Performance Anxiety Changes With Exercise (PACE)

Clinical, Neuroendocrine and Physiological Effects of Exercise in Patients With Music Performance Anxiety

This study investigates the effect of high-intense aerobe exercise training (HIIT) and aerobe exercise of low intensity on clinical and physiological parameters (anxiety, activity, cortisol, alpha amylase, heart rate, heart rate variability, spiroergometry) in patients with Music Performance Anxiety (MPA). Half of the patients will receive HIIT, while the other half will receive aerobe exercise of low intensity.

In this study, 20 patients with MPA will receive a high-intensive aerobe training (HIIT, 6 HIIT-sessions of 20 minutes within a period of 12 days). Additionally, 20 MPA-patients will undergo a less intense aerobe training matched regarding frequency and duration of sessions. Prior to the first training session, after completing the training (day 12) and 10 days after the Training (day 22), symptoms of anxiety and will be assessed by using questionnaires. Moreover, heart rate and heart rate variability will be obtained and activity level is measured using accelerometers. Before and after the training there will be an assessment of saliva samples for measuring cortisol and alpha amylase. Furthermore, a standardized performance situation is established before and after the Training. Before, during and after the performance anxiety ratings, cortisol, alpha amylase, heart rate and heart rate variability are assessed. The investigators hypothesize, that patients with MPA which undergo HIIT, will show a stronger and more sustained improvement of both, clinical symptoms and physiological measures. Specifically, a decreased heart rate, higher heart rate variability and decreased endocrinological parameters.

Aerobe bicycle ergometer training within 77-95% of maximum oxygen consumption; duration of each training session: 20 minutes; frequency of training: 6 sessions within 12 days

Aerobe training below 70% of maximum oxygen consumption (including light stretching and simple exercises adapted from yoga figures); duration of training session: 20 minutes; frequency of training: 6 sessions within 12 days

Aerobe bicycle ergometer training within 77-95% of maximum oxygen consumption; duration of each training session: 20 minutes; frequency of training: 6 sessions within 12 days

Aerobe training below 70% of maximum oxygen consumption (including light stretching and simple exercises adapted from yoga figures); duration of training session: 20 minutes; frequency of training: 6 sessions within 12 days

Bühnenangstfragebogen is a questionnaire measuring Music Performance Anxiety. It is the German Version of the PAQ (Performance Anxiety Questionnaire)

personality inventory measuring neuroticism, extraversion, openness to experience, agreeableness, conscientiousness

SPK is the German Version of the social cognitions questionnaire. It measures cognitions in social situations

Cortisol is an established marker of the psychophysiological stress response and obtained with help of Salivettes absorbing saliva

Alpha amylase is an established marker of the psychophysiological stress Response and obtained with help of Salivettes absorbing saliva

From Baseline to post therapy (+12 days) and during performance situations 1 (Baseline) and 2 (+15 days)

Change from Baseline to post therapy (+12 days), from Baseline to Follow-up and during performance situations 1 (Baseline) and 2 (+15 days)

Change from Baseline to post therapy (+12 days), from Baseline to follow-up (+22 days) and during performance situations 1 (Baseline) and 2 (+15 days)

Inclusion Criteria: Diagnosis of social anxiety disorder, Performance only subtype due to DSM-5 Appropriate abilities to communicate and to complete the questionnaires Written informed consent Possibility of regular attendance at the training sessions Participant is a classical instrumentalist Exclusion Criteria: Other severe mental conditions than MPA (e.g. schizophrenia, severe depressive episode, addiction) Acute suicidality Epilepsy or other disorders of the central nervous system (e.g. tumor, encephalitis) Contraindications to aerobe exercise Training Start or modification of an anxiolytic pharmacotherapy or other therapy within the last four weeks Current psychotherapy no sufficient capability to consent to trial