A Pilot Test of the Additive Benefits of Physical Exercise to CBT for OCD

Abstract

The majority of "responders" to first-line cognitive-behavioural therapy (CBT) and pharmacological treatments for obsessive-compulsive disorder (OCD) are left with residual symptoms that are clinically relevant and disabling. Therefore, there is pressing need for widely accessible efficacious alternative and/or adjunctive treatments for OCD. Accumulating evidence suggests that physical exercise may be one such intervention in the mood and anxiety disorders broadly, although we are aware of only two positive small-scale pilot studies that have tested its clinical benefits in OCD. This pilot study aimed to test the feasibility and preliminary efficacy of adding a structured physical exercise programme to CBT for OCD. A standard CBT group was delivered concurrently with a 12-week customized exercise programme to 11 participants. The exercise regimen was individualized for each participant based on peak heart rate measured using an incremental maximal exercise test. Reports of exercise adherence across the 12-week regimen exceeded 80%. A paired-samples t-test indicated very large treatment effects in Yale-Brown Obsessive-Compulsive Scale scores from pre- to post-treatment in CBT group cohorts led by expert CBT OCD specialists (d = 2.55) and junior CBT clinician non-OCD specialists (d = 2.12). These treatment effects are very large and exceed effects typically observed with individual and group-based CBT for OCD based on leading meta-analytic reviews, as well as previously obtained treatment effects for CBT using the same recruitment protocol without exercise. As such, this pilot work demonstrates the feasibility and significant potential clinical utility of a 12-week aerobic exercise programme delivered in conjunction with CBT for OCD.

GABA concentration in sensorimotor cortex following high‐intensity exercise and relationship to lactate levels

“…; Rector et al . ; Brellenthin & Koltyn, ). How this occurs remains unclear, although is probably related to the effects of exercise on brain plasticity and metabolism (Johansen‐Berg & Duzel, ).…”

Exercise for Mood and Anxiety Disorders: The State-of-the Science

“…Powers, Medina, Burns, Kauffman, Monfils, Asmundson, Diamond, McIntyre, and Smits (this issue) conducted a randomized controlled trial and showed that exposure therapy preceded each week by exercise increased brain-derived neurotrophic factor (BDNF)—a protein shown to play an important role in the extinction of conditioned fear—and reduced PTSD symptoms more than exposure therapy without exercise. In the eighth article, Rector, Richter, Lerman, and Regev (this issue) treated participants with obsessive compulsive disorder (OCD) using group CBT and gym prescribed exercise. They found very large pre- to post-treatment within group effect sizes for the combined intervention on several measures of OCD and other symptoms.…”

A pilot randomized controlled trial of aerobic exercise as an adjunct to OCD treatment

“…These findings were consistent with an earlier work (N=11) conducted by Lancer and colleagues[34] where 6 weeks of brisk walking was associated with significant decreases in OCD symptoms. More recently, Rector and colleagues[21] provided gym memberships and exercise prescriptions to 11 patients with OCD who were beginning CBT treatment for OCD and found significant reductions in OCD symptoms after 12 weeks. While these preliminary studies demonstrated promising findings, each was an uncontrolled pilot study with a small sample.…”

“…For example, with the exception of several open pilot trials[19–21], there have been no well-controlled, randomized trials of aerobic exercise for symptom reduction in OCD. The purpose of this study was to conduct an RCT of aerobic exercise for patients with OCD who, despite standard treatments, remain clinically symptomatic.…”