What is the importance of exercise during the skills acquisition phase of Cognitive Behavioral Therapy (CBT)?

From the Guidelines

The answer is "All of the above." During the skills and acquisition phase of Cognitive Behavioral Therapy (CBT), exercise is important for multiple reasons.

Key Benefits of Exercise in CBT

• It simultaneously builds physical strength, flexibility, and endurance, which helps patients improve their physical functioning, as supported by a systematic review by Brosseau et al in 2008 that found strengthening exercises had a clinically and statistically significant benefit in reducing disability 1.
• Exercise also bolsters the patient's sense of control over their body and situation, which is psychologically beneficial during therapy.
• Additionally, exercise provides pain relief, potentially through the activation of endogenous opioid systems in the brain, as suggested by the findings of a meta-analysis by Nüesch et al that evaluated the efficacy of aerobic exercise in patients with FMS and found a statistical benefit of aerobic exercise in improving quality of life and pain 1. These combined benefits make exercise a valuable component of CBT, particularly for patients dealing with chronic pain or physical limitations. The multifaceted advantages of exercise support both the physical and psychological aspects of recovery that CBT aims to address, with exercise being a crucial element in enhancing the overall effectiveness of CBT. Furthermore, the recommendation for exercise in CBT is based on high-quality evidence, including randomized controlled trials and meta-analyses, such as the study by Donta et al in 2003, which reported that exercise alone and in combination with cognitive-behavioral therapy improved fatigue, distress, cognitive symptoms, and mental health functioning in patients with FMS 1.

From the Research

Importance of Exercise in CBT Skills Acquisition Phase

• Exercise is important during the skills and acquisition phase of CBT because it:
  • Builds strength, flexibility, and endurance
  • Bolsters the patient’s sense of control
  • Provides pain relief, potentially through opioid activation
  • All of the above, as exercise has been shown to have a positive impact on both physical and mental health 2, 3, 4, 5

Relationship Between Exercise and CBT

• Studies have demonstrated that exercise, in combination with CBT, can be an effective treatment for chronic pain and opioid use disorder 2, 3, 5
• Exercise has been shown to reduce pain severity and sensitivity, improve physical function, and enhance overall well-being 3, 4, 5
• The use of exercise as a coping strategy for chronic pain is supported by research, which suggests that it can be a valuable adjunct to traditional CBT approaches 4, 6

Mechanisms Underlying Exercise and CBT

• The mechanisms underlying the benefits of exercise in CBT are not fully understood, but may involve the activation of opioid receptors, reduction of inflammation, and enhancement of cognitive function 2, 3, 5
• Further research is needed to fully elucidate the relationships between exercise, CBT, and chronic pain management 2, 3, 4, 5, 6