Affective disorders, also known as mood disorders, are clinical psychological disorders. The most common affective disorders are major depressive disorder, dysthymic disorder, bipolar disorder, and cyclothymic disorder. A core feature of these disorders is dysfunction in emotion processing and neurohormonal regulation leading to subjective feelings of sadness, depressed mood, and loss of pleasure in things normally pleasurable (anhedonia) for 2 weeks or more. These symptoms must also subjectively impair the fulfillment of social or occupational responsibilities. Additional possible symptoms include cycling episodes of mania in bipolar disorder; insomnia or hypersomnia; feelings of worthlessness, guilt, suicidal thoughts; and psychomotor agitation (restlessness, pacing) or psychomotor retardation (fatigue, tiredness). Affective disorders often co-occur with anxiety disorders, such as panic disorder, generalized anxiety disorder, posttraumatic stress disorder, and social phobia. Women are at greater risk than men for the development of both affective and anxiety disorders.
Diagnosis of an affective disorder, mood disorder, or anxiety disorder requires an extensive in-person interview with a licensed clinical psychologist or psychiatrist to establish whether criteria for the diagnosis are met. A score on a self-report survey of depression or anxiety symptoms, even when administered by a licensed clinician, is not sufficient for diagnosis. The primary diagnostic criteria have been set forth by the American Psychiatric Association (APA) in the Diagnostic and Statistical Manual for Mental Disorders, 4th Edition, Text Revision (DSMIV-TR) and by the World Health Organization in the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). Adherence to these diagnostic standards have been difficult in the fields of sport and exercise psychology, as few in the field have the necessary credentials or lack the financial or collegial resources.
Nevertheless, it is critical to understand the effects of leisure-time physical activity and acute and chronic exercise on affective and anxiety disorders. The focus here will be on the use of exercise as a treatment intervention among individuals diagnosed with affective or anxiety disorders. However, it is also important to understand how these disorders may affect physical activity behavior in general. Symptoms of depression are associated with lower levels of physical activity and inhibition of behavioral activation. For example, feelings of hopelessness and fatigue are difficult to overcome, and, as such, these patients experience difficulty in engaging in effortful tasks. In addition, among athletes, there is evidence that a core feature of the staleness syndrome (as a result of overtraining) is depressed mood, and the symptoms of staleness map directly onto the diagnostic criteria for a major depressive episode. Monitoring depressed mood in athletes may be a method to help avoid staleness during an overtraining period.
Major Depressive Disorder
Epidemiological studies consistently indicate that greater levels of physical activity or cardiorespiratory fitness are related to reduced risk for the future development of major depression in both men and women. Engaging in regular physical activity provides protection against symptoms of depression, compared with being sedentary. However, there is not strong evidence for a dose response effect, so greater levels of physical activity are not necessarily more protective. Exercise training has been shown to be an effective treatment for major depression. Both aerobic exercise (walking, jogging) and resistance exercise, compared with a wait list or non-exercise control condition, have been shown to effectively reduce symptoms of depression and result in a remission in symptoms of depression. Walking or jogging exercise interventions, 4 to 6 months in duration (but longer is better), have been shown to be as effective as antidepressant drug therapy and cognitive behavioral therapy compared with a placebo. Exercise is a good treatment option or adjuvant to treatment for major depression; however, adding exercise training to pharmacologic or cognitive behavioral therapy does not produce synergistic effects. The behavioral deactivation and extreme feelings of hopelessness and fatigue present clear challenges to the initiation of and adherence to a physical activity or exercise training program, although one possible advantage of exercise training over pharmacotherapy is that remission of symptoms may persist for a longer time after the exercise and drug treatments have ended.
Although there is increasing interest in using exercise as a treatment in bipolar disorder, and high-functioning bipolar disorder patients report exercise as one of many methods they use to help maintain emotional stability, very little empirical research and no clinical trials for exercise have been conducted in patients with bipolar disorder. One study has shown that markers of cardiovascular disease risk can be improved with exercise in patients diagnosed with bipolar disorder, but it is unknown if exercise can improve the core symptoms of bipolar disorder.
Patients diagnosed with panic disorder tend to be less physically active than their healthy counterparts. This may be due, in part, to feelings of discomfort experienced during exercise. The physiological arousal due to exercise (increased heart rate and respiration) is similar to the core symptoms of a panic attack, and thus may be avoided. Another reason may be due to false beliefs that exercise will cause a panic attack. The evidence, however, clearly indicates that exercise is safe for people diagnosed with panic disorder and exercise, even at maximal capacity, does not cause panic attacks. The very few documented instances of panic attack during exercise can be viewed as chance occurrences relative to the number of documented exercise and physical activity sessions that did not involve a panic attack. Exercise training is known to be a very useful treatment for panic disorder and can be useful as a cognitive restructuring tool (“I can sweat and breathe hard and my heart can beat very fast, and it does not mean I am about to die or that I am going crazy”). Exercise is comparable to pharmacological treatments for reducing clinician rated symptoms of panic disorder. However, the combination of drug treatment with exercise training does not produce a synergistic effect.
Generalized Anxiety Disorder
There is epidemiological evidence that greater levels of physical activity or cardiorespiratory fitness are related to reduced risk for the future development of anxiety disorders. However, very few studies have tested the effects of exercise as a treatment for generalized anxiety disorder (GAD). In two clinical trials, both aerobic exercise and resistance exercise resulted in significant symptom reductions compared with a wait-list control condition. Exercise has not currently been compared with drug treatments or other treatment methods. Additionally, the affective experience during or immediately after exercise in GAD patients has not been examined. There is very little information about how a single session of exercise affects symptoms in people clinically diagnosed with affective or anxiety disorders.
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