Short Sprints May Beat Relaxation Therapy for Treating Panic Disorder

Imagine your heart hammering, your breath coming in sharp gasps, sweat prickling across your skin. For most of us, that’s just what happens after a hard run. But for the roughly 2 to 3 per cent of people living with panic disorder, those same sensations can strike without warning, triggering waves of terror that seem to come from nowhere.

Now a team in São Paulo, Brazil, has turned that overlap into a treatment. In a clinical trial of 72 adults with panic disorder, researchers found that brief bursts of intense running, alternated with gentle walking, reduced the severity and frequency of panic attacks more effectively than a standard relaxation technique used in cognitive behavioural therapy. And the benefits held up for at least six months.

The logic, when you think about it, is rather elegant. A well-established component of CBT for panic disorder is something called interoceptive exposure, where a therapist deliberately triggers the bodily sensations people associate with panic (the pounding heart, the breathlessness, the dizziness) in a controlled setting. The idea is to teach the brain that these feelings aren’t dangerous. Traditionally, this has meant things like voluntary hyperventilation or spinning on a chair in a therapist’s office. Effective, perhaps, but not exactly what you’d call fun.

Ricardo William Muotri, a postdoctoral fellow at the Anxiety Disorders Program of the University of São Paulo Medical School, and his colleagues wondered whether exercise could do the same job, only better. Vigorous physical activity produces many of the same physiological responses as a panic attack, but in a context your body recognises as healthy rather than threatening.

To test this, they recruited 102 sedentary adults diagnosed with panic disorder from the emergency room of São Paulo’s Cardiology Institute, people who had turned up with chest pain and racing hearts only to learn the cause was psychiatric, not cardiac. All participants had been free of any medication for at least 12 weeks. They were randomly assigned to one of two groups: brief intermittent intense exercise, or Jacobson’s progressive muscular relaxation training, a credible comparison that matched the exercise group for therapist contact and session time but didn’t involve exposure to feared bodily sensations.

The exercise protocol was surprisingly modest. Sessions began with stretching and a 15-minute walk, then came short, sharp 30-second sprints interspersed with 4.5 minutes of walking. In the first fortnight, participants did just one sprint per session. By the end of the 12-week programme, they were doing six. The relaxation group, meanwhile, worked through a systematic routine of tensing and releasing nine muscle groups, from hands to feet, three times a week.

Both groups improved over the course of the trial, which isn’t surprising given that even placebo treatments (and both groups received identical placebo pills) tend to shift the needle somewhat in anxiety disorders. But the trajectories diverged sharply. On the Panic Agoraphobia Scale, a 13-item measure of panic disorder severity, the exercise group’s scores dropped to roughly half those of the relaxation group by week 12, and the gap actually widened slightly at the 24-week follow-up. At that point, the exercisers were averaging fewer than one panic attack per week, compared with about 1.5 in the relaxation group.

Depression scores told a similar story, with the exercise group continuing to improve even after the programme ended while the relaxation group’s gains started to fade.

What’s perhaps most striking is how few people dropped out. Only three of the 72 enrolled participants failed to complete the trial, a retention rate that would make most clinical researchers a bit envious. Muotri and his colleagues suspect this is partly because participants found the exercise inherently rewarding, a far cry from the office-based procedures that some patients experience as artificial and (frankly) tedious.

“Healthcare professionals can adopt brief intermittent intense exercise as a natural and low-cost interoceptive exposure strategy,” says Muotri. “It doesn’t need to take place in a clinical setting, so that exposure to the symptoms of a panic attack is brought closer to the patient’s daily life.”

There are caveats, of course. The trial specifically recruited sedentary people who were naive to exercise stress tests, so it remains unclear whether the approach would work as well for someone who already runs regularly and whose body is habituated to the sensations of exertion. The follow-up was also limited to six months, and panic disorder tends to be a chronic, relapsing condition. Still, the prospect of a treatment that is cheap, requires no specialist equipment, improves physical health as a side benefit and can be supervised by a range of healthcare professionals, not just psychologists, is one worth paying attention to. For people trapped in the cruel paradox of panic disorder, where fear of your own body’s signals keeps you sedentary and sedentariness makes the signals worse, learning to sprint through the fear could be exactly what’s needed.

Study link: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.1739639/full