Anxiety disorders in patients with cardiopulmonary diseases: A brief review

Abstract

This manuscript reviews the current literature involving clinical anxiety and cardiopulmonary disease, considers the hypothesized physiological mechanisms for anxiety, and discusses the use of exercise as a treatment for both anxiety and cardiopulmonary diseases. The literature summary consists of original investigations, meta-analysis, commentaries, and review publications in order to better understand the biological and psychological mechanisms for using exercise as treatment and to provide details specific to cardiopulmonary disease and anxiety management. A gap in the literature exists concerning the anxiolytic effects of exercise as a psychological and physical treatment in cardiopulmonary populations. The findings from this review support further investigation into the use of exercise to ameliorate the burden of anxiety in cardiopulmonary disease patients.

This review evaluates the current literature surrounding cardiopulmonary disease and anxiety. A systematic literature search identified articles discussing the prevalence, association, and risk of anxiety in cardiopulmonary patients. Though depression is often studied in this population, recent investigation supports a need for further research regarding anxiety in cardiopulmonary patients. Treatment to manage patients’ psychological profile can reduce exacerbations of known disease, reduce hospital readmission, and improve functional capacity, and overall quality of life.

Keywords

Anxiety / Cardiopulmonary disease / CAD / COPD / Exercise

References

[[1]] E. Anderson, J.L. Durstine. Physical activity, exercise, and chronic disease: a brief review. Sports Med Health Sci, 1 ( 2019), pp. 3-10, DOI: 10.1016/j.smhs.2019.08.006

[[2]] American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. Wolters Kluwer, Philadelphia, PA ( 2017). ISBN-13: 978-1496339072

[[3]] CDC/National Center for Health Statistics. FastStats - Statistic by Topic. Centers for Disease Control and Prevention (2015).

[[4]] NHLBI.Chapter 4:Disease Statistics. National Institute of Health ( 2012).

[[5]] P.P. Hannley. Move more, eat less. Am J Med, 127 (8) ( 2014), pp. 681-684, DOI: 10.1016/j.amjmed.2014.05.026

[[6]] J.F. Todaro, B.J. Shen, S.D. Raffa, et al.. Prevalence of anxiety disorders in men and women with established coronary heart disease. J Cardiopulm Rehabil Prev, 27 ( 2007), pp. 86-91, DOI: 10.1097/01.HCR.0000265036.24157.e7

[[7]] J.A. Wedzicha, T.A. Seemungal. COPD exacerbations: defining their cause and prevention. Lancet, 370 ( 2007), pp. 786-796, DOI: 10.1016/S0140-6736(07)61382-8

[[8]] B. Wipfli, D. Landers, C. Nagoshi, et al.. An examination of serotonin and psychological variables in the relationship between exercise and mental health. Scand J Med Sci Sports, 21 ( 2011), pp. 474-481, DOI: 10.1111/j.1600-0838.2009.01049.x

[[9]] M.E. Kunik, K. Roundy, C. Veazey, et al.. Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest, 127 ( 2005), pp. 1205-1211, DOI: 10.1378/chest.127.4.1205

[[10]] A.M. Yohannes, T.G. Willgoss, R.C. Baldwin, et al.. Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: prevalence, relevance, clinical implications and management principles. Int J Geriatr Psychiatr, 25 ( 2010), pp. 1209-1221, DOI: 10.1002/gps.2463

[[11]] J. Maurer, V. Rebbapragada, S. Borson, et al.. Anxiety and depression in COPD: current understanding, unanswered questions, and research needs. Chest, 134 (4 Suppl) ( 2008), pp. 43S-56S, DOI: 10.1378/chest.08-0342

[[12]] I. Kawachi, D. Sparrow, P.S. Vokonas, et al.. Symptoms of anxiety and risk of coronary heart disease: the normative aging study. Circulation, 90 ( 1994), pp. 2225-2229, DOI: 10.1161/01.cir.90.5.2225

[[13]] B.E. Cohen, D. Edmondson, I.M. Kronish. State of the art review: depression, stress, anxiety, and cardiovascular disease. Am J Hypertens, 28 (11) ( 2015), pp. 1295-1302, DOI: 10.1093/ajh/hpv047

[[14]] Z. Khayyam-Nekouei, A. Yousefy. Application of cognitive-behavioral therapy for reducing anxiety in cardiac patients. ARYA Atheroscler, 3 (2) ( 2007), pp. 69-71.

[[15]] N. Vogelzangs, A. Seldenrijk, A.T.F. Beekman, et al.. Cardiovascular disease in persons with depressive and anxiety disorders. J Affect Disord, 125 (1-3) ( 2010), pp. 241-248, DOI: 10.1016/j.jad.2010.02.112

[[16]] D.C. Turk. A diathesis-stress model of chronic pain and disability following traumatic injury. Pain Res Manag, 7 ( 2002), pp. 9-19, DOI: 10.1155/2002/252904

[[17]] A. Rozanski, J.A. Blumenthal, J. Kaplan. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation, 99 ( 1999), pp. 2192-2217, DOI: 10.1161/01.cir.99.16.2192

[[18]] American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Association, Washington, D.C ( 2013). book/10.1176/appi.books.9780890425596

[[19]] B. Martin, T. Hauer, R. Arena, et al.. Cardiac rehabilitation attendance and outcomes in coronary artery disease patients. Circulation, 126 ( 2012), pp. 677-687, DOI: 10.1161/circulationaha.111.066738

[[20]] J.A. Blumenthal, W. Jiang, D.S. Krantz, et al.. Stress management and exercise testing in cardiac patients with myocardial infarction. Arch Intern Med, 157 ( 1997), pp. 2213-2223, DOI: 10.1001/archinte.1997.00440400063008

[[21]] A.L. Dunn, M.H. Trivedi, J.B. Kampert, et al.. Exercise treatment for depression: efficacy and dose response. Am J Prev Med, 28 ( 2005), pp. 1-8, DOI: 10.1016/j.amepre.2004.09.003

[[22]] G.F. Fletcher, C. Landolfo, J. Niebauer, et al.. Promoting physical activity and exercise: JACC health promotion series. J Am Coll Cardiol, 72 ( 2018), pp. 1622-1639, DOI: 10.1016/j.jacc.2018.08.2141

[[23]] J. Huang, Y. Zheng, D. Gao, et al.. Effects of exercise on depression, anxiety, cognitive control, craving, physical fitness and quality of life in methamphetamine-dependent patients. Front Psychiatr, 10 ( 2020), pp. 1-7, DOI: 10.3389/fpsyt.2019.00999

[[24]] C.E. Garber, B. Blissmer, M.R. Deschenes, et al.. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc, 43 (7) ( 2011), pp. 1334-1359

[[25]] G. Liguori.ACSM's Guidelines for Exercise Testing and Prescription. (eleventh ed.ed.), Wolters Kluwer, Philadelphia, PA ( 2021). In Press

[[26]] J.J. Rately, E. Hagerman. Spark: The Revolutionary New Science of Exercise and the Brain. Little, Brown and Company, New York (2008). ISM-978-0-316-11350-2

[[27]] B.M. Wipfli, C.D. Rethorst, D.M. Landers. The anxiolytic effects of exercise: a meta-analysis of randomized trials and dose-response analysis. J Sport Exerc Psychol, 30 ( 2008), pp. 392-410, DOI: 10.1123/jsep.30.4.392

[[28]] D.M. LeBouthillier, G.J.G. Asmundson. A single bout of aerobic exercise reduces anxiety sensitivity but no intolerance of uncertainty or distress tolerance: a randomized controlled trial. Cognit Behav Ther, 44 (4) ( 2015), pp. 252-263, DOI: 10.1080/16506073.2015.1028094

[[29]] L. Stojanovska, V. Apostolopoulos, R. Polman, et al.. To exercise, or, not to exercise, during menopause and beyond. Maturitas, 77 ( 2014), pp. 318-323, DOI: 10.1016/j.maturitas.2014.01.006

[[30]] A. Agil, F. Abike, A. Daskapan, et al.. Short-term exercise approaches on menopausal symptoms, psychological health, and quality of life in postmenopausal women. OGIJ, 5 ( 2010), pp. 1-7, DOI: 10.1155/2010/274261

[[31]] S.A. Neeper, F. Gomez-Pinilla, J. Choi, et al.. Exercise and brain neurotrophin's. Nature, 373 ( 1995), p. 109, DOI: 10.1038/373109a0

[[32]] L.T. Ferris, J.S. Williams, C.L. Shen. The effects of acute exercise on serum brain-derived neurotropic factor levels and cognition function. Med Sci Sports Exerc, 39 (4) ( 2007), pp. 728-734, DOI: 10.1249/mss.0b013e31802f04c7

[[33]] S. Suliman, S.M. Hemmings, S. Seedat. Brain-derived neurotrophic factor (BDNF) protein levels in anxiety disorders: systematic review and meta-regression analysis. Front Integr Neurosci, 7 (55) ( 2013), pp. 1-11, DOI: 10.3389/fnint.2013.00055

[[34]] A.B. Klein, R. Williamson, M.A. Santini, et al.. Blood BDNF concentrations reflect brain-tissue BDNF levels across species. Int J Neuropsychopharmacol, 14 ( 2011), pp. 347-353, DOI: 10.1017/S1461145710000738

[[35]] P. Rasmussen, P. Brassard, H. Adser, et al.. Evidence for a release of brain-derived neurotrophic factor from the brain during exercise. Exp Physiol, 94 (10) ( 2009), pp. 1062-1069, DOI: 10.1113/expphysiol.2009.048512

[[36]] P. Thoren, J.S. Floras, P. Hoffmann, et al.. Endorphins and exercise: physiological mechanisms and clinical implications. Med Sci Sports Exerc, 22 (4) ( 1990), pp. 417-428. PMID: 2205777

[[37]] A. Dietrich, W.F. McDaniel. Endocannabinoids and exercise. J Sports Med, 38 ( 2004), pp. 536-541, DOI: 10.1136/bjsm.2004.011718

[[38]] J.W. Holaday. Cardiovascular effects of endogenous opiate systems. Annu Rev Pharmacol Toxicol, 23 ( 1983), pp. 541-594, DOI: 10.1146/annurev.pa.23.040183.002545

[[39]] S.K. Droste, A. Gesing, S. Ulbricht, et al.. Effects of long-term voluntary exercise on the mouse hypothalamic-pituitary-adrenocortical axis. Endocrinology, 144 ( 2003), pp. 3012-3023, DOI: 10.1210/en.2003-0097

[[40]] C. Tsigos, G.P. Chrousos. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res, 53 ( 2002), pp. 865-871, DOI: 10.1016/s0022(02)00429-4

[[41]] A.M. Stranahan, K. Lee, M.P. Mattson. Central mechanisms of HPA axis regulation by voluntary exercise. NeuroMolecular Med, 10 ( 2008), pp. 118-127, DOI: 10.1007/s12017-008-8027-0

[[42]] E. Zschucke, B. Renneberg, F. Dimeo, et al.. The stress-buffering effect of acute exercise: evidence for HPA axis negative feedback. Psychoneuroendocrinology, 51 ( 2015), pp. 414-425, DOI: 10.1016/j.psyneuen.2014.10.019

[[43]] W.M. Mampuya. Cardiac rehabilitation past, present and future: an overview. Cardiovasc Diagn Ther, 2 (1) ( 2012), pp. 38-49, DOI: 10.3978/j.issn.2223-3652.2012.01.02

[[44]] M. Pacurari, R. Kafoury, P.B. Tchounwou, et al.. The renin-angiotensin-aldosterone system in vascular inflammation and remodeling. Int J Inflamm, 2014 ( 2014), pp. 1-13, DOI: 10.1155/2014/689360