Psychological Responses to Acute Exercise in Patients With Stress-induced Exhaustion Disorder: a Cross-over Randomized Trial

Background Understanding acute psychological responses to physical exercise is important since they likely influence the initiation and maintenance of this behavior. Given its effectiveness in reducing symptoms in various psychological disorders, physical exercise should be further explored in Exhaustion Disorder (ED; ICD-10-SE: F43.8A), a condition characterized by persistent exhaustion following long-term psychosocial stress. Currently, no studies are available on the psychological effects of acute exercise in ED patients. Aims This study aims to (1) investigate the psychological responses to acute exercise in ED patients compared to healthy controls and (2) determine if these responses differ between low and moderate exercise intensities. Methods We conducted a two-armed cross-over trial in two groups: ED patients (n = 30) and healthy controls (n = 30). On two separate occasions, participants completed a 22-minute exercise at low or moderate intensity on a cycle ergometer, in randomized order. The main outcome was perceived fatigue, and secondary outcomes were feelings of energy, anxiety, stress, perceived exertion, and perceived psychological discomfort, all measured before, during, and up to 24 hours after exercise. Effects of the exercise conditions were assessed with repeated measures analysis of variance. Results ED patients reported higher exertion and psychological discomfort before and during exercise, higher fatigue, anxiety, and stress but lower energy throughout the trial compared to the controls. ED patients experienced more reduced fatigue and stress after both intensities (p < 0.05), and a more elevated energy after moderate-intensity exercise compared to controls (p < 0.05). No interactions between groups were found for anxiety over time. No differences were observed between pre-exercise and 6 hours or 24 hours post-exercise in any variables. The only intensity effect (p < 0.05) in the ED patients was a more pronounced energy decline 30 minutes after moderate-intensity exercise. Conclusions A 22-minute exercise was perceived as more strenuous by patients with exhaustion disorder and generated greater improvements in feelings of fatigue, energy, and stress compared to healthy individuals, without delayed negative changes. These findings can inform intervention design and guide clinical practice. Trial registration The study was retrospectively registered on 05/30/2024 at Clinical Trials.gov, with trial registration number 2022-04943-01.