Gymnastik- och idrottshögskolan, GIH

Background

Is exercise beneficial or detrimental for patients with stress-induced exhaustion disorder (ED)? While previousstudies have shown the benefits of exercise for various mental health conditions, its effects on ED —characterized by persistent fatigue following chronic psychosocial stress — remain underexplored.This study compares the effects of acute exercise on heart rate variability (HRV) and cortisol between patientswith ED and healthy controls across two exercise intensities. The results could provide insights into how EDinfluences the body’s ability to handle and recover from exercise.

Methods

We conducted a two-armed cross-over trial comparing ED patients (n = 30) and healthy controls (n = 30). Onseparate occasions, they performed 22-minute cycling sessions at either low or moderate intensity. Wemeasured HRV and salivary cortisol before, after, and 30 minutes after exercise. HRV measures RMSSD,LF/HF, and SD2/SD1 were analyzed. Exercise effects were assessed using linear mixed models.

Findings

RMSSD was significantly lower in the ED group than controls (p <0.05), but there was no difference in exerciseresponse between groups or intensities. SD2/SD1 and LF/HF values in response to exercise were higher in theED group (p <0.05), indicating increased sympathetic activation. This effect was particularly pronounced atmoderate intensity. There were no differences across groups, time, or intensity for cortisol.

Discussion

The findings indicate chronic dysregulation of the autonomic nervous system in individuals with ED, withaltered autonomic responses to exercise, slower recovery, and increased sympathetic activity post-exercise.These results can inform treatment strategies for ED patients.

BACKGROUND: Understanding psychological responses to acute exercise, defined as a single bout of physical exercise, in clinical populations is essential for developing tailored interventions that account for the psychological benefits and challenges of exercise. Given its effectiveness in reducing symptoms in various psychological disorders, exercise should be further explored in Exhaustion Disorder ICD-10-SE: F43.8A (ED), characterized by persistent exhaustion following long-term psychosocial stress. Currently, no studies address the psychological responses to acute exercise in ED patients.

AIMS: This study aims to (1) compare the psychological responses to acute exercise between ED patients and healthy controls and (2) assess response differences between low and moderate exercise intensities.

METHODS: We conducted a two-armed cross-over trial comparing ED patients (n = 30) and healthy controls (n = 30). Participants completed a 22-min exercise at low or moderate intensity on a cycle ergometer, on separate occasions, in randomized order. The primary outcome was perceived fatigue (POMS); secondary outcomes included feelings of energy, anxiety, stress, exertion, and psychological discomfort, measured before, during, and up to 24 h post-exercise. Exercise effects were assessed using repeated measures analysis of variance.

RESULTS: ED patients reported higher levels of exertion, psychological discomfort, fatigue, anxiety, and stress but lower energy throughout the trial compared to controls. Unlike controls, the ED group showed significant fatigue and stress reductions post-exercise (p < 0.05). Additionally, ED patients showed a more elevated energy after moderate-intensity exercise compared to controls (p < 0.05). Both groups experienced anxiety reductions post-exercise, with no group interactions over time. No differences were observed between pre- and 6 or 24 h post-exercise in any variables. The only intensity effect (p < 0.05) in the ED patients was a more pronounced energy decline 30 min after moderate-intensity exercise.

CONCLUSIONS: A 22-min exercise session was perceived as more strenuous by patients with exhaustion disorder (ED) and generated greater improvements in feelings of fatigue, energy, and stress compared to healthy individuals without delayed negative effects. These findings highlight the specific psychological responses in ED to exercise and can inform intervention design tailored specifically to this population.

TRIAL REGISTRATION: The study was retrospectively registered on 05/30/2024 at Clinical Trials.gov, with trial registration number 2022-04943-01.

Background: Internet-based Cognitive Behavior Therapy (ICBT) and mindfulness interventions are commonly used to treat elevated levels of stress. There are however few high-quality studies that examine ICBT with integrated mindfulness components for symptoms of stress and exhaustion, and the role of mindfulness exercises in digital treatment.

Method: The aim of the present study was to evaluate if a mindfulness-focused ICBT-program could reduce symptoms of stress and exhaustion, and increase quality of life, in a randomized controlled trial including 97 self-referred participants between 18 and 65 years who experienced elevated levels of stress.

Results: The intervention group had significantly reduced symptoms of stress and exhaustion, and increased quality of life, compared to the control group. Compared with the controls, participants in the intervention group showed a significant improvement with moderate to large effects on the primary outcome measure perceived stress (d = 0.79), and the secondary outcomes, exhaustion (d = 0.65), and quality of life (d = 0.40). Participants in the ICBT group also increased their level of mindfulness (d = 0.66) during the program. The amount of mindfulness training was significantly associated with an increased level of mindfulness, which in turn was significantly associated with reduced stress symptoms.

Conclusions: Mindfulness-focused ICBT can be an effective method to reduce stress-related mental health problems and the amount of mindfulness training seems to be of importance to increase the level of experienced mindfulness after treatment.

Stress has become one of the major challenges of modern society, especially within the working population, causing significant costs and personal problems. However, the range of prevention and treatment is not at all proportionate to the needs of the public. Internet provides new options for broad dissemination and a growing body of evidence suggest that internet-based interventions for stress could be effective. However, few studies have examined the efficacy in clinical samples or how participants experience these new treatment delivery formats. Further, only a limited number of studies have evaluated the efficacy of work-focused stress interventions on work-related outcomes (e.g., absenteeism), and if recovery has the potential in stress-prevention.

In the present thesis, internet-based cognitive behavioural stress interventions (iCBT), designed to reduce symptoms of stress and increase recovery and workparticipation among 117 managers and 260 employees, were evaluated in three randomized controlled trials (Study I, III and IV) and a qualitative study (Study II). Results of Study I and III indicate that the iCBT for managers and employees with stress-related disorders was effective in reducing symptoms of chronic stress. In Study III effects on work-related outcomes, e.g., work ability and absenteeism, were only seen in the work-focused iCBT. In Study II, participants found the work-focused iCBT to be accessible and feasible and reported positive experiences on stress and well-being in both life and at work. Finally, preliminary results in Study IV suggest that recovery experiences, an important protective factor against chronic stress, could be improved by a brief internet-based recovery intervention.

In conclusion, if implemented, these relatively brief and accessible interventions could be a feasible way to increase access to treatment and learning distressed employees and others how to prevent and recover from stress-related disorders. 

In this study, a previously evaluated guided Internet-based cognitive behavior therapy for social anxiety disorder (SAD) was adapted for mobile phone administration (mCBT). The treatment was compared with a guided self-help treatment based on interpersonal psychotherapy (mIPT). The treatment platform could be accessed through smartphones, tablet computers, and standard computers. A total of 52 participants were diagnosed with SAD and randomized to either mCBT (n = 27) or mIPT (n = 25). Measures were collected at pre-treatment, during the treatment, post-treatment and 3-month follow-up. On the primary outcome measure, the Liebowitz Social Anxiety Scale - self-rated, both groups showed statistically significant improvements. However, mCBT performed significantly better than mIPT (between group Cohens d = 0.64 in favor of mCBT). A larger proportion of the mCBT group was classified as responders at post-treatment (55.6% versus 8.0% in the mIPT group). We conclude that CBT for SAD can be delivered using modern information technology. IPT delivered as a guided self-help treatment may be less effective in this format.