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Overview of Anxiety Disorders

These disorders are emotional states of apprehension and fear that create physiologic arousal responses mediated through the sympathetic system. These disorders include adjustment disorders, post-traumatic stress disorder, obsessive-compulsive disorders, and general anxiety disorder. Individuals with these disorders can exhibit numerous abnormal signs and symptoms that are also associated with physical activities. Clients with these conditions typically avoid exercise activities, as normal responses to exercise can be interpreted as an increase in their state of anxiety.1 Clients with anxiety disorders benefit from behavioral therapies, medications, and exercise programs to manage their anxiety levels.1,2

Concurrent Symptoms That May Occur With Anxiety Disorders

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Increase respiration rate Elevated heart rate
Elevated blood pressure Increased muscle tension
Sweating Irritability
Hyperalertness Dizziness

Comorbidities to Consider

  • Clients with heart disease and pulmonary conditions may have significant deconditioning that limits their daily activities.

Client Examination

Keys to Examination of Clients

  • Screen your clients for heart disease and any physical limitations before they begin an exercise program.

  • Perform testing and the beginning of an exercise program in a controlled environment to limit the effects on their level of anxiety.

  • Discuss with your clients the benefit of exercise for controlling their levels of anxiety and their readiness to begin an exercise program.

Recommended Baseline Testing of Fitness Levels

  • Assess aerobic capacity with activities with which the client is familiar, such as walking, treadmill walking, or cycle ergometry testing.

  • Vital signs need to be assessed before and during exercise to ensure that changes are due to normal physiologic responses.

  • Clients should be screened for their overall mobility and if any comorbidities will limit their exercise activities.

Exercise Prescription


Type: Walking, biking, running, weight lifting

Intensity: Moderate, progressing to high levels, 70%-90% of maximum heart rate3,4,5,6

Duration: At least 20 minutes per day

Frequency: 5–7 days per week

Getting Started

Clients with anxiety disorders benefit the most from higher intensity exercise performed 5 to 7 days per week for 30 to 60 minutes.3,5 Add resistance training into the exercise program using parameters that promote aerobic capacity, and maintain a regular exercise program. Encourage these clients to adopt a variety of activities that promote aerobic fitness to maintain their fitness levels and to manage their anxiety levels. Clients who successfully manage their anxiety disorders may be encouraged to participate in competitive endurance events. Anticipate that clients may need to participate in regular aerobic activities for up to 10 weeks before experiencing significant reduction in their anxiety ...

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