There are very few guarantees in life but chances are you’ll experience back pain at some point in your lifetime, as about 8 out of 10 people will deal with it at least once. The type of back pain you may experience will depend on your age, habits, and health, and it’s important to realize that some cases can be avoided while others are completely out of your control.

The spine consists of 33 bones called vertebrae, which are stacked on top of one another and interlocked to form the spinal column. The vertebrae are connected by small joints that allow the spine to move in various directions, and in between each vertebra is a structure called an intervertebral disc. These discs are filled with a jelly-like substance and their purpose it to absorb shock and prevent these bones from rubbing against each other. Together, these features allow you to rotate and turn your torso, and they help to make the spine one of the sturdiest structures in the body. But as with every other body part, there are many different things that can go wrong within the back, and the result is often pain.

The amount of control you have over your back pain decreases with older age

Between sports, playing with friends, and due to their seemingly never-ending source of energy, most kids lead a pretty active lifestyle. As a result of the constant activity, their bodies can take quite a beating, which are very resilient but still have a breaking point. When pushed too far, the result can be back pain, which is more common in children and adolescents than you might think.

Most of these cases are due to strains and sprains of the muscles and ligaments of the back, which can occur either from a single injury or over time after continuing to abuse the back. In particular, children that participate in various sports year-round without enough time to recover may have a higher risk for injuries like back pain. There’s also been an increase in adolescent back pain related to being overweight, as the extra weight puts stress on the immature spine and throws off posture, which causes the lower back to work harder to stay upright.

While these types of problems are possible throughout life, in young adults, back pain is more commonly associated with other types of resting behaviors. Many individuals in this age group spend a great deal of time on screens such as laptops, tablets, and smartphones. Hunching over and staring at a screen with poor posture for extended periods of time can strain the muscles attached to the back and the result is often lower back pain. These are also examples of habits that can be changed to prevent pain from occurring.

With age, different problems arise due to age-related changes that may be less under your control. One of the more common changes that occurs with age is that the intervertebral discs eventually begin to dry out. These discs are originally soft and squishy to better absorb shock, but over time they lose some of their height and strength, and can no longer take on as much impact. Other changes that usually start to occur in middle age include a narrowing of the space surrounding the spinal canal and a weakening of the joints that connect the vertebrae together. As a result of all of these age-related changes, a number of other conditions become more likely to strike, such as:

• A herniated disc: occurs when some of the softer jelly-like substance pushes out through a tear in its tougher exterior, which may or may not cause symptoms
• Spinal stenosis: the name for the narrowing of the spinal canal, which can put pressure on the spinal cord and lead to pain
• Spondylosis: a general term used to describe any pain related to age-related changes in the spine, which becomes more common with aging

All of these back-related issues remain likely for older adults over age 65, but other conditions like osteoarthritis and osteoporosis become even more common in later life as well. Osteoarthritis occurs when individuals lose some of the protective cartilage surrounding the ends of the vertebrae, which allows them to rub against one another and often results in pain. Osteoporosis is a condition that causes bones to become weak and brittle, which increases the chances of fractures in the back. Further adding to the potential for back pain in older age is the loss of flexibility that many individuals experience. Reduced flexibility often has a negative impact on activity levels, which can create a vicious cycle of less movement and a higher risk for injuries like back pain.

So as you can see, back pain can occur at any age, and the risk for it increases as we get older. While this may not be the most encouraging piece of news, the most important thing to understand is that you have the power to influence your risk based on the habits and behaviors that define your life.

Neck pain remains one of the most common reasons patients seek treatment

Neck pain is extremely common, as it ranks fourth of all conditions that are responsible for causing disability. As a result, neck pain is also one of the most common reasons that individuals seek out treatment, and the majority of them go to their primary care doctor for an evaluation. Doctors usually recommend medication, additional testing, a referral to a specialist, or some combination of these interventions, but evidence is lacking to support many of the approaches that are used. On the other hand, recently published guidelines recommend many of the interventions used by physical therapists for neck pain—such as education, stretching exercises, and manual therapy—as research has found them to be effective for reducing patients’ costs and their use of healthcare. Seeing a physical therapist early is also generally recommended, but research evaluating how the timing of going to therapy affects costs and healthcare usage on neck pain patients is lacking. For this reason, a study was conducted to investigate the impact of seeing a physical therapist at different points in time on costs and healthcare use.

Patient records are collected and analyzed

To conduct the study, researchers scanned medical records to identify patients with neck pain who sought out care from a physical therapist, and they found 308 that fit all the necessary criteria. Once the patients records were collected, the researchers divided them into three groups depending on when the patient consulted with a physical therapist: 1) early physical therapy (for those who saw a therapist within 14 days of first seeing a medical professional), 2) delayed physical therapy (between 15-90 days), and 3) late physical therapy (91 days or more). Using these groups, data from the patients was then analyzed to determine if there were any associations between the time it took for them to see a physical therapist and their overall usage of healthcare services over one year. They particularly focused on opioid prescriptions, spinal injections, and imaging tests (X-rays, MRIs, and CT scans), as well as the overall costs of these services for each patient.

Patients with neck pain are encouraged to see a physical therapist early to save on costs and avoid unnecessary interventions

Of the 308 patients in the study, 160 (52%) consulted a physical therapist within 14 days for their neck pain, while 74 (24%) did so in 15-90 days, and 74 (24%) waited for more than 90 days. In general, results showed that those who saw physical therapist early typically underwent fewer treatments and tests, and spent less on their care compared to those in the “delayed” and “late” groups. More specifically, it was found that consulting a physical therapist late (>90 days) for neck pain was associated with a more imaging tests, spinal injections, and opioid prescriptions, all of which added up to more healthcare utilization. In addition, patients in this late physical therapy group spent an average of $2,172 more on healthcare over one year compared to those in the early physical therapy group who consulted within 14 days. Taken together, these findings suggest that when a patient sees a physical therapist early for their neck pain rather than waiting, they may be reducing their chances of undergoing tests and treatments that may not be necessary, and saving on healthcare costs as a result. Patients who currently have neck pain are therefore encouraged to consult with a physical therapist as soon as possible so they can get started on a personalized treatment program right away while avoiding additional interventions that have questionable value.

-As reported in the November ’18 issue of BMC Health Services Research

According to the Centers for Disease Control and Prevention (CDC), about 20% of Americans have experienced neck pain at least once in just the past three months. If you count yourself as one of these individuals or are dealing with neck pain currently, the most important question you probably have is: how can I relieve my pain right now?

Many causes of neck pain and stiffness are related to muscles in the region becoming weaker over time from poor posture and other bad habits that lead to misuse of the neck. So in a way, the sum of many of your daily behaviors can be seen as a major indicator of whether or not you’ll develop neck pain and how severe it will be.

This also means that if you have neck pain at this very moment, one of the best things you can do is to take a close look at how you use your neck throughout the day and identify any postures that might be contributing to your pain. For example, if you take public transportation to work, observe your neck position throughout your commute. If you notice that you tilt your head down when reading or to the side when taking a nap, you should try to change your habits to avoid these movements and consider using a neck pillow for the short naps to keep your neck properly aligned.

Here are some additional tips that will help to alleviate your neck pain right now:

• Use ice or heat: for minor neck pain that has just started, try applying an icepack to the neck for 20-30 minute intervals every few hours the first 2-3 days; after this period, apply heat to the area with a hot compress, heating pad, or hot shower
• Perform neck stretches: it’s important to keep moving your neck even when you’re in pain, but to avoid any jerking movements that can put strain on the neck; there are also some specific stretches you can perform anywhere:
  • Roll your shoulders backwards in a circle for 10 repetitions
  • Squeeze your shoulder blades together for 10 repetitions
  • Bring your ear to your shoulder 10 times on each side
  • When riding in a car, push your head back into the head rest while keeping it straight, and hold it for 30 seconds
• Exercise in a pool: many individuals find pools—especially those kept at a warm temperature—to be soothing for neck pain; aquatic exercise, gentle swimming strokes, or simply moving around the water with the neck submerged may all help
• Reduce stress: high levels of stress can cause you to tense the muscles in your neck and may make pain worse; this is why it’s important to try to find ways to reduce your stress in order to prevent further neck pain and stiffness
• Stay hydrated: the intervertebral discs that cushion all the bones of the spine are made primarily of water, so staying properly hydrated will help to keep them strong and flexible, increasing your chances of recovering from neck pain

Many of the recommendations for prevention also apply to treatment, so if you’re interested in learning more ways to ease your neck pain, read our last newsletter that covers some smart neck pain prevention tactics.

The neck has an incredibly important job to do. It supports the head and allows us to move it in a wide range of directions so that we can better navigate the world around us. But because of how frequently it’s used and its position in the body, the neck is also a very common location for pain, and sometimes all it takes is one bad night’s sleep to ruin your day.

In any given individual, there are many factors that may be responsible for the development of neck pain. What is most important to realize is that some of these factors are completely out of your control, while others can be modified and improved to reduce your chances of developing neck pain. For example, age-related changes to the structures of the upper spine will eventually occur in all individuals. Nothing can be done to stop these changes, and they may contribute to neck pain for some people.

But on the other hand, there are many changes that you can make to your life right now that can help prevent neck pain from occurring. Most of these modifications relate to avoiding postures and positions that might strain or otherwise aggravate the neck, particularly in bed and at workstations—the two places where we generally spend most of our time.

Bed setup

We spend roughly one-third of our lives sleeping, so the habits we develop in both our sleeping patterns and in how our beds are set up can have a major impact on the rest of the day. Sleeping in the wrong position or on a pillow that’s not supportive enough can both lead to neck pain either the next morning or gradually over time. To optimize your bed setup, we recommend the following tips:

• Avoid sleeping on your stomach: the best sleeping position is on the back, followed by the side, while stomach sleeping turns the neck to the side and can lead to neck pain; sleeping positions are often established earlier in life and difficult to change, but trying to start a night’s sleep on the back will increase your chances of staying there
• Use a pillow that’s right for you: make sure your pillow is of the appropriate firmness for your neck; different types of pillows are better for different individuals, but a good rule of thumb is to try to use a pillow that keeps your upper spine in neutral alignment, which means the natural curve of the neck is supported and maintained; feather and memory foam pillows may be helpful, while pillows that are too high or too stiff should be avoided
• Get enough sleep every night: aim for the recommended 7-9 hours each night, as not getting enough sleep can actually lead to more pain

Workstation setup

For many individuals, a great deal of time every day is also spent sitting at a desk and working on a computer. As with bed setups, the way in which a workstation is set up affects the neck and can play a part in the development of pain developing. To ensure that your workstation is not adding any strain to your neck, we recommend the following:

• Make sure your computer is at eye level and not too close or far away from you; you shouldn’t have to crane your neck down or strain your eyes to look at it
• When seated, the feet should be flat on the floor and the back of the chair should be in an upright position
• Keep the keyboard directly in front of you, close by, and at a height so your shoulders are relaxed, elbows slightly bent, and wrist and hands straight
• Consider using a document holder placed next to your computer to avoid constant neck movement when switching between the two

Other

• Avoid neck strain when using your phone by raising it to eye level, taking frequent breaks, and minimizing phone time
• Use a headset or headphones if you are on the phone frequently
• Use a neck pillow for flights and long car rides
• Regularly perform stretching and strengthening exercises for the neck to keep it flexible and strong

There’s a good reason that we often call things that bother us a “pain in the neck.” Neck pain is one of the most common health problems in the world, and it’s second only to back pain in terms of painful muscle and bone disorders. Statistics vary on just how prevalent neck pain is, but some figures estimate that as many as 80% of Americans experience it at least once each year. Depending on your age, there are different types of problems that can affect the neck, but the result is usually the same: neck pain and discomfort that gets in the way of normal movement.

The skeletal part of your neck is called the cervical spine, which is made up of seven bones (vertebrae). The vertebrae are referred to as C1-C7—the “C” stands for cervical—starting at the base of the skull (C1) and counting up towards the chest area (C7). Between each vertebra is an intervertebral disc, which cushions the bones and serves as a shock absorber. We use our cervical spine every time we nod, turn, or rotate our head in any direction, and this wide range of motion is one of the main reasons neck pain is so common.

For children and young adults, neck pain is far less common than it is later in life, but there are still plenty of issues that can occur. In this age group, most neck problems are due to strains and sprains of the muscles and ligaments in the neck. Here’s what usually happens:

• Neck muscles and ligaments are flexible, but sometimes they can be pushed too far
• This often occurs from holding bad postures—like staring down at a computer or cellphone—for extended periods of time, or sleeping on the neck wrong
• Symptoms include pain and discomfort in the back, side, or front of the neck that limits movement and activity

As we get older, neck strains and sprains remain common, but a number of other neck-related conditions are also more likely to start developing. In the course of the normal aging process, several age-related changes begin to occur in certain parts of the cervical spine. What generally tends to happen is that the structures that make up the neck become weaker, the intervertebral discs lose some of their height, and the joints in the neck adapt to other changes in the body. Eventually, these changes make the structures of the neck slightly less effective, and as a result:

• Osteoarthritis may develop, which occurs from losing some of the protective cartilage that surrounds the ends of bones
• Spondylosis is another general term used to describe any pain related to age-related changes in the spine; this also becomes more common with aging
• Problems with the intervertebral discs can lead to a herniated, or “slipped” disc, which may cause pain and other symptoms that radiate through the arms

These types of issues typically tend to develop between ages 40-60, but can be seen even earlier in certain individuals. Symptoms also range significantly, as some people experience regular pain and physical limitations, while others don’t notice any symptoms, even though these age-related changes are still occurring.

For adults over the age of 65, age-related changes continue to occur and may begin to become more advanced in some cases. This means that conditions like osteoarthritis and spondylosis are even more likely at this age, and they can be more severe for some individuals. Other conditions like spinal stenosis and osteoporosis also become more common in older age and add to the list of possible neck problems. Spinal stenosis is a narrowing of the spinal canal that puts pressure on the structures within it, while osteoporosis is a condition that causes bones to become weak and brittle. Other mobility limitations could make neck-related issues even more of an impairment for the elderly, but all of these problems are still treatable.

What’s important to understand is that while there is nothing that can be done to stop the aging process, there are countless changes you can make to your everyday life that can significantly reduce your chances of experiencing neck pain at any stage of life.

This type of fracture is especially common in older adults

The radius is the larger of the two bones of the forearm, and the end of this bone closest to the wrist is called the distal radius. A distal radius fracture is another term for a broken wrist, and it is one of the most common of all injuries. Fractures of the distal radius account for between 15-20% of all fractures, but they are especially common in individuals over the age of 60. In this age group, they are the second most common type of fracture behind hip fractures. Treatment for distal radius fractures typically consists of realigning the broken bone and then putting the patient in a wrist cast. Unfortunately, more than 50% of patients continue to have problems with their wrist after this procedure, which can lead to poor long-term outcomes. After the cast is removed, patients are usually instructed to follow a course of physical therapy. This can either be accomplished with a supervised program within a physical therapy clinic or with a home-exercise program designed by a physical therapist. Although both of these types of programs are commonly used, it’s not completely clear which is more effective. For this reason, a powerful study called a randomized-controlled trial (RCT) was conducted to compare a supervised physical therapy program to a home-exercise program for older adults with distal radius fractures.

Patients randomly assigned to one of two six-week treatments

Patients older than 60 who had been diagnosed with a distal radius fracture were invited to participate in the study. A total of 74 individuals were accepted and randomly assigned to one of two treatment groups: the supervised physical therapy group or the home-exercise group. All patients were treated with realignment and a cast for about 6.5 weeks and began their rehabilitation afterward. The supervised physical therapy consisted of hour-long sessions 2-3 times per week for a total of 12 sessions, and each session began with 15 minutes of wrist and hand exercises performed in a 93°F whirlpool bath. After this, the therapist performed a specific set of mobilizations of the wrist joint and then instructed patients to perform three other exercises designed to improve the flexibility of their wrist. For the home-exercise program, a physical therapist taught each patient how to properly perform a set of exercises at home during a 30-minute session. Their home-exercise program lasted 20-30 minutes and was to be performed twice a day for six weeks. It consisted of various stretching exercises and got progressively more difficult as time went on. All patients were evaluated before treatment began, immediately afterward and then after six months for wrist pain and function, as well as several other outcomes.

Patients in the supervised physical therapy group experience greater improvements

Results showed that overall, patients in both groups improved in all of the measurements taken. However, the participants who followed supervised physical therapy experienced significantly greater improvements in wrist function, as well as less pain and better wrist flexibility, compared to those who followed a home-exercise program. This was found to be the case immediately after treatment, as well as six months later. These findings suggest that a supervised physical therapy program will lead to better outcomes for individuals older than 60 with a distal radius fracture, but more research is needed to confirm this. In the meantime, patients who experience this injury should seek out the services of a physical therapist for appropriate treatment, since both forms of physical therapy were found to be beneficial for all patients in this study.

-As reported in the March ’17 issue of The Journal of Hand Therapy

Although research has been performed on the topic, several questions remain

Depression is common in older adults, with statistics showing that up to 9.3% of this population is affected by it. Dealing with depression later in life is often a significant burden, as it tends to result in increased health care costs, impairments in physical and mental functioning, and a higher risk for suicide and death. Antidepressants are the most common treatment for depression, with a class of drugs called selective serotonin reuptake inhibitors (SSRIs) typically offered as the first line option. Unfortunately, antidepressants are associated with a number of side effects in older adults, including falls, fractures, epilepsy, and heart-related problems. In addition, many individuals would prefer not to take medications for their condition, and this shows why alternative strategies are needed. Exercise has been suggested as a non-drug alternative treatment for older adults with depression, and several studies have evaluated its effects on this population. One large-scale review of these studies called a meta-analysis found that exercise provided a small-to-moderate effect on older patients, but there were several problems with this study, and many important questions remain. For this reason, researchers decided to conduct and updated meta-analysis to develop a clearer idea of how exercise affects older adults with depression and if it should be recommended.

Six medical databases searched for relevant studies

Investigators performed a search of six major medical databases for randomized-controlled trials (RCTs) that evaluated the impact of any type of exercise on adults over the age of 60. RCTs are high-quality studies in which groups of patients are randomly assigned to undergo different treatments, and they are considered the gold standard for determining if an intervention is indeed effective. This search led to eight RCTs being included in the meta-analysis, which contained data on 267 adults with depression. In these RCTs, 129 patients underwent an exercise program, while the other 138 did not participate in any exercises and served as controls for comparison. Once collected, these studies were reviewed and their findings were compared to one another with the goal of establishing a clear conclusion.

Researchers conclude that exercise should be considered a routine part of treatment for older adults with depression

The results of this meta-analysis showed that exercise had a large and significant antidepressant effect on older adults with depression. More specifically, researchers found these large and significant effects to be associated with exercise of moderate intensity—such as brisk walking—and in studies that used both aerobic exercise and strength training, and in both supervised and unsupervised formats. They also determined that some of the results published in the prior meta-analysis were underestimated due to bias, meaning that the actual effect of exercise was likely greater than the analysis suggested. With this in mind, researchers concluded that exercise should be advocated as a routine component of treatment for older adults with depression. One of the best ways to help older adults get involved in an exercise program is through physical therapy. Physical therapists are movement experts that work with patients on an individualized basis to provide a customized exercise program that considers their strengths and goals. Working one-on-one with a physical therapist can help depressed older adults become more active in their daily lives, leading to better overall health and reduced symptoms as a result.

-As reported in the July-Sept. ’16 issue of Revista Brasileira de Psiquiatria

Stress is everywhere in today’s world

The world we live in today can seem like a breeding ground for stress. As a result, stress is an unavoidable part of life for a significant portion of the population. Recent statistics suggest that 70% of Americans experience some form of stress or anxiety every day, and most say that it interferes with their lives to at least a moderate degree. While daily stress generally comes and goes, about one in four individuals will go on to develop a mental health condition of some sort in their lifetime. Whether stress is an occasional inconvenience or an everyday impairment, most of us would probably agree that we could benefit from less in our lives. These days, there seems to be nearly as many apparent cures for stress as there are causes for it, and the effectiveness of each one varies significantly. But one of the most tried and true solutions to reduce stress is actually pretty simple: get more exercise.

Exercise benefits the body and brain in a number of ways

Getting regular aerobic exercise—which includes walking, running, and any other activity that increases your heart rate—will bring about a number of positive changes to your body, particularly to your metabolism and heart. It can also exhilarate and relax, and provide both stimulation and a calming effect by the same process. This calming effect is how exercise can manage stress and stress-related disorders like anxiety and depression as well. There are several explanations as to why exercise is responsible for these mental benefits, but it seems likely that the changes are related to both chemical and behavioral factors. On the chemical end, exercise has been found to reduce levels of the body’s stress hormones, such as adrenaline and cortisol. It also stimulates the production of endorphins, the body’s natural painkillers that are responsible for the “runner’s high” and feelings of relaxation many people experience after a hard workout. Behavioral factors have also been found to play a role in this process, as positive changes reinforce and encourage positive actions. What this means is that when you see improvements in your body—such as increased strength, better stamina, or a smaller waistline—it makes you feel better about yourself, which will all go on to reduce your stress levels as a result.

Take your pick from the many exercise options available

When done regularly, nearly any time of exercise will help bring about these positive physical and mental changes for you. Brisk walking and jogging are some of the most popular and easiest ways to get active and clear the mind, but others may prefer hiking, biking, swimming, yoga, high-intensity interval training, kayaking, or even rock climbing. It’s really up to you to find some type of exercise—or several—that work for you and do them on a regular basis. There is also a special sort of exercise known as autoregulation exercise that is specifically designed to replace the vicious cycle of stress with a cycle of relief. Several approaches may be used to accomplish this, such as deep breathing exercises, mental exercises like meditation, and progressive muscle relaxation, which focuses on loosening up tight and tense muscles throughout the body, one group at a time.

A physical therapist can help get you on your best foot forward

Current guidelines recommend getting about 150 minutes of moderate-intensity exercise (like brisk walking) or 75 minutes of vigorous-intensity exercise (like jogging) every week. If you are just starting to integrate exercise into your life or increasing the amount you already do, it may take time to reach these marks, so a gradual approach is always best. Seeing a physical therapist can also help you get to where you want to be. Physical therapists are movement experts that work with patients on a personalized basis to help them move better and more frequently. So if you’re trying to increase your weekly exercise, a physical therapist can provide you with recommendations on what types you should attempt, or they may find a specific exercise program based on your abilities and goals to help you succeed.

-Summarized from an article published in Harvard Health

Difficult to evaluate this connection with the evidence available

Statistics suggest that about 10-20% of adults over the age of 65 are depressed. The number of older adults that are frail—which essentially means being weak and having a higher chance of getting injured—is also estimated to be similar. Both depression and frailty are associated with a number of negative effects in older age, such as a lower quality of life, increased use of health insurance and a higher chance of experiencing other health issues or dying. When both of these conditions are present at the same time, the effects can be even worse, with many of these individuals experiencing accelerated mental decline and disability. This shows why it’s important to understand the connection between depression and frailty, as it can help identify patients who are affected by either or both conditions, as well as to develop strategies to address them. Although there is some data available on this association, there are no large-scale studies that have focused on the two conditions exclusively. For this reason, a high-quality pair of studies called a systematic review and meta-analysis was conducted to determine how many older adults with frailty also have depression and vice versa.

Three major databases searched for relevant studies

To conduct the review, researchers performed a search of three major medical databases for studies that investigated depression and frailty in adults with an average age of 60 years and older. To be included, studies also had to utilize respectable criteria for defining both depression and frailty, and had to include a control group of patients who did not have these conditions for comparison purposes. This search led to 63 studies being screened and 24 of these meeting the necessary criteria for inclusion into the review. Once collected, the findings from these 24 studies were evaluated and compared to one another to determine how common frailty and depression were in older adults.

Exercise can be helpful for treating both frailty and depression

Results showed that there were 8,023 older adults that had frailty, and of these, 38.6% were also depressed. Similarly, 2,167 older adults were found to have depression, and 40.4% of them were also frail. Further analysis from five studies showed that when patients with depression were compared to individuals without depression, there was a significantly higher risk of also having frailty. Finally, the overall quality of the included studies was found to be good, which shows that these findings can be considered reliable. Taken together, this systematic review and meta-analysis show that a significant portion of older adults who are frail are also depressed, and vice versa. While this finding is alarming, the good news is this: treatment that targets either of these conditions can actually lead to improvements in both of them at the same time. Exercise, in particular, is an effective tool to manage both depression and frailty, as it leads to positive changes in both mental and physical health. This is one of the primary reasons physical therapy is highly recommended for older adults with any type of impairment, since it is based on helping individuals move better and more frequently. With this in mind, elderly individuals who are frail or depressed—or both—are strongly encouraged to seek out the services of a physical therapist. Doing so can result in lasting changes in both their physical and mental health, and in turn, improve their overall quality of life.

-As reported in the July ’17 issue of Ageing Research Reviews

Updated analysis needed in light of new studies and flaws in prior research

Anxiety disorders are a group of mental health conditions that include generalized anxiety disorder, panic disorder, and phobias. Together with stress-related issues like post-traumatic stress disorder (PTSD), these conditions have all been found to have negative impact on patients’ lives, such as a reduced quality of life and increased risk for heart disease and early death. Targeted medications and a psychiatric intervention called cognitive behavioral therapy (CBT) are typically recommended as the primary treatments for patients with anxiety and stress disorders, but the outcomes are not always positive. About one-third of patients do not respond to medications or CBT, and these interventions are not available in certain parts of the world. Exercise is considered an alternative for the patients that are either unable or unwilling to try medications or CBT, but there has only been one high-quality study (meta-analysis) on the topic. At the time, this study concluded that there was not enough information to recommend exercise for anxiety disorders. Since then, however, additional research has been published, and researchers have pointed out certain flaws in the original meta-analysis. For this reason, an updated meta-analysis was conducted to evaluate the effects of exercise on symptoms in patients with anxiety or stress disorders.

Seven databases searched for relevant studies

The investigators performed a search of seven major medical databases for randomized-controlled trials (RCTs) that investigated the effectiveness of exercise in adults with an anxiety or stress-related disorder. RCTs evaluate specific interventions by randomly assigning patients to different groups, and they are considered the gold standard for determining if a treatment is beneficial. This search led to 62 studies being screened, and six RCTs fit the necessary criteria to be included in the meta-analysis. Once collected, the findings of these six RCTs were evaluated and compared to one another to assess the impact of exercise on patients.

Based on positive results, exercise should be considered a treatment option for anxiety

The six included RCTs contained data on 262 participants, with 132 undergoing an exercise treatment program and the other 130 serving as the control group, who did not undergo exercise and were used for comparison. Results showed that exercise significantly reduced symptoms of anxiety in these patients, who had a variety of disorders that included PTSD, generalized anxiety disorder, panic disorder, or social phobia. When compared to the control group, the effect size of exercise was found to be in the medium range.

Physical therapists can help promote exercise in patients with anxiety

These findings support the use of exercise for patients with anxiety or stress disorder, and the researchers suggested that it should therefore be considered a viable option for these patients. Physical therapists are movement specialists that promote and prescribe exercise for a wide variety of conditions. While they are often viewed as professionals that only treat physical problems, this study shows why they can also be utilized to help overcome mental health issues like anxiety. Patients with anxiety or stress-related disorders are therefore encouraged to seek out the services of a physical therapist for an exercise therapy program that can help them better manage their symptoms while also improving their health and fitness in the process.

-As reported in the March ’17 issue of Psychiatry Research