The Resistance Exercise Training for Worry Trial: Replication and Expansion

A recent clinical trial supported the anxiolytic effects of regularly-performed resistance exercise training compared to a waitlist control among young adults with and without at least subclinical, or analogue, Generalized Anxiety Disorder. Although the evidence to date is promising, waitlist control conditions cannot control for potential social and psychological benefits of engaging with most interventions, including social contact, expectations for improvement, and mastery experiences, which could potentially be achieved from easier activities. Therefore, this trial aims to replicate the previously investigated World Health Organization and American College of Sports Medicine guidelines-based resistance exercise training program, and expand on this research by more rigorously examining the effects on anxiety and worry symptoms, independent of potential social and psychological benefits of engagement with the intervention. Consequently, this trial quantifies the acute and chronic effects of moderate-to-high intensity, guidelines-based resistance exercise training compared to a low intensity SHAM attention control on signs and symptoms of Generalized Anxiety Disorder among at-risk young adult women with Analogue Generalized Anxiety Disorder. This trial consists of a two-week familiarization protocol, eight weeks of formal resistance exercise training, and a one-month post-intervention follow-up.

• Moderate-to-High Intensity Resistance Exercise Training (Behavioral), also known as Strength training, Weight-lifting: Resistance exercise training was designed in accordance with World Health Organization and American College of Sports Medicine guidelines. The eight-week, twice-weekly intervention was designed such that moderate-to-high intensity participants could achieve two sets of 8-12 repetitions of the eight exercises before volitional fatigue, a deterioration in lifting form, or failure to complete a repetition, using loads of approximately 70-80% of their estimated one-repetition maximum. Completed in the following order, the exercises were: barbell back squat, barbell bench press, hexagon bar deadlift, barbell bent over row, dumbbell lunges, seated dumbbell lateral raises, weighted or unweighted abdominal crunches, and seated dumbbell bicep curls. There was one minute of rest between each set, and two minutes of rest between each exercise. If participants could complete two sets of 12 repetitions, load was increased gradually by approximately 5% in the following session.
• Low Intensity SHAM Resistance Exercise Training Attention Control (Behavioral): The low intensity SHAM condition was matched all features of engagement with the moderate-to-high intensity intervention apart from load, and load progression. Low intensity SHAM participants completed the same program with loads of approximately 20% of their estimated one-repetition maximum. To maintain low intensity, repetitions completed on the main, heavier lifts (i.e., back squat, bench press, deadlift, bent over row) were increased from 10 in one session to 12 in the next; load was then increased by approximately 10% in the following session, and 10 reps were performed again. On the remaining lighter, assistance lifts, eight repetitions were performed per set, then one repetition was added to both sets in each session, and load was increased by the smallest increment possible when two sets of 12 repetitions were performed. Borg's 6-20 rating of perceived exertion scores were used to monitor intensity, such that if scores exceeded 11, load and reps were not progressed.

Primary outcomes

• Analogue Generalized Anxiety Disorder Status [Baseline]: Psychiatric Diagnostic Screening Questionnaire Generalized Anxiety Disorder subscale score of 6 or greater (Zimmerman \& Mattia, 2001)
• Analogue Generalized Anxiety Disorder Status [Week 1]: Psychiatric Diagnostic Screening Questionnaire Generalized Anxiety Disorder subscale score of 6 or greater (Zimmerman \& Mattia, 2001)
• Analogue Generalized Anxiety Disorder Status [Week 4]: Psychiatric Diagnostic Screening Questionnaire Generalized Anxiety Disorder subscale score of 6 or greater (Zimmerman \& Mattia, 2001)
• Analogue Generalized Anxiety Disorder Status [Week 8]: Psychiatric Diagnostic Screening Questionnaire Generalized Anxiety Disorder subscale score of 6 or greater (Zimmerman \& Mattia, 2001)
• Analogue Generalized Anxiety Disorder Status [Week 12]: Psychiatric Diagnostic Screening Questionnaire Generalized Anxiety Disorder subscale score of 6 or greater (Zimmerman \& Mattia, 2001)
• Analogue Generalized Anxiety Disorder Status [Baseline]: Penn State Worry Questionnaire of 45 or greater (Meyer et al., 1990)
• Analogue Generalized Anxiety Disorder Status [Week 1]: Penn State Worry Questionnaire of 45 or greater (Meyer et al., 1990)
• Analogue Generalized Anxiety Disorder Status [Week 4]: Penn State Worry Questionnaire of 45 or greater (Meyer et al., 1990)
• Analogue Generalized Anxiety Disorder Status [Week 8]: Penn State Worry Questionnaire of 45 or greater (Meyer et al., 1990)
• Analogue Generalized Anxiety Disorder Status [Week 12]: Penn State Worry Questionnaire of 45 or greater (Meyer et al., 1990)
• Worry Symptoms [Baseline]: 16-item Penn State Worry Questionnaire (Meyer et al., 1990)
• Worry Symptoms [Pre-week 1]: 16-item Penn State Worry Questionnaire (Meyer et al., 1990)
• Worry Symptoms [Week 1]: 16-item Penn State Worry Questionnaire (Meyer et al., 1990)
• Worry Symptoms [Week 2]: 16-item Penn State Worry Questionnaire (Meyer et al., 1990)
• Worry Symptoms [Week 3]: 16-item Penn State Worry Questionnaire (Meyer et al., 1990)
• Worry Symptoms [Week 4]: 16-item Penn State Worry Questionnaire (Meyer et al., 1990)
• Worry Symptoms [Week 5]: 16-item Penn State Worry Questionnaire (Meyer et al., 1990)
• Worry Symptoms [Week 6]: 16-item Penn State Worry Questionnaire (Meyer et al., 1990)
• Worry Symptoms [Week 7]: 16-item Penn State Worry Questionnaire (Meyer et al., 1990)
• Worry Symptoms [Week 8]: 16-item Penn State Worry Questionnaire (Meyer et al., 1990)
• Worry Symptoms [Week 12]: 16-item Penn State Worry Questionnaire (Meyer et al., 1990)

Secondary outcomes

• Anxiety Symptoms [Baseline]: Trait anxiety was measured using the Trait (STAI-Y2) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Anxiety Symptoms [Pre-week 1]: Trait anxiety was measured using the Trait (STAI-Y2) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Anxiety Symptoms [Week 1]: Trait anxiety was measured using the Trait (STAI-Y2) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Anxiety Symptoms [Week 2]: Trait anxiety was measured using the Trait (STAI-Y2) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Anxiety Symptoms [Week 3]: Trait anxiety was measured using the Trait (STAI-Y2) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Anxiety Symptoms [Week 4]: Trait anxiety was measured using the Trait (STAI-Y2) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Anxiety Symptoms [Week 5]: Trait anxiety was measured using the Trait (STAI-Y2) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Anxiety Symptoms [Week 6]: Trait anxiety was measured using the Trait (STAI-Y2) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Anxiety Symptoms [Week 7]: Trait anxiety was measured using the Trait (STAI-Y2) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Anxiety Symptoms [Week 8]: Trait anxiety was measured using the Trait (STAI-Y2) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Anxiety Symptoms [Week 12]: Trait anxiety was measured using the Trait (STAI-Y2) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Anxiety Symptoms [Baseline]: State anxiety was measured using the State (STAI-Y1) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Anxiety Symptoms [Pre-acute resistance exercise bout week 1]: State anxiety was measured using the State (STAI-Y1) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Anxiety Symptoms [Post-acute resistance exercise bout week 1]: State anxiety was measured using the State (STAI-Y1) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Anxiety Symptoms [Pre-acute resistance exercise bout week 8]: State anxiety was measured using the State (STAI-Y1) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Anxiety Symptoms [Post-acute resistance exercise bout week 8]: State anxiety was measured using the State (STAI-Y1) subscale of the State-Trait Anxiety Inventory (Spielberger, 2010)
• Depressive Symptoms [Baseline]: 16-item Quick Inventory of Depressive Symptomatology (Rush et al., 2003)
• Depressive Symptoms [Pre-week 1]: 16-item Quick Inventory of Depressive Symptomatology (Rush et al., 2003)
• Depressive Symptoms [Week 1]: 16-item Quick Inventory of Depressive Symptomatology (Rush et al., 2003)
• Depressive Symptoms [Week 2]: 16-item Quick Inventory of Depressive Symptomatology (Rush et al., 2003)
• Depressive Symptoms [Week 3]: 16-item Quick Inventory of Depressive Symptomatology (Rush et al., 2003)
• Depressive Symptoms [Week 4]: 16-item Quick Inventory of Depressive Symptomatology (Rush et al., 2003)
• Depressive Symptoms [Week 5]: 16-item Quick Inventory of Depressive Symptomatology (Rush et al., 2003)
• Depressive Symptoms [Week 6]: 16-item Quick Inventory of Depressive Symptomatology (Rush et al., 2003)
• Depressive Symptoms [Week 7]: 16-item Quick Inventory of Depressive Symptomatology (Rush et al., 2003)
• Depressive Symptoms [Week 8]: 16-item Quick Inventory of Depressive Symptomatology (Rush et al., 2003)
• Depressive Symptoms [Week 12]: 16-item Quick Inventory of Depressive Symptomatology (Rush et al., 2003)
• Mood [Baseline]: Subscales of the Profile of Mood States - Brief Form (McNair et al., 1992)
• Mood [Pre-week 1]: Subscales of the Profile of Mood States - Brief Form (McNair et al., 1992)
• Mood [Week 1]: Subscales of the Profile of Mood States - Brief Form (McNair et al., 1992)
• Mood [Week 2]: Subscales of the Profile of Mood States - Brief Form (McNair et al., 1992)
• Mood [Week 3]: Subscales of the Profile of Mood States - Brief Form (McNair et al., 1992)
• Mood [Week 4]: Subscales of the Profile of Mood States - Brief Form (McNair et al., 1992)
• Mood [Week 5]: Subscales of the Profile of Mood States - Brief Form (McNair et al., 1992)
• Mood [Week 6]: Subscales of the Profile of Mood States - Brief Form (McNair et al., 1992)
• Mood [Week 7]: Subscales of the Profile of Mood States - Brief Form (McNair et al., 1992)
• Mood [Week 8]: Subscales of the Profile of Mood States - Brief Form (McNair et al., 1992)
• Mood [Week 12]: Subscales of the Profile of Mood States - Brief Form (McNair et al., 1992)
• Mood [Pre-acute resistance exercise bout week 1]: Subscales of the Profile of Mood States - Brief Form (McNair et al., 1992)
• Mood [Post-acute resistance exercise bout week 1]: Subscales of the Profile of Mood States - Brief Form (McNair et al., 1992)
• Mood [Pre-acute resistance exercise bout week 8]: Subscales of the Profile of Mood States - Brief Form (McNair et al., 1992)
• Mood [Post-acute resistance exercise bout week 8]: Subscales of the Profile of Mood States - Brief Form (McNair et al., 1992)
• Analogue Major Depressive Disorder Status [Baseline]: Psychiatric Diagnostic Screening Questionnaire Major Depressive Disorder subscale score of 9 or greater (Zimmerman \& Mattia, 2001)
• Analogue Major Depressive Disorder Status [Week 1]: Psychiatric Diagnostic Screening Questionnaire Major Depressive Disorder subscale score of 9 or greater (Zimmerman \& Mattia, 2001)
• Analogue Major Depressive Disorder Status [Week 4]: Psychiatric Diagnostic Screening Questionnaire Major Depressive Disorder subscale score of 9 or greater (Zimmerman \& Mattia, 2001)
• Analogue Major Depressive Disorder Status [Week 8]: Psychiatric Diagnostic Screening Questionnaire Major Depressive Disorder subscale score of 9 or greater (Zimmerman \& Mattia, 2001)
• Analogue Major Depressive Disorder Status [Week 12]: Psychiatric Diagnostic Screening Questionnaire Major Depressive Disorder subscale score of 9 or greater (Zimmerman \& Mattia, 2001)
• Analogue Panic Disorder Status [Baseline]: Psychiatric Diagnostic Screening Questionnaire Panic Disorder subscale score of 4 or greater (Zimmerman \& Mattia, 2001)
• Analogue Panic Disorder Status [Week 1]: Psychiatric Diagnostic Screening Questionnaire Panic Disorder subscale score of 4 or greater (Zimmerman \& Mattia, 2001)
• Analogue Panic Disorder Status [Week 4]: Psychiatric Diagnostic Screening Questionnaire Panic Disorder subscale score of 4 or greater (Zimmerman \& Mattia, 2001)
• Analogue Panic Disorder Status [Week 8]: Psychiatric Diagnostic Screening Questionnaire Panic Disorder subscale score of 4 or greater (Zimmerman \& Mattia, 2001)
• Analogue Panic Disorder Status [Week 12]: Psychiatric Diagnostic Screening Questionnaire Panic Disorder subscale score of 4 or greater (Zimmerman \& Mattia, 2001)
• Analogue Social Anxiety Disorder Status [Baseline]: Psychiatric Diagnostic Screening Questionnaire Social Anxiety Disorder subscale score of 4 or greater (Zimmerman \& Mattia, 2001)
• Analogue Social Anxiety Disorder Status [Week 1]: Psychiatric Diagnostic Screening Questionnaire Social Anxiety Disorder subscale score of 4 or greater (Zimmerman \& Mattia, 2001)
• Analogue Social Anxiety Disorder Status [Week 4]: Psychiatric Diagnostic Screening Questionnaire Social Anxiety Disorder subscale score of 4 or greater (Zimmerman \& Mattia, 2001)
• Analogue Social Anxiety Disorder Status [Week 8]: Psychiatric Diagnostic Screening Questionnaire Social Anxiety Disorder subscale score of 4 or greater (Zimmerman \& Mattia, 2001)
• Analogue Social Anxiety Disorder Status [Week 12]: Psychiatric Diagnostic Screening Questionnaire Social Anxiety Disorder subscale score of 4 or greater (Zimmerman \& Mattia, 2001)
• Sleep Quality [Baseline]: Pittsburgh Sleep Quality Index (Buysse et al., 1989)
• Sleep Quality [Week 1]: Pittsburgh Sleep Quality Index (Buysse et al., 1989)
• Sleep Quality [Week 4]: Pittsburgh Sleep Quality Index (Buysse et al., 1989)
• Sleep Quality [Week 8]: Pittsburgh Sleep Quality Index (Buysse et al., 1989)
• Sleep Quality [Week 12]: Pittsburgh Sleep Quality Index (Buysse et al., 1989)
• Irritability Symptoms [Baseline]: 21-item Irritability Questionnaire (Craig et al., 2008)
• Irritability Symptoms [Week 1]: 21-item Irritability Questionnaire (Craig et al., 2008)
• Irritability Symptoms [Week 4]: 21-item Irritability Questionnaire (Craig et al., 2008)
• Irritability Symptoms [Week 8]: 21-item Irritability Questionnaire (Craig et al., 2008)
• Irritability Symptoms [Week 12]: 21-item Irritability Questionnaire (Craig et al., 2008)
• Rumination [Baseline]: Rumination-Reflection Questionnaire (Trapnell and Campbell, 1999)
• Rumination [Week 1]: Rumination-Reflection Questionnaire (Trapnell and Campbell, 1999)
• Rumination [Week 4]: Rumination-Reflection Questionnaire (Trapnell and Campbell, 1999)
• Rumination [Week 8]: Rumination-Reflection Questionnaire (Trapnell and Campbell, 1999)
• Rumination [Week 12]: Rumination-Reflection Questionnaire (Trapnell and Campbell, 1999)
• Cognitive Functioning [Baseline]: Stroop Colour and Word Test (Williams et al., 1996)
• Cognitive Functioning [Pre-acute resistance exercise bout week 1]: Stroop Colour and Word Test (Williams et al., 1996)
• Cognitive Functioning [Post-acute resistance exercise bout week 1]: Stroop Colour and Word Test (Williams et al., 1996)
• Cognitive Functioning [Pre-acute resistance exercise bout week 8]: Stroop Colour and Word Test (Williams et al., 1996)
• Cognitive Functioning [Post-acute resistance exercise bout week 8]: Stroop Colour and Word Test (Williams et al., 1996)
• Cognitive Functioning [Week 8]: Stroop Colour and Word Test (Williams et al., 1996)
• Cognitive Functioning [Baseline]: Trail Making Test (Tombaugh, 2004)
• Cognitive Functioning [Pre-acute resistance exercise bout week 1]: Trail Making Test (Tombaugh, 2004)
• Cognitive Functioning [Post-acute resistance exercise bout week 1]: Trail Making Test (Tombaugh, 2004)
• Cognitive Functioning [Pre-acute resistance exercise bout week 8]: Trail Making Test (Tombaugh, 2004)
• Cognitive Functioning [Post-acute resistance exercise bout week 8]: Trail Making Test (Tombaugh, 2004)
• Cognitive Functioning [Week 8]: Trail Making Test (Tombaugh, 2004)
• Resistance Exercise Expectations [Baseline]: 15-item Expected Psychological Outcomes of Resistance Exercise Training (EPO-RET) questionnaire, derived from the Expected Psychological Outcomes of Exercise Questionnaire (Lindheimer et al., 2020). Participants were asked "For each of the below outcomes, think about how you would expect to feel after completing a resistance exercise program (2 sessions per week for 8-12 weeks) relative to how you typically feel".
• Resistance Exercise Expectations [Week 1]: 15-item Expected Psychological Outcomes of Resistance Exercise Training (EPO-RET) questionnaire, derived from the Expected Psychological Outcomes of Exercise Questionnaire (Lindheimer et al., 2020). Participants were asked "For each of the below outcomes, think about how you would expect to feel after completing a resistance exercise program (2 sessions per week for 8-12 weeks) relative to how you typically feel".
• Resistance Exercise Expectations [Week 4]: 15-item Expected Psychological Outcomes of Resistance Exercise Training (EPO-RET) questionnaire, derived from the Expected Psychological Outcomes of Exercise Questionnaire (Lindheimer et al., 2020). Participants were asked "For each of the below outcomes, think about how you would expect to feel after completing a resistance exercise program (2 sessions per week for 8-12 weeks) relative to how you typically feel".
• Resistance Exercise Expectations [Week 8]: 15-item Expected Psychological Outcomes of Resistance Exercise Training (EPO-RET) questionnaire, derived from the Expected Psychological Outcomes of Exercise Questionnaire (Lindheimer et al., 2020). Participants were asked "For each of the below outcomes, think about how you would expect to feel after completing a resistance exercise program (2 sessions per week for 8-12 weeks) relative to how you typically feel".
• Resistance Exercise Expectations [Week 12]: 15-item Expected Psychological Outcomes of Resistance Exercise Training (EPO-RET) questionnaire, derived from the Expected Psychological Outcomes of Exercise Questionnaire (Lindheimer et al., 2020). Participants were asked "For each of the below outcomes, think about how you would expect to feel after completing a resistance exercise program (2 sessions per week for 8-12 weeks) relative to how you typically feel".
• Resistance Exercise Expectations [Pre-acute resistance exercise bout week 1]: 15-item Expected Psychological Outcomes of Acute Resistance Exercise (EPO-ARE) derived from the Expected Psychological Outcomes of Exercise Questionnaire (Lindheimer et al., 2020). Participants are asked to "think about how you would expect to feel after one resistance exercise workout relative to how you typically feel".
• Resistance Exercise Expectations [Post-acute resistance exercise bout week 1]: 15-item Expected Psychological Outcomes of Acute Resistance Exercise (EPO-ARE) derived from the Expected Psychological Outcomes of Exercise Questionnaire (Lindheimer et al., 2020). Participants are asked to "think about how you would expect to feel after one resistance exercise workout relative to how you typically feel".
• Resistance Exercise Expectations [Pre-acute resistance exercise bout week 8]: 15-item Expected Psychological Outcomes of Acute Resistance Exercise (EPO-ARE) derived from the Expected Psychological Outcomes of Exercise Questionnaire (Lindheimer et al., 2020). Participants are asked to "think about how you would expect to feel after one resistance exercise workout relative to how you typically feel".
• Resistance Exercise Expectations [Post-acute resistance exercise bout week 8]: 15-item Expected Psychological Outcomes of Acute Resistance Exercise (EPO-ARE) derived from the Expected Psychological Outcomes of Exercise Questionnaire (Lindheimer et al., 2020). Participants are asked to "think about how you would expect to feel after one resistance exercise workout relative to how you typically feel".
• Physical Activity [Baseline]: 7-day Physical Activity Recall (Blair et al., 1985)
• Physical Activity [Pre-week 1]: 7-day Physical Activity Recall (Blair et al., 1985)
• Physical Activity [Week 1]: 7-day Physical Activity Recall (Blair et al., 1985)
• Physical Activity [Week 2]: 7-day Physical Activity Recall (Blair et al., 1985)
• Physical Activity [Week 3]: 7-day Physical Activity Recall (Blair et al., 1985)
• Physical Activity [Week 4]: 7-day Physical Activity Recall (Blair et al., 1985)
• Physical Activity [Week 5]: 7-day Physical Activity Recall (Blair et al., 1985)
• Physical Activity [Week 6]: 7-day Physical Activity Recall (Blair et al., 1985)
• Physical Activity [Week 7]: 7-day Physical Activity Recall (Blair et al., 1985)
• Physical Activity [Week 8]: 7-day Physical Activity Recall (Blair et al., 1985)
• Physical Activity [Week 12]: 7-day Physical Activity Recall (Blair et al., 1985)
• Muscle-Strengthening Exercise Activity [Baseline]: Muscle-Strengthening Exercise Questionnaire - Short Version (Shakespear-Druery et al., 2022)
• Muscle-Strengthening Exercise Activity [Week 1]: Muscle-Strengthening Exercise Questionnaire - Short Version (Shakespear-Druery et al., 2022)
• Muscle-Strengthening Exercise Activity [Week 4]: Muscle-Strengthening Exercise Questionnaire - Short Version (Shakespear-Druery et al., 2022)
• Muscle-Strengthening Exercise Activity [Week 8]: Muscle-Strengthening Exercise Questionnaire - Short Version (Shakespear-Druery et al., 2022)
• Muscle-Strengthening Exercise Activity [Week 12]: Muscle-Strengthening Exercise Questionnaire - Short Version (Shakespear-Druery et al., 2022)

Sex: Female, ages: 18 Years to 40 Years

Inclusion Criteria:

* Female
* Aged 18-40y
* Met criteria for analogue Generalized Anxiety Disorder

Exclusion Criteria:

* Medical contraindications to doing resistance exercise training
* Currently involved in formal resistance exercise training
* Currently pregnant or post-partum

• Matthew P. Herring, PhD, Principal investigator, University of Limerick