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Brief intermittent intense exercise as interoceptive exposure for panic disorder: a randomized controlled clinical
Ricardo William Muotri1, Alan Campos Luciano1, Alia Garrudo Guirado2
1Anxiety Disorders Program, Institute of Psychiatry, University of Sao Paulo (USP), Sao Paulo, Brazil.
Frontiers in Psychiatry
|February 25, 2026
Summary
Brief intermittent intense exercise (BIE) is a feasible and effective interoceptive exposure strategy for panic disorder (PD). This exercise-based approach significantly reduces panic symptoms and attack frequency compared to relaxation training, with sustained benefits.
Area of Science:
- Psychiatry
- Clinical Psychology
- Exercise Science
Background:
- Interoceptive exposure (IE) is key in cognitive-behavioral therapy for panic disorder (PD).
- Standard IE can be aversive, limiting patient engagement.
- Vigorous physical exercise offers a potentially more acceptable method for eliciting interoceptive cues.
Purpose of the Study:
- To assess the feasibility and efficacy of a brief intermittent intense exercise (BIE) program as an IE strategy.
- To compare BIE with Jacobson's relaxation training (RT) in treatment-free PD patients.
Main Methods:
- A 12-week randomized clinical trial involving 72 sedentary adults with PD.
- Participants were allocated to either a BIE program (n=37) or RT (n=35).
- Outcomes included the Panic Agoraphobia Scale (PAS), panic attack frequency, and anxiety/depression scales.
Main Results:
- The BIE group showed significantly greater improvement in PAS scores compared to the RT group at 12 and 24 weeks.
- BIE resulted in fewer panic attacks and lower depression scores at follow-up.
- A significant group × time interaction favored BIE on PAS scores (F = 56.1, p < 0.001).
Conclusions:
- A 12-week BIE program is a feasible and effective IE strategy for PD.
- BIE demonstrates superior efficacy over RT in reducing panic symptom severity and panic attack frequency.
- Exercise-based IE presents a low-cost, engaging option for PD treatment programs.
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