Inspiratory Muscle Training and Diaphragmatic Breathing in GAD

This study will compare inspiratory muscle training and diaphragmatic breathing exercises in individuals with generalized anxiety disorder (GAD). It aims to investigate whether adding either breathing-based intervention to a combined exercise program improves anxiety symptoms and other health-related outcomes compared with adding progressive muscle relaxation. Participants will be randomly assigned to one of three groups. All groups will receive the same combined exercise program. In addition, the first group will perform inspiratory muscle training, which involves breathing against resistance to strengthen the inspiratory muscles. The second group will perform diaphragmatic breathing exercises, which focus on using the diaphragm during breathing. The third group will receive Jacobson's progressive muscle relaxation technique, which involves systematically tensing and relaxing different muscle groups. All interventions will be delivered over eight weeks using a hybrid telerehabilitation approach combining face-to-face, synchronous online, and independent home-based sessions. The study will evaluate anxiety symptoms, respiratory muscle strength, pulmonary function, functional exercise capacity, dyspnea, quality of life, depression symptoms, and heart rate variability. The findings may provide further evidence on the comparative effects of these interventions when added to a combined exercise program in individuals with GAD.

Inclusion Criteria: Diagnosis of generalized anxiety disorder (GAD) by a psychiatrist according to DSM-5 criteria. A score of 10 or higher on the Generalized Anxiety Disorder-7 (GAD-7) scale. Receiving clinically stable pharmacological treatment. Aged 18-65 years. No condition that prevents the use of a smartphone or access to the internet. Exclusion Criteria: Severe pulmonary diseases (e.g., chronic obstructive pulmonary disease \[COPD\] or an asthma attack) or cardiac diseases (e.g., unstable angina). A primary psychiatric diagnosis other than generalized anxiety disorder. Orthopedic or neurological limitations that prevent exercise. Severe cardiovascular disease. Pregnancy. Substance use disorder. Recent abdominal or thoracic surgery.