be quite triggering for people with anxiety.

It’s important to acknowledge this and discuss some ways to work through anxiety that’s triggered by exercise. I’ll break down the problems first and then address solutions at the end of the article.

Ways Exercise Can Trigger Anxiety

1. Sensations of exertion are similar to anxiety.

People who are anxious often don’t like feeling a raised heart rate, sweating, and other physical sensations that are similar to anxiety. This varies a lot by person. For example, my spouse who has a history of panic attacks doesn’t mind jogging and uses it for stress relief, but some anxious people fear that exercise could trigger a panic attack.

2. More generally, any out of the ordinary physical sensations unsettle people with anxiety.

People who are anxious tend to be hypervigilant to any change in their physical sensations. They often mentally check-in on how they’re feeling physically as a way of assessing “Am I safe? Am I ok.”

Personally, after I’ve exercised, I often find myself feeling very distracted by the normal types of sensations you get from using parts of your body in new/different ways. I don’t think these sensations indicate anything is wrong but, especially after strength training, all day I find myself being aware of non-typical sensations in my body and it’s distracting and fatiguing. If you’re a Highly Sensitive Person, you may be particularly prone to feeling distracted by physical sensations.

3. You fear pain or injuries.

Here’s another personal example: When I was a college student I had years of problems with pain from writing and typing. As soon as I wasn’t a student anymore these issues almost completely disappeared, to my great relief! However, sometimes when I exercise I get some twinges of similar pain (e.g., golfer’s elbow) and I get very anxious that my prior issues are going to set in again. I know pain means i need to try an exercise in a different way and improve my form, but I feel nervous to try that in case it doesn’t work and it kicks off a pain cycle I can’t stop.

4. Social anxiety gets in the way of exercising.

The most obvious example of social anxiety impacting exercise is fear of what you look like while exercising. People with social anxiety often have specific fears about appearing flushed or sweaty, or smelling. However, there are also much subtler versions of social anxiety that impact exercising.

Last week at the gym, I wanted to use the pull-up machine. It was available but someone else was using the machine next to it. I instantly created an anxiety-based mental rule – “Don’t use the machine if anyone is using the one next door. It’s awkward to be that close to someone else exerting themselves.” The irony was that I waited for both machines to be free and as soon as I got on the pull-up machine, someone came and started using the machine next door, so I ended up exercising next to someone anyway.

Here’s another time I noticed anxiety-related thinking getting in the way of exercising. My gym has staff available if you want to ask for advice about using the machines. It’s their job to do this. Yet, it took me months to pluck up the courage to ask for a few demos and for them to check my form. For some reason, I didn’t feel entitled to their time even though I’m a paying member like everyone else.

5. Stupid comments stick with you.

Anxious people tend to be prone to rumination. Therefore if anyone has made a comment to you that has put you off exercising, you’re probably still thinking about it. I remember a trainer made a comment to me along the lines of “If you just do that, it probably won’t do anything.” Even though I disagreed, the comment still lingered with me and deflated my enthusiasm for doing it at all.

6. Other idiosyncratic fears and anxieties.

Being prone to anxiety means your brain will come up with anything and everything to feel anxious about. For instance, exercising makes me feel relaxed, tired, and hungry. The problem is that I get too relaxed and when I get home after the gym I want to sit around eating and not work. So, I end up worrying that exercising is going to make me more hungry than what I burn off, and will result in not getting enough work done! Another thing I fear is getting sick from other people’s germs, even though I clean the equipment with the provided disinfectant wipes before I start.

Try paying attention to any random anxiety-thoughts about exercising that your brain comes up with! You can then say to yourself “Oh, that’s just my anxiety-brain again.”

Solutions to Get Yourself Exercising In Spite of Anxiety

Even if exercise triggers some anxiety for you, it’s highly likely it’ll be a net positive and may have a massively beneficial impact on your anxiety. Try the following strategies to minimize anxiety triggered by exercise.

  • Exercise in whatever way you like. You don’t have to do the classic gym program of weights and cardio. The goal is just to be active. Some days I go to the gym and jog, but other days I go and walk at 3 miles an hour and watch YouTube or read Slack on my phone! Some days I borrow a basketball from the front desk and go shoot baskets, do the rock climbing wall, or just use the machines. Increasingly, activity guidelines recognize the value of any physical activity. This is a great goal.
  • If you’re going to join a gym, consider a more community-orientated one. The gym I go to is has a huge age range of (mostly middle-aged and older) people working out. It’s usually very uncrowded and virtually no one there looks like your typical gym bunny. This sort of atmosphere can help cut down on social comparison and help you focus on the goal of being active rather than changing your appearance.
  • Pay attention to what sort of exercise leaves you feeling good, and make changes as needed to accommodate injuries and niggles. Try exercises that work big muscle groups and experiment with what helps you feel most relaxed. For instance, I like just hanging (from bars) as a way to stretch out my body.
  • Ask for advice from staff and trainers, but remember you don’t have to take it. You can design whatever workout works for you.

Panic attack after exercise

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