Yes, Workout-Induced Panic Attacks Are a Real Thing

Experts talk about how exercise can spiral into panic, and what to do if you start heading down that path.

There's nothing more exhilarating than a good run when that boost of endorphins makes you feel like you're on top of the world.

However, for some people, that workout high can feel dangerously high. Instead of a rush of wellbeing, feelings of intense anxiety can follow a strenuous workout, causing disorientating symptoms such as heart palpitations, dizziness, and an overwhelming sense of dread.

Yep, it's a panic attack, and it can be completely debilitating, says Eva Ritvo, M.D., a Miami-based psychiatrist—so much so that people will even confuse these paralyzing symptoms with those of a heart attack.

Does this sound mildly familiar? Read on for more insight into why workout-induced panic attacks can happen, what they feel like, and what to do if you think you're at risk.

Panic Attacks: The Basics

To understand how workout-induced panic attacks happen, it's helpful to paint a picture of what happens in your body during a regular panic attack.

"A panic attack is a state of extreme arousal that doesn't match the situation, and usually feels very unpleasant," says Dr. Ritvo.

Panic attacks start inside part of the brain called the amygdala, which is referred to as the "fear center" and plays a critical role in your response to threatening situations, according to Ashwini Nadkarni, M.D., an associate psychiatrist at Harvard Medical School. "Any time you're faced with some sort of fear-inducing stimulus, your brain will take the sensory information from that threat stimulus (for instance, could be visual, tactile, or in the case of exercise, bodily sensations) and convey it to the amygdala," she says.

Once the amygdala is ignited, it sets off a cascade of events inside the body, says Dr. Nadkarni. This often activates the sympathetic nervous system (which induces the body's fight or flight response) and triggers the release of large amounts of adrenaline. This, in turn, often produces the telltale symptoms of a panic attack: palpitations, pounding or accelerated heart rate, sweating, trembling or shaking, shortness of breath, chest pain, and more.

What Causes Exercise-Induced Panic Attacks?

There are a few different factors at play when you're having an exercise-enduced panic attack vs. a regular panic attack.

For starters, an excess of lactic acid can be one of the major reasons behind an attack, says Dr. Ritvo. ICYDK, lactic acid is a compound your body creates during intense workouts. You might think of it as the reason behind your sore muscles, but that build-up of lactic acid affects your brain as well. Some people have more difficulty clearing lactic acid from their brain than others, says Dr. Ritvo. As this acid builds up, it can cause the amygdala to over-fire, ultimately leading to a panic attack.

"When you breathe really fast or hyperventilate, it causes changes in your levels of carbon dioxide and oxygen in your blood," explains Dr. Nadkarni. "This, in turn, causes brain blood vessels to narrow and lactic acid build up in the brain. The amygdala's sensitivity to this acidity (or 'over-firing') is part of what makes certain people more vulnerable to panic."

woman having panic attack during workout anxiety
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Also, elevated heart rate and breathing rate (which are both synonymous with exercise) both cause a release of cortisol, the body's stress hormone, says Dr. Ritvo. For some people, it dials-in your workout performance; for others, that cortisol can lead to increased perspiration and limited focus, which can ignite feelings of hyperarousal and panic.

Dr. Nadkarni breaks it down:

Ashwini Nadkarni, M.D.

"Among the symptoms of panic attacks are shallow breathing, a racing heart, sweating palms and the feeling that you're having an out-of-body experience—and it also happens to be the case that when you exercise, your heart rate goes up, you breathe faster, and you sweat.

This, of course, is perfectly normal. But if you have anxiety or, on one random occasion, pay closer attention or too much attention to your body's level of arousal, you might misinterpret your body's normal reaction to exercise, and a panic attack can result. If you then experience fear of feeling this way again, the dread of future panic attacks is what comes together to define a panic disorder."

— Ashwini Nadkarni, M.D.

Who's at risk for exercise-induced panic attacks? It's not likely for just anyone to panic in spin class; people who have an underlying anxiety or panic disorder (whether diagnosed or otherwise) are more prone to have a workout-induced panic attack, says Dr. Nadkarni. "Studies show that people with panic disorder are genetically more sensitive to inhaling carbon dioxide, which increases brain acidity," she says. "Lactate is always produced and cleared in the brain —even if you're not diagnosed with any sort of mood disorder—but a genetic tendency to generate it and accumulate it can increase both someone's tendency to experience panic attacks in general and risk for panic attacks during workouts."

Are Some Exercises More Triggering Than Others?

While a run or Zumba class may be stress-relieving for some people, aerobic exercises like these can often induce panic attacks in patients with panic disorder, says Dr. Nadkarni.

Aerobic (or cardio) exercise, by nature, uses a lot of oxygen. (The word "aerobic" itself means "requiring oxygen.") Your body is forced to circulate blood faster in order to get oxygen to your muscles, which elevates your heart rate and mandates that you to take faster and deeper breaths. Because these two things increase cortisol in the body and trigger hyperarousal, aerobic exercise can be more likely to cause a panic attack than, say, a slow weight lifitng session or barre class, which don't elevate your heart and breathing rate as much.

It's worth noting, though, that the exercise itself isn't to blame; it's all about how your body is responding to the exercise.

Dr. Nadkarni

"A certain heart rate is not what triggers panic, but rather, how a person interprets their normal bodily function during exercise."

— Dr. Nadkarni

And, over time, engaging in regular cardio exercise can actually help. New research looked at the effects of aerobic exercise on anxiety symptoms in patients with panic disorder (PD), and found that aerobic exercise does cause an acute increase in anxiety—but that the gradual practice of aerobic exercises promotes a reduction in overall anxiety levels, according to a recent study published by the journal Clinical Practice & Epidemiology in Mental Health. Why? It comes back to that lactic acid build-up: "It's hypothesized that exercise can reduce anxiety by improving the brain's ability to prevent lactic acid accumulation," says Dr. Nadkarni.

So if you properly ease your way into cardio exercise and do it regularly, it can help reduce overall anxiety (in addition to improving cardiovascular health and reducing symptoms of depression in some participants, according to the study).

What to Do If You're Working Out and Have a Panic Attack

If you're having a panic attack while exercising, there a few things you can do to help calm yourself down, according to Dr. Ritvo:

  • Stop exercising and see if you can slow your heart rate down.
  • Try deep breathing exercises [below].
  • If you're working out inside, get some fresh air (if possible).
  • Take a warm shower or bath, if you have one accessible.
  • Talking to or phoning a friend often relieves anxiety.
  • It may feel good to stretch or lay down until the anxiety decreases.

Try these two breathing exercises recommended by Dr. Ritvo to reduce anxiety:

4-7-8 breathing method: Inhale slowly for four counts, hold for seven counts, then exhale for eight counts.

Box breathing technique: Inhale for four counts, hold for four counts, exhale for four counts, then pause for four counts before inhaling again.

If you spiraled out of control during a recent workout, your best bet is (you guessed it!) to see your doctor. Dr. Ritvo advises talking with your physician about booking an appointment with a psychiatrist since these trained professionals can prescribe medications to help those suffering from debilitating anxietyor help you find ways to manage it. (P.S. Did you know there are tons of therapy apps now?)

How to Prevent Workout-Induced Panic Attacks

When you want to get back into the swing of things workout-wise, it's helpful to get to know how much exercise your body can tolerate so you don't trigger panic attacks, says Dr. Ritvo.

Workouts like Pilates or yoga can be really beneficial since they combine breath with movement and helps you focus on taking long, slow breaths. It also allows for moments of relaxation between active poses, which ultimately allows your heart and respiratory rates to slow down.

But since exercising your heart is important, you can't skip cardio forever. Dr. Ritvo suggests working your way back up to more aerobic exercises. Brisk walking is a great place to start, as you can easily slow down or stop if you feel your heart is racing too fast, she says. (Try this walking workout with a few butt exercises thrown in.)

Long term, engaging in certain practices (like stretching and doing breathing exercises) regularly can help keep panic at bay. "Panic attacks are overfilling of the sympathetic nervous system," says Dr. Ritvo. "Anything you can do to strengthen the opposite side of your nervous system may be helpful in preventing future panic attacks."

Eva Ritvo, M.D.

"Panic attacks are overfilling of the sympathetic nervous system. Anything you can do to strengthen the opposite side of your nervous system may be helpful in preventing future panic attacks."

— Eva Ritvo, M.D.

Taking care of someone else, feeling connected to others, relaxing over a bite to eat, resting (which can be getting proper sleep each night, taking a nap, getting a massage, taking a warm bath or shower, etc.), taking a few slow deep breaths, meditating, and listening to a relaxation tape or soft music are all activites that help stimulate the parasympathetic side of the nervous system, says Dr. Ritvo.

"Do these things regularly so your nervous system comes back to a healthier balance," she says. "Many of us are overstimulated and live in a constant state of anxiety. This makes us more prone to a panic attack from whatever our unique trigger may be."

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