Associate Professor and Head
Language Education Department
Faculty of Education,
The University of the Western Cape,
Bellville, Western Cape, Republic of South Africa.
Phone: Office 027-21 949-2449/ Cell: 091-725233933
Journal of English as an International Language
Asian EFL Journal
Excecutive Board Member
International TESOL Accrediting Authority
Date of birth: October 07, 1952
Languages: English (associate first language), Tamil (first language), Hindi (third language)
Summary of Qualifications
Ph.D. in Applied Linguistics/ English Studies
March 1999 – November 2003 (completed and passed viva voce),
University of Nottingham, United Kingdom. Graduated: July 8, 2004.
MA in (Linguistics) TESOL, 1997,
University of Surrey, United Kingdom.
MA in English, 1975,
University of Madras, India.
Recipient of St. Bernard’s Special Merit Award in 1998 for excellence in teaching and community service, Assumption University, Bangkok, Thailand.( Featured in Assumption University Hall of Fame)
Summary of Experience
I have over 30 years of experience as a professional in the field of ELT/ TESOL (adults). I have worked in various capacities and have served diverse secondary and tertiary institutions in India, Ethiopia, Thailand, Bahrain, Armenia, U.A.E. and South Africa.
International Professional Service
• November 1995- October 2002: Served the Thailand TESOL Executive Committee in the capacities of Secretary and Chair, SIG Literature and Literacy.
• August 2006 – August 2008: Served the Armenian English Language Teachers’ Association (AELTA) as Special Adviser.
• September 2006-August 2008: served as teacher development consultant for Peace Corps Armenia.
• November 2006 – present: Serving on the Editorial Board of the Asian EFL Journal, a prestigious international refereed journal. Since June 2007, I have been serving the journal as one of its Associate Editors and in this capacity, I oversee and coordinate editorial reviews and submissions across the world, supervise rewrites of papers accepted for publication in addition to providing advisory to the Senior Executive/Associate Editor on submissions that qualify for acceptance as well as rejection.
• August 25, 2010- Serving as Chief Editor of the Journal of English as an International Language (EILJ), an international refereed journal. In this capacity, I screen, and coordinate editorial reviews and submissions across the world. This will entail supervising and scrutinizing rewrites of papers accepted for publication in addition to providing both acceptance notification and rejection advisory to the authors. Furthermore, I oversee the final production stages of the journal’s issues twice a year, in addition to editing and writing foreword for every issue
Refereed Book chapters -3
Refereed/Peer Reviewed Journal Articles- 15
Edited collections and Forewords- 8
Forthcoming publications – 3
Conference Presentations- 20
Postgraduate Thesis Supervisions
MA/ M.Ed- 13
PhD- completed- 3, on-going- 2
External Refereeing of MA Theses: 3
MA/ MED Theses Examination: 4
I have received outstanding student evaluations throughout my teaching career. My students have always spoken highly of my human-centered approach to their learning and my sensitivity to their voice and agency.
Statement of Teaching Philosophy and Research Interests
My PhD, which is an ethnographic action research, investigates into the educational practice of reading and writing in an EFL/ESL classroom context and its implications for social and critical literacy. The study, which is a longitudinal classroom investigation, attempts a hermeneutic description of second language learning as a response phenomenon and underscores the urgency to view the phenomenon in interrelated terms with the help of a constructivist epistemology.
An uncritical acceptance and emphasis of modernist assumptions in our current practices of language education has done more harm than good to our student populations. Furthermore, the hegemony of a psycholinguistic/scientific research tradition in foreign and second language settings has reduced our students to statistical entities on spreadsheets denying them of their agency and subjecthood. Consequently, the research preoccupations with a psycholinguistic objectivity of inputs and outputs have neither enhanced our understanding of how and why our students learn a foreign/second language the way they do nor has it helped us come to terms with the social and cultural dimensions of their language learning. To the contrary, such preoccupations have promoted an unwholesome and asocial view of learning and living much to the detriment of language education.
If language education is to bring about constructive social change, empowerment and democratic citizenry, it should provide substantial opportunity for our students to engage with it emotionally and aesthetically. Only then will our students realize the beneficial impact of their interpretive and imaginative abilities in the use of their language and only then, will our students realize the immediacy and primacy of their meaning creations through their use of language. Such endeavours and outcomes are not only vital to our students’ language development but are also crucial to their emotional and intellectual development without which they will be defenseless in a world characterized by a culture of categorical stupidity and illiteracy.
The current prevalence of bibliometric/ calculable thinking, statistical data and the use of information technology in quantitative studies appear to promote objective, value free and atemporal knowledge of language development as the ultimate goal of language teaching research. Such a position contradicts what we experience in real life situations and contexts because our knowledge of daily living and learning is eminently subjective and unmistakably value-laden. Therefore it is a naivety to say that knowledge should be value-free if it is to be objective as the need to be value-free is in itself not free of value.
Viewed in the light of these observations, it is contingent on language educators to promote research and teaching practices which will capture the quintessential aspects of learning as a lived through experience and articulate the centrality of constructivist/hermeneutic understanding of students’ language development and qualitative/interpretive epistemologies. Needless to say that this stance underlies my publications and teaching repertoire, I wish to explore the following research themes further in my educational practice of teaching and research:
• Reader Response in EFL/ESL
• Critical Reading and Critical Literacies
• Imaginative Writing as a Basis for Rhetorical Maturity
• The Use of Interpretive Reading and Writing in EAP
• Literature in EFL/ESL
• The Use of Response Journals in Language Education
• The Use of Mastery-Models in EFL/ESL Testing Frameworks
• Text-Based Approaches to Academic Reading and Writing
• Reading-Teacher Development
• Figurative Language and its Educational Implications
• Narratives in Language Teaching Research
As I have a dual background in Literature and Applied linguistics in addition to a PhD in ELT, I believe that I am well-equipped to bring an inter-disciplinary perspective to the context of TESOL education and its specialist training/developmental needs in any given higher education setting. I further believe that my wide international teaching experience can provide the input, stimulus and synergy for classroom and community based research into the educational practices of reading and writing aimed at promoting constructive social change, critical and social literacies. In addition, it can lay the groundwork for vibrant innovative approaches to language teaching.
Ph.D. in Applied Linguistics /English Studies supervised by Professor Ronald Carter and co-supervised by Professor Alan Maley.
March 1999 – November 2003 (examined and completed), University of Nottingham, United Kingdom
Graduated: July 8, 2004
Thesis title: An Investigation of L2 Students’ Reading and Writing in a Literature –Based Language Programme
My PhD, which is an ethnographic action research project based on 250 hours of classroom work, investigates into the educational practice of reading and writing in a Thai TESOL classroom context along with its implications for social and critical literacy.
Implemented in two iterations, the study deployed personal-response, reader-response approaches to promote expressive and sociocultural models of reading and writing that were meant to address the current poverty of reading and writing endemic in second language education. Rejecting modernist assumptions in second language education and its preoccupations with a scientific/psycholinguistic research tradition, the study undertakes a hermeneutic description of second language learning as a response phenomenon and underscores the urgency to view the phenomenon in interrelated terms with the help of a constructivist/qualitative epistemology.
1993 – 1997, University of Surrey, United Kingdom
MA in Linguistics, TESOL
Core Modules (Assessment by assignment and synoptic examination):
Phonetics and Phonology
Second Language Acquisition
Electives (Assessment by assignment):
• Written Genres
Dissertation: The Use of Graded Readers in the Teaching of Reading and Writing
MA in English
1973 – 1975, Madras Christian College, University of Madras, India
Major: (Branch vii) English Language and Literature
Subjects of study (Assessment by course work and exam):
• Modern Literature 1(Elizabethan)
• Modern Literature 11(Neo Classical)
• Modern Literature 111(Romantic)
• Modern Literature 1V(Victorian)
• Modern Literature V(Twentieth Century)
• The English language
Workshop, “The Use of Representational Materials.”
Sixteenth Thai TESOL Annual Convention, Pattaya, Thailand, January 1996.
Workshop, “The Use of Figurative Language In the EFL Classroom.”
First Pan-Asian Conference on Language Teaching, Bangkok, Thailand, January 1997.
Workshop, “Teacher-Mediated Learner Autonomy.”
Eighteenth Annual Thai TESOL Annual Convention, Hatyai, Thailand, January 1998.
Workshop, “Critical Language Awareness in the EFL Classroom.”
Nineteenth Annual Thai TESOL Convention, Bangkok, Thailand, January 1999.
Paper, “Investigating Students’ Journals in an Action Research Study.”
Second pan-Asian Conference on Language Teaching, Seoul, S.Korea, October 1999.
Workshop, “The Use of Imagination and Creativity.”
Twentieth Annual Thai TESOL Convention, Khonkhaen, Thailand, January 2000.
Workshop, “Poetry in the EFL Classroom.”
Twenty-first Annual Thai TESOL Convention, Bangkok, Thailand, January 2001.
Workshop, “Critical Thinking in the EFL Classroom.”
American University Alumni Conference, Bangkok, Thailand, October 2001.
Workshop, “Relocating the Journal in the EFL Classroom.”
Twenty-second Annual Thai TESOL Convention, Chiangmai, Thailand, January 2002.
Paper, “The Prevalence of Literature in Language Education: A Prospect, Reality and Response.”
Staff Seminar, Department of English Language and Literature, University of Balamand, Tripoli, Lebanon, January 20, 2006.
Paper, “A Practitioner’s Perceptions on Assessment: Emerging Narratives of Teacher Empowerment.”
First Annual Conference of the International Language Testing Association (ILTA), Armenia Chapter, Yerevan, Armenia, November 11, 2006.
Plenary Address, “Changes and Challenges in ELT.”
AELTA Annual Convention, Yerevan, Armenia, November 18, 2006
Workshop, “The How and Why of Expressive-Process Approach to EFL.”
Peace Corps Armenia Teacher training Convention, Yerevan, Armenia, November 20, 2006
Paper, “Qualitative methodology: Interpretations for Empowerment.”
Graduate Studies seminar organized by the College of Health Sciences at American University of Armenia, Yerevan, Armenia, March 14, 2007.
Plenary Address, “Democratizing and Dehegamonizing Literature in the Service of Language Education: Endeavors of Empowerment.”
Second International Conference of the Armenian Association for the Study of English (AASE), Yerevan, Armenia, October 18, 2007.
Paper, “Signposting a Socially Aligned Approach to Language: Issues and Insights for Teaching and Research.”
Fifth CAM TESOL Annual Convention, Phnom Penh, Cambodia, February 21, 2009.
Plenary Address, “Calling Attention to Constructivism in ELT.”
AELTA 11th Annual Convention, Yerevan, Armenia, October 31, 2009.
Joint Paper, Nunn, & R. Sivasubramaniam, S. (with 3 undergraduate students Yasmine Guefrachi, Hadeel Al Shami & Ayesha Tariq), “Researching Competent Texts with Competent Students.”
The Middle East – North Africa Writing Centers Alliance (MENAWCA 2011) Conference at American University of Sharjah, in Sharjah, UAE, February 17-18, 2011.
Joint Paper , Nunn, R.,& Sivasubramaniam, S., Guefrachi, Y., Tariq, A., Al Shami, H. (2012) “Establishing Voice and Agency in Students’ Writing.” In Sharda, R.S. (Ed.) Hans Raj Mahila Maha vidyalaya, Mahatma Hans Raj Marg, Jalandhar, India: Proceedings of International Conference on English Language & Literary Studies (March 9-10, 2012.
Poster session, “Anchoring Constructivism in Language Teacher education: Issues for Promoting Student Teachers’ Voice and Agency.”
Higher Education South Africa (HESA) Teacher Education Conference, the University of Pretoria, Pretoria, Republic of South Africa, September 17-18, 2012.
Paper, “Folklore in Language Classrooms.”
12th Biennial International Conference of the South African Folklore Society (SAFOS) Tshwane University of Technology, Pretoria, Republic of South Africa, September 19-21, 2012.
Graduate Theses Supervision
University of the Western Cape
John Foncha( completed in November 2012) Investigating the role of Language in the Identity Construction of Scholars: Coming to Terms with Inter-Cultural Communicative Competence.
Buque, Domingos. (Mozambique) (likely to finish by May-2013). Literacy programmes in Mozambique: Adults’ motivations, perspectives and expectations – the case of multilingual Maputo and Pemba provinces
Mironko, Beatrice. (Rwanda). (likely to finish by May-2013 Factors influencing academic success in English for Academic Purposes in a Faculty of Science and Technology in Rwanda.
Godfroid Kartalayi (DR Congo) (will complete by the end of 2013) The DR Congo English state examination (ESE): Fundamental validity Issues.
Verbra Frances Pfeiffer ( will complete by the end of 2013) Investigating the Role of Expressive Writing in a Literacy Pedagogy with a Focus on Motivating High School Students to Becoming Better Writers ( A classroom-based Ethnographic study).
Godefroid Bantumbandi Katalayi (Completed in November 2011) The DR Congo English State Examination: Evaluating Context Validity Evidence
American University of Armenia
Ani Arakelyan (2008), An Investigation of the Influence of Dialogue Journal in an Armenian Setting.
Anna Gevorgyan (2008), Investigating the Dynamics and Outcomes of implementing Differentiated Instruction in an Armenian EFL Setting.
Arpine Sargsyan (2008), Using Literature to promote Language Learning in Armenian EFL Settings: Issues and Insights for Implementation.
Hayarpi Papygyan (2008), An Investigation of Extensive Reading in Armenian EFL Settings: Attitudes, Practices and Procedures of Evaluation.
Lilit Petrosyan (2008), An Investigation of the AUA Graduate Students’ Attitudes Towards reading: Coming to Terms with Literacy, Culture and empowerment.
Marine Arakelyan (2007), Motivation as One of the Contributing Personality Factors to Success in the EFL Classroom.
Gohar Hovakimyan (2007), The Roles of teachers and Learners in the English Teaching Classrooms of Armenia.
Liana Gregorian (2007), An Evaluation of the Implementation of the English Language teachers’ Professional Portfolio in Armenian EFL Settings.
Melissa Brown (2007), A study of Language, Culture and Interaction in an Extra-Curricular Debate Club.
Marina Badalyan (2007), Task- Based Learning and Students’ Motivation in the Armenian Classroom
Lusine Boyajyan (2006), Use of Hedging Devices in Good and Poor EFL Essays
Assumption University Bangkok
Ms. Chatsuda Komindr (2002), A Small Scale Investigation of the Role of Extensive Reading in the Thai EFL Classroom.
External Refereeing of MA Theses
Gobhain, E. A., ESP in Medical Schools and the Balance between EFL and ELF from Students’ Perspective: A Study at Jazan University/ Egypt, July 2011.
Paine, M., Standard v Non-Standard Englishes: Which model are we teaching and why? Oxford Brookes University, U.K. July 2011.
Roh, T., A Study of Language Attitudes through English Accent Evaluations by Koreans in the Philippines, University of the Philippines, Manila, August 2011.
MA/ MED Theses Examination
• Olanrewaju, Cohesion and Coherence as Discourse Markers in the English Narrative Essays of Undergraduate Students in Gautng Province, Tshwane University of Technology, Pretoria, South Africa, December 2012.
• Shanali Candice Govendaer, On the fringes of a diaspora: An Appraisal of the literature on language diaspora and globalization in relation to a family of Tamil-speaking, Sri Lankan migrants to South Africa, University of Cape Town, South Africa, September 2012 .
• Ancyfrida Prosper, What do Grade 1 learners write? A study of Literacy Development at a Multilingual Primary School in the Western Cape. University of the Western Cape, South Africa, July 2012.
• Nonhlanhla Shandu, Digital Literacy: ICT Integration in English First Additional Language Teaching. University of the Western Cape, South Africa, January 2012.
“New Horizons in English Language Training”
An instructional guide/reference manual for the teacher trainees at the Education ministry’s Teacher training Institutes (TTI) Ethiopia, July, 1986
R.Nunn & Sivasubramaniam. S., (Eds) From Defining EIL Competence to Designing EIL Learning, July 2011, S. Korea: Asian EFL Journal Press, A Division of Time Taylor International.
Refereed Book Chapters
• S. Sivasubramaniam, “Anchoring Literature in Extensive Reading Programmes: Issues and Insights for Promoting Intersubjectivity in the Classroom.” In Cirocki. A, (Ed) (June 2009), Extensive Reading in English Language Teaching. Munich: Lincolm-Europa.
• S. Sivasubramaniam, “Extensive Reading as Semiotic Mediation: a Celebration of Lived through Experiences.” In Cirocki. A, (Ed) (June 2009), Extensive Reading in English Language Teaching. Munich: Lincolm-Europa.
• S. Sivasubramaniam, “Articulating an Alternate Voice in Language Teaching Research.” In. Nunn and Adamson (Eds). ( June 2009) Accepting Alternative Voices in EFL Journal Articles. S.Korea: Asian EFL Press.
Refereed /Peer-reviewed Journal Publications
• S. Sivasubramaniam, ‘Text-Based Focus in a Literature-Based Approach to Language Teaching’ The English Teacher, Vol. 1, No.3, 1996.
• S. Sivasubramaniam, ‘A Book Review of “Now Read On” McRae, J. and Vethamani, M. 2000 London: Routledge’ English Teacher, Vol.3, No.3, 2000.
• S. Sivasubramaniam, ‘Signposting a Turnaround for Literature in Mainstream EFL/ESL: A Personal Enrichment Approach’ Thai TESOL Bulletin, Vol. 19, No. 1, 2006.
• S. Sivasubramaniam, ‘Promoting the Prevalence of Literature in the Practices of Foreign and Second Language Education: Issues and Insights’ Asian EFL Journal, Vol. 8, No.4, 2006.
• S. Sivasubramaniam, ‘Attempting a Well-defined Choice of Texts in Literature-Based EFL/ESL Settings: An Act of Teacher Empowerment’ Thai TESOL Bulletin, Vol. 19, No.2, 2006.
• S. Sivasubramaniam, ‘A Practitioner’s Perceptions on Assessment: Emerging Narratives of Teacher Empowerment’ Foreign Languages in Armenia, Issue 2, 2007.
• T. Sakhyan & Sivasubramaniam.S, ‘The Difficulties of Armenian Scholars trying to Publish in International Journals.’ ABAC Journal, Vol.28, No.2. 2008.
• S. Sivasubramaniam, ‘Responding to Reading: Issues and Insights for Promoting Agency, Voice and Subjecthood in Reading and Assessment’ Asian EFL Journal, Vol. 11, No.1, 2009.
• L.Bilton & Sivasubramaniam.S, ‘An Inquiry into Expressive Writing: A Classroom-Based Study’ Language Teaching Research, (with L.Bilton) Vol.13, No.3 2009
• S. Sivasubramaniam, ‘Democratizing and Dehegamonizing Literature in the Service of language Education: Endeavours of Empowerment’. Armenian Anglistika Folica, Vol.6, No.2.2009.
• S. Sivasubramaniam, ‘Constructivism in EIL: Issues and Insights for Teaching of EIL.’ Journal of English as an International Language, Vol.6, No.1. 2011.
• Gyulazyan. I. & Sivasubramaniam. S., The ELP as a Tool for Democratising Language Teaching. Journal of English as an International Language, Vol.7, No.1. 2012.
• G.B. Katalayi & Sivasubramaniam.S., Careful Reading versus Expeditious Reading: Investigating the Construct Validity of a Multiple-choice Reading Test. Journal of Language Teaching and Research, Vol.4, No. 3 2013(In press).
• Arpine. S. & Sivasubramaniam. S., Implementing Literature in Armenian EFL Setting: An Ethnographic Study. Asian EFL Journal, Vol.15, No.3, 2013
• Sivasubramaniam. S., Folktales in Language classrooms. South African Journal for Folklore Studies, (special issue to be released in October 2013.)
Forthcoming Refereed Publications
• Signposting a Socially Aligned Approach to Second/ Foreign Language Education: Issues and Insights for Teaching and Research.
• Testing or Taunting? Signposting the Prevalence of Humanistic Testing in Language Education
• A narrative of student teachers’ perceptions on Reading: Is it a product, process or practice?
Edited Journal collections:
S. Sivasubramaniam & P. Robertson (2011) (Eds) Journal of English as an International Language, Vol.6, No.1. (100 pages).
S. Sivasubramaniam & P. Robertson (2011) (Eds) Journal of English as an International Language, Vol.6, No.2. (120 pages).
S. Sivasubramaniam & P. Robertson (2012) (Eds) Journal of English as an International Language, Vol.7, No.1. (107 pages).
S. Sivasubramaniam & P. Robertson (2012) (Eds) Journal of English as an International Language, Vol.7, No.2. (120 pages).
Available in PDF E book format; http://www.eilj.com
S. Sivasubramaniam. Journal of English as an International Language, Vol.6, Issue 1, p. ii-iv (2011)
S. Sivasubramaniam. Journal of English as an International Language, Vol.6, Issue 2, p. ii-iv (2011)
S. Sivasubramaniam. Journal of English as an International Language, Vol.7, Issue 1, p. iii-v (2012)
S. Sivasubramaniam. Journal of English as an International Language, Vol.7, Issue 2, p. ii-v (2012)
Effects of Exercise and Physical Activity on Anxiety
Elizabeth Anderson1 and Geetha Shivakumar1,2,*
1VA North Texas Health Care System, Dallas, TX, USA
2Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
Edited by: Eduardo Lusa Cadore, Federal University of Rio Grande do Sul, Brazil
Reviewed by: Eduardo Lusa Cadore, Federal University of Rio Grande do Sul, Brazil
This article was submitted to Frontiers in Affective Disorders and Psychosomatic Research, a specialty of Frontiers in Psychiatry.
Author information ►Article notes ►Copyright and License information ►
Received 2013 Apr 11; Accepted 2013 Apr 11.
Copyright © 2013 Anderson and Shivakumar.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in other forums, provided the original authors and source are credited and subject to any copyright notices concerning any third-party graphics etc.
This article has been cited by other articles in PMC.
The beneficial effects of regular physical activity on health are indisputable in the field of modern medicine. Exercise is often the first step in lifestyle modifications for the prevention and management of chronic diseases. According to a US Department of Health and Human Services report on physical activity, regular exercise significantly reduced causes of mortality by up to 30% for men and women (DHHS, 2002). These health benefits are seen consistently across all age groups and racial/ethnic categories. The Centers for Disease Control and Prevention currently recommends 30 min of moderate- to high-intensity exercise for at least 5 days a week for all healthy individuals (DHHS, 2002).
In addition to significantly lowering causes of mortality, regular exercise and physical activity lowers prevalence of chronic disease(s). There is a strong evidence to support that 2–2.5 h of moderate- to high-intensity exercise per week is sufficient to reduce one’s risk for the occurrence of a chronic disease(s). Numerous epidemiological studies have shown that exercise improves one’s self-esteem, and a sense of wellbeing. Individuals who exercise regularly exhibit slower rates of age-related memory and cognitive decline in comparison to those who are more sedentary. Such observations have provided the basis for using exercise to improve memory and cognition in cognitive disorders such as Alzheimer’s Dementia. Adults who engage in regular physical activity experience fewer depressive and anxiety symptoms, thus supporting the notion that exercise offers a protective effect against the development of mental disorders (van Minnen et al., 2010).
Anxiety disorders are common psychiatric conditions with a lifetime prevalence of nearly 29% in the United States (Kessler et al., 2005). These disorders are chronic, debilitating, and impact multiple aspects of one’s life. The economic burden of anxiety disorders in the US was estimated to be $42.3 billion in the 1990s (Greenberg et al., 1999). The prominent anxiety disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) are General Anxiety Disorder (GAD), Panic Disorder (PD), Posttraumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD), Social Anxiety Disorder, and Specific Phobia (APA, 2000). The exact etiology and pathophysiology of these conditions is not fully understood. Comprehending the effects of exercise and physical activity on the mechanisms of anxiety disorders might further our knowledge of these psychiatric disorders. The purpose of this article is to highlight the known and emerging mechanisms that may result in the anxiolytic effects of exercise.
Broadly, regular exercise results in physiological changes and adaptations in the human body. Studies have shown that regular aerobic exercise is associated with lower sympathetic nervous system and hypothalamic-pituitary-adrenal (HPA) axis reactivity (Crews and Landers, 1987; Åstrand, 2003; Jackson and Dishman, 2006; Rimmele et al., 2007).
The HPA axis plays a critical role in developing adaptive responses to physical and psychological stressors (De Kloet et al., 2005). Dysregulations in the HPA axis have long been implicated in the manifestations of depressive and anxiety symptoms (Landgraf et al., 1999; Steckler et al., 1999). Acute stress leads to alterations in adrenocorticotropic hormone (ACTH) and excess levels of glucocorticoids. Chronic stress, as seen in PTSD, has been associated with lower concentrations of peripheral cortisol and upregulation of the glucocorticoid receptors resulting in increased central feedback sensitivity. Depending on the experimental paradigm used for chronic stress, some studies have shown decreased plasma ACTH and corticosterone levels while other studies have shown increased corticosterone secretion (Irwin et al., 1986; Kant et al., 1987). In preclinical studies, voluntary exercise alters the releases of corticotrophin-releasing factor (CRF) from the hypothalamus and ACTH from the anterior pituitary (Salmon, 2001; Droste et al., 2003). These findings suggest that exercise induced changes in the HPA axis modulates stress reactivity and anxiety in humans.
Abnormalities in monoamine function in the brain have been implicated in the pathophysiology of anxiety spectrum disorders. In animal studies, learned helplessness resulting from chronic electric shock was associated with a reduced release of serotonin in the frontal cortex (Miller et al., 1975; Petty et al., 1992). Learned helplessness is also associated with a depletion of norepinephrine (Petty et al., 1993). It is postulated that the reductions in serotonergic and noradrenergic levels reflects synthesis not being able to keep up with demand (Charney et al., 2004). Animal models also provide evidence that regular aerobic exercise increases serotonergic and noradrenergic levels in the brain, similar to the effects of antidepressants (Praag, 1982; Veale, 1987; Chaouloff, 1989; Meeusen and De Meirleir, 1995). Researchers have observed increased extraneuronal uptake of norepinephrine and increased levels of norepinephrine in the hippocampus and frontal cortex of rodents after treadmill training and wheel running (Dunn et al., 1996; Dishman, 1997). Increases in serotonin synthesis, metabolism, and release have been noted following exercise (Dunn and Dishman, 1991; Meeusen and De Meirleir, 1995; Wilson and Marsden, 1996; Chaouloff, 1997). Animal models utilizing chronic voluntary wheel running have also shown small increases in serotonergic neural activity in the dorsal raphe nucleus, an area of brain that is abundant in serotonergic neurons, during uncontrollable stress (Greenwood et al., 2003). Treadmill exercise training also increases levels of prepro-galanin mRNA, suggesting that gene expression for galanin is sensitive to the stress from exercise training and may have a “neuromodulating role” in the noradrenergic response in the locus ceruleus, an area of brain rich in noradrenergic neurons (O’Neal et al., 2001).
Another possible mechanism for the anxiolytic effects of exercise is via mediation by the endogenous opioid system. Endogenous opioids have a role in the regulation of mood and emotional responses (Bodnar and Klein, 2005). For example, abnormal levels of both central and peripheral β-endorphins have been discovered in individuals diagnosed with depression (Scarone et al., 1990; Darko et al., 1992). The endorphin hypothesis posits that the mood elevations and reduced anxiety following acute exercise is due to the release and binding of β-endorphins (endogenous opioids) to their receptor sites in the brain. Studies demonstrate that exercise increases endogenous opioid activity in the central and peripheral nervous system and may induce a euphoric state and reduce pain (Harber and Sutton, 1984; Morgan, 1985; North et al., 1990; Thorén et al., 1990). When opioid antagonists were administered following regular exercise, the endorphin produced analgesic effects were attenuated, but there were no changes in the mental health benefits suggesting that the exercise-related surge in endorphins may not completely account for mental health benefits in these studies (Carr et al., 1981; Moore, 1982; Howlett et al., 1984; Thorén et al., 1990; Yeung, 1996).
Brain-derived neurotrophic factor (BDNF), the most abundant neurotrophin in the brain has been linked to both anxiety and depression. Stress-induced depressive and anxious behaviors are correlated with decreased BDNF levels especially in the hippocampus (Duman and Monteggia, 2006). Furthermore, infusions of BDNF into the dorsal raphe nucleus have been shown to have an a antidepressant effect (Altar, 1999). Evidence also suggests that BDNF may be a mediator of the anxiety reducing effects of antidepressant medications (Chen et al., 2006). Increases in BDNF following physical activity have also been observed. Following 20 days of voluntary wheel running compared to non-wheel running rats, BDNF mRNA levels increased in the hippocampus and caudal neocortex (Meeusen and De Meirleir, 1995; Russo-Neustadt et al., 1999). These changes in BDNF increases functioning in the serotonergic system and may promote neuronal growth (Altar, 1999).
Evidence for Neurogenesis
New neuronal growth in the adult brain, particularly in the hippocampus, has been implicated in the treatment of psychiatric conditions including depression and anxiety (Eisch, 2002). Detection and evaluation of hippocampal neurogenesis is an active area of investigation in recent years (Eisch, 2002). In primate models of chronic stress, the hippocampus has been shown to be highly sensitive to the toxic effects of excessive glucocorticoids, thus impairing the process of neurogenesis (Uno et al., 1989). Neuroplasticity is further supported by the stress-related changes found in studies of hippocampus function. Animal studies have shown exercise up regulates hippocampal neurogenesis (Duman et al., 2001). Exercise is also believed to positively influence surrogate measures of adult hippocampal neurogenesis such as β-endorphins, vascular endothelial growth factor, BDNF, and serotonin, all of which are thought be common pathophysiologic mechanisms for anxiety disorders.
Anxiety sensitivity and exposure
Anxiety sensitivity is a term for the tendency to misinterpret and catastrophize anxiety-related sensations based on the belief that they will result in disastrous physical, psychological, and/or social outcomes (Broman-Fulks and Storey, 2008; Smits et al., 2008). McWilliams and Asmundson (2001) found an inverse relationship between anxiety sensitivity and exercise frequency and suggested that this relationship was due to avoidance of the physiological sensations of exercise that may be interpreted as anxiety and panic. A number of research studies have pointed to the effectiveness of short-term aerobic exercise to reduce anxiety sensitivity (Broman-Fulks and Storey, 2008; Smits et al., 2008; Ströhle et al., 2009). Exposing someone with high anxiety sensitivity to the physiological symptoms they fear, such as rapid heartbeat, in the context of physical exercise increases their tolerance for such symptoms (McWilliams and Asmundson, 2001). This exposure reveals that the feared physiological sensations may be uncomfortable, but do not pose a serious threat (Ströhle et al., 2009). Repeated exposures through regular aerobic exercise may also facilitate habituation to the feared sensations (Beck and Shipherd, 1997).
According to social cognitive theory, one’s sense of self-efficacy regarding their ability to exert control over potential threats has an important relationship to anxiety arousal. Individuals who trust their ability to manage potential threats (high self-efficacy) are not plagued by thoughts of worry and experience lower levels of anxiety arousal. Based on the theory of self-efficacy, Bandura posited that a treatment will be successful if it is able to rebuild a sense of self-efficacy by supplying experiences of self-mastery. It has been debated that exercise can increase self-efficacy by supplying experiences of successfully coping with the stress of exercising (Petruzzello et al., 1991). As fitness improves, the individual receives feedback of greater endurance, less pain, greater duration capabilities, etc. As a result, self-efficacy should increase (Petruzzello et al., 1991). In fact, one study suggested that exercise with an emphasis on increasing self-efficacy, in this case, martial arts, was more effective in reducing state anxiety than exercise such as riding a stationary bike (Bodin and Martinsen, 2004). In a study examining the relationship between exercise intensity and self-efficacy effects on anxiety reduction in a non-clinical population, researchers found that the influence of self-efficacy on decreased anxiety was exhibited in the moderate intensity exercise group, but not in the light- and high-intensity exercise groups (Katula et al., 1999). These two studies suggest that exercise providing an optimal level of challenge best utilizes the power of self-efficacy.
Distraction or “time out” has been proposed as another reason why exercise is effective at reducing anxiety. Based on their study that found that distraction techniques such as meditation, and quiet rest were as effective as a single session of exercise in reducing state anxiety, Bahrke and Morgan (1978) suggested that the anxiolytic benefits of exercise may result from it being a distraction from stressors and a “time out” from daily activities. The results of meta-analyses supporting this hypothesis are mixed. Exercise and cognitively based distraction techniques were shown to have equal effectiveness at reducing state anxiety, however exercise was more effective in reducing trait anxiety (Petruzzello et al., 1991). In addition, the anxiolytic effects of exercise have been shown to last for a longer period of time than those produced by therapies based on distraction techniques (Raglin and Morgan, 1985).
There is strong evidence from animal studies that exercise and regular activity positively impacts the pathophysiological processes of anxiety. Numerous studies and meta-analyses show that exercise is also associated with reduced anxiety in clinical settings. Similar to the heterogenic nature of the anxiety, no single mechanism sufficiently accounts for the anxiolytic nature of exercise. Physical activity positively impacts a number of biological, as well as psychological, mechanisms. The role of exercise in the enhancement of neurogenesis in humans has drawn significant attention in recent years and its implications for anxiety disorders are an exciting area of investigation. Future studies are needed to further this type of work, as well as studies specifically exploring clinical applications of exercise in anxiety disorders.
Conflict of Interest Statement
The authors declare that research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
This work was supported by VISN 17 New Investigator Award (PI Shivakumar).
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