In our article on panic disorder and exercise, we described the reasons that some people experience anxiety from exercise. In this article, we will provide tips both for prevention of this anxiety and management when it happens in the moment. I have even partnered with Tasha to create a cardio-based workout that might be more friendly to folks who struggle with cardio due to anxiety concerns: Moderate Intensity Cardio: Friendly for Exercise-Induced Anxiety.

Tips for prevention 

As always, I recommend seeking help from a mental health professional to manage your anxiety, particularly if it is impacting your life in multiple ways. However, if you are looking to keep up your cardiovascular fitness, here are some tips you can use to try to prevent yourself from having increased anxiety or panic during your workout(s):

• Start low and slow and build up! This one can be interpreted in a few different ways. For one, it is helpful to build your way up over time to being able to do more. We can easily get in the mindset of always needing to push ourselves to see best results. However, if panic attacks are preventing you from doing cardio workouts at all, then starting low and slow and gradually increasing intensity each week or month might be a way to build up to eventually being able to handle the higher intensity workouts. Try initially doing lower intensity and shorter duration workouts and increase intensity and duration one at a time. There is also no rule that says you need to do high intensity workouts — maybe stick with low- or moderate-intensity workouts.
  
  Second, do an extended warm-up before your cardio workouts. I know it often feels like we are short on time and skipping the warm up will help us to get the most out of our workout in shorter times. However, jumping right into high intensity exercise confuses our bodies and minds and makes us more likely to spiral into anxiety or panic attacks. Not to mention, your body needs to be effectively prepared for a workout regardless of anxiety levels. Therefore, try starting with this total body warm-up or, for a total body cardio workout, try doing extended lower-body, upper-body, and cardio-based warm-ups before even getting into your cardio workout. If you need to, modify the intensity of even the warm-up movements to fit your needs.
   
• Don’t avoid aerobic exercise. Unfortunately, people who have panic disorder tend to have lower cardiovascular fitness due to their increased avoidance of aerobic exercise. This can lead to all sorts of health concerns later in life (Muotri & Bernik, 2014). In addition to these physical health problems, avoidance coping can actually increase your anxiety in the long-term. It seems counterintuitive because why would I do things intentionally that cause me to feel out of control with anxiety? However, avoidance of the things we are anxious about (exercise being one example) only increases our fear or anxiety of that thing in the long-run. Therefore, be sure to keep active in some way to manage this exercise anxiety across time.
   
• Ongoing self-care and stress management. Because of the autonomic dysregulation experienced by people with panic and other anxiety disorders, we want to do as much as we can to strengthen our parasympathetic nervous system to help counterbalance the overactive sympathetic nervous system. Therefore, self-care and stress management become a necessity for optimal functioning. Ultimately, the self-awareness that tends to accompany self-care will help us to be in touch with our minds and bodies (and the connection between them) and be able to distinguish that our physiological response to exercise is not the same as the physiological experience of anxiety.
   
• Find ways of exercising that bring you joy. Exercise is a stressor. Even when we know that it will benefit us in the long-term, it is still putting our bodies into fight-or-flight mode. When that is paired with activity we don’t like to do, this adds additional cognitive stress to our experience. To minimize how much stress we are experiencing during a workout, try to limit yourself to things you love doing. Go for walks or hikes, dance around your house to music you love, go swimming, run around with your dog, or join a sports team. I have been playing pickleball with my husband and we sweat a lot while playing!

Tips for managing anxiety/panic during a workout

No matter how much we do to prevent our anxiety from happening, chances are good that this will not change overnight and you might benefit from some tips for managing anxiety and/or a panic attack as it happens. 

• Bring your heart rate down: If you start to have anxiety during a workout (not quite at the level of a panic attack), be sure to slow down and bring your heart rate to a more manageable level. Walk around the space you are in while breathing deeply to bring it down.
   
• Take breaks: Again, nothing says you have to push through and do a 20 minute workout in exactly 20 minutes. Pause and take breaks as much as you need, as this can help you get on top of your anxiety before it spirals! When you notice your anxiety increasing, maybe that is a good time for a water break and to curate a song that tends to bring you into a desired mood state. Slowly ease back in when you are ready.
   
• Deep breathing: If you are having either increased anxiety or a panic attack, you can engage in deep breathing to calm yourself in the moment. Deep breathing activates the parasympathetic nervous system, which helps signal to your body that it is time to calm down now. Try square breathing or this workout that teaches several styles of breathing for stress management.
   
• 5-4-3-2-1 technique: The 5-4-3-2-1 technique is a grounding exercise ideal for folks in the middle of a panic attack. With this activity, you will identify 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste. Engaging with your 5 senses will help you to become tuned into your body, which is easy to disconnect from when it feels like it is betraying you during a panic attack. However, it brings you into the present moment and forces you to slow down and notice your surroundings, which is inherently calming. 

Try doing these even when you don’t have anxiety to intentionally accustom yourself with how relaxation and activity feel differently in your body. This will also help you to know what to do when you are anxious and have limited cognitive resources to devote to coping. However, trying out many techniques (even ones not listed here) will help you to have multiple strategies to employ when needed.