Physical exercise as an adjunct to pharmacotherapy in the management of generalized anxiety disorder

Generalized Anxiety Disorder (GAD) is a prevalent and debilitating condition where first-line pharmacotherapies often yield only partial responses, significant side effects, and high relapse rates, creating a notable treatment gap. This review aimed to synthesize the scientific evidence on the effectiveness, mechanisms, and implementation of physical exercise as an adjunctive strategy to pharmacotherapy in GAD management. A structured narrative review of the literature was conducted across databases including PubMed/MEDLINE and the Cochrane Library. The results reveal that physical exercise exerts potent anxiolytic effects through multiple neurobiological pathways, including normalization of Hypothalamic-Pituitary-Adrenal (HPA) axis activity, modulation of neurotransmitter systems, and upregulation of Brain-Derived Neurotrophic Factor (BDNF). Clinical evidence from randomized controlled trials supports these mechanisms, demonstrating that adjunctive exercise significantly reduces symptom severity and improves remission rates. In conclusion, integrating a structured exercise prescription with standard pharmacotherapy offers a synergistic therapeutic effect, providing a more robust, durable, and holistic approach to GAD management that can improve overall patient outcomes.