Psychological responses to acute exercise in patients with stress-induced exhaustion disorder: a cross-over randomized trial, 2025, Kling et al

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Psychological responses to acute exercise in patients with stress-induced exhaustion disorder: a cross-over randomized trial

Jenny Kling, Robert Persson Asplund, Örjan Ekblom, Victoria Blom

Background
Understanding psychological responses to acute exercise, defined as a single bout of physical exercise, in clinical populations is essential for developing tailored interventions that account for the psychological benefits and challenges of exercise. Given its effectiveness in reducing symptoms in various psychological disorders, exercise should be further explored in Exhaustion Disorder ICD-10-SE: F43.8A (ED), characterized by persistent exhaustion following long-term psychosocial stress. Currently, no studies address the psychological responses to acute exercise in ED patients.

Aims
This study aims to (1) compare the psychological responses to acute exercise between ED patients and healthy controls and (2) assess response differences between low and moderate exercise intensities.

Methods
We conducted a two-armed cross-over trial comparing ED patients (n = 30) and healthy controls (n = 30). Participants completed a 22-min exercise at low or moderate intensity on a cycle ergometer, on separate occasions, in randomized order. The primary outcome was perceived fatigue (POMS); secondary outcomes included feelings of energy, anxiety, stress, exertion, and psychological discomfort, measured before, during, and up to 24 h post-exercise. Exercise effects were assessed using repeated measures analysis of variance.

Results
ED patients reported higher levels of exertion, psychological discomfort, fatigue, anxiety, and stress but lower energy throughout the trial compared to controls. Unlike controls, the ED group showed significant fatigue and stress reductions post-exercise (p < 0.05). Additionally, ED patients showed a more elevated energy after moderate-intensity exercise compared to controls (p < 0.05). Both groups experienced anxiety reductions post-exercise, with no group interactions over time. No differences were observed between pre- and 6 or 24 h post-exercise in any variables. The only intensity effect (p < 0.05) in the ED patients was a more pronounced energy decline 30 min after moderate-intensity exercise.

Conclusions
A 22-min exercise session was perceived as more strenuous by patients with exhaustion disorder (ED) and generated greater improvements in feelings of fatigue, energy, and stress compared to healthy individuals without delayed negative effects. These findings highlight the specific psychological responses in ED to exercise and can inform intervention design tailored specifically to this population.

Link | PDF (BMC Psychiatry) [Open Access]
 
Previous research has shown that a 30-min aerobic exercise bout can reduce mental health symptoms post-exercise across several psychiatric conditions. In patients with depression, it significantly decreased depression symptoms, regardless of exercise intensity [13]. Similarly, for patients with generalized anxiety disorder (GAD), running at a vigorous intensity significantly reduced anxiety and elevated energy compared to quiet rest [14]. Additionally, moderate-intensity exercise had anxiolytic and anti-panic effects compared to quiet rest in patients with panic disorder [15].

In contrast, a meta-analysis on the effects of acute exercise effects in individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) found increased fatigue post-exercise, with more pronounced elevations several hours afterward [16]. Although ED and ME/CFS share several similarities, such as severe exhaustion, sleep disturbances, and cognitive difficulties, one key difference is the post-exertional malaise in ME/CFS [17].
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Exclusion criteria for all participants were: (1) ME/CFS, (2) chronic pain disorder, (3) recent post-covid, (4) current suicide risk, (5) current drug use or addiction, (6) current or previous bipolar disorder, (7) current or previous psychosis disorder, (8) untreated hypothyroidism, (9) blood pressure > 200/110, (10) medication with beta-blockers, or (11) other known somatic comorbidity that may affect physical and mental response.
 
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I have skimmed some parts. It seems like they have done a decent job. It’s still open-label and subjective outcomes, but it doesn’t seem like they go beyond the evidence, and they put weight on the experiences of the patients.
 
Good to see ME/CFS was excluded.

Earlier in the course of my ME I several times when trying to get back to being more active, a shortish burst of physical exercise, be it swimming or fell walking would result in what I possibly incorrectly term ‘an endorphin high’, that resulted in foolish over exertion triggering subsequent PEM or once when fell walking downright dangerous running up and down rocky crags and scree slopes.
 
I may be wrong but it seems like a complete waste of space. They took people who said they found exercise exhausting and they found exercise exhausting - isn't that it?

I was amused by the title though. Made me think:

'What's your psychological response to this 'ere cross over exercise lad?

Eee by gum!!

You should be so lucky, when I were a boy we had to put the right arm through one ear and out the other in gym class and cross it over the left knee. That's what I call a proper cross-over exercise... and so on.
 
Jonathan Edwards said:
I may be wrong but it seems like a complete waste of space. They took people who said they found exercise exhausting and they found exercise exhausting - isn't that it?
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I may be wrong as well, but it seems like ED isn’t defined as «exhaustion after exercise». The dogma is that exercise is good for nearly every mental health and fatigue disorder, so they wanted to check how ED-patients would respond to it.
 
Jonathan Edwards said:
They took people who said they found exercise exhausting and they found exercise exhausting - isn't that it?
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That's not what they found at all.

While they reported exercise was more strenuous during the task, they found that people who felt exhausted due to stress actually had increased energy after moderate exercise, which suggests this is very different to ME/CFS.
 
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