Does High-Intensity Exercise Combined with Exposure Sessions Improve Treatment Outcomes in Obsessive-Compulsive...

Physical exercise administered before or after exposure has been shown to have beneficial effects on treatment outcomes in anxiety- and trauma-related disorders. However, this approach has not yet been examined for obsessive-compulsive disorder (OCD). This randomized controlled trial investigated whether high-intensity exercise administered immediately after exposure therapy improves treatment outcomes in patients with OCD.

Ninety-seven inpatients with OCD participated in an 8-week exposure-based treatment phase during inpatient care, comprising 2 sessions per week, and were randomly assigned to either high-intensity exercise (ExpoHI) or low-intensity control (ExpoLI) administered immediately after a standardized exposure and response prevention session. OCD severity was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at admission, discharge, and 6-month follow-up. The secondary outcomes included general psychopathological symptoms.

ExpoHI showed significantly greater reductions in Y-BOCS scores at discharge (between-group difference: -3.14 points, p = 0.009), corresponding to a moderate-to-large between-group effect size (Cohen's d = 0.76), which was maintained at the 6-month follow-up (p = 0.030; Cohen's d = 0.68). Responder rates at discharge were significantly higher in the ExpoHI group (85.4%) than in the ExpoLI group (61.2%) (p = 0.011), whereas remission rates did not differ between groups. ExpoHI also showed greater reductions in depressive symptoms at follow-up.

High-intensity exercise immediately following exposure therapy produced greater reductions in obsessive-compulsive symptoms than the active control condition. These findings suggest that exercise may be a feasible adjunct for exposure-based treatment.