The topic of September’s publications of interests is the role of physical exercise in symptom management of post-traumatic stress disorder.
Rosenbaum, S., Vancampfort, D., Steel, Z., Newby, J., Ward, P. B., & Stubbs, B. (2015). Physical activity in the treatment of Post-traumatic stress disorder: A systematic review and meta-analysis. Psychiatry Research, 230(2), 130–136. https://doi.org/10.1016/j.psychres.2015.10.017
Background
People with PTSD experience high levels of cardiovascular disease and comorbid mental health problems. Physical activity (PA) is an effective intervention in the general population. We conducted the first systematic review and meta-analysis to determine the effect of PA on PTSD.
Method
We searched major electronic databases from inception till 03/2015 for RCTs of PA interventions among people with PTSD. A random effects meta-analysis calculating hedges g was conducted.
Results
From a potential of 812 hits, four unique RCTs met the inclusion criteria (n=200, mean age of participants 34–52 years). The methodological quality of included trials was satisfactory, and no major adverse events were reported. PA was significantly more effective compared to control conditions at decreasing PTSD and depressive symptoms among people with PTSD. There was insufficient data to investigate the effect on anthropometric or cardiometabolic outcomes. Results suggest that PA may be a useful adjunct to usual care to improve the health of people with PTSD.
Conclusions
Although there is a relative paucity of data, there is reason to be optimistic for including PA as an intervention for people with PTSD, particularly given the overwhelming evidence of the benefits of PA in the general population. Robust effectiveness and implementation studies are required.
McGranahan, M. J., & O’Connor, P. J. (2021). Exercise training effects on sleep quality and symptoms of anxiety and depression in post-traumatic stress disorder: A systematic review and meta-analysis of randomized control trials. Mental Health and Physical Activity, 20, 100385. https://doi.org/10.1016/j.mhpa.2021.100385
Background
Sleep problems are common in post-traumatic stress disorder (PTSD). Exercise can improve sleep quality, but whether this occurs among those with PTSD is unclear. A systematic review and meta-analysis was conducted to estimate the magnitude of the effect of exercise training on overall sleep quality in patients with PTSD. Secondarily, the impact of exercise training on symptoms of PTSD, anxiety, and depression were evaluated.
Method
Articles published before April 1, 2020, were located through PubMed, Web of Science, PsycINFO, and Google Scholar. Exercise training interventions that measured sleep quality in patients with PTSD were evaluated for inclusion. In total, 1,948 articles were screened, 40 were further appraised, and four were analyzed. Hedges’ d effect sizes were calculated for sleep quality. Due to the relationship between poor sleep and symptoms of PTSD, anxiety, and depression, symptom changes with exercise training were analyzed.
Results
The four studies involved a total of 149 participants (61% males) with a mean (SD) age of 44.7 (16.3) years. The exercise intervention duration ranged from 3 to 12 weeks. All 5 effect sizes for overall sleep quality supported a favorable effect of exercise training; the mean Hedges’ d (95% CI) was −0.47 (−0.18, −0.75), p < 0.05. Exercise training was consistently associated with small or moderate improvements in PTSD, anxiety, and depression symptoms.
Conclusions
The small body of evidence suggests that exercise training has promise for improving overall sleep quality and PTSD, anxiety, and depression symptoms among those with PTSD.
Fetzner, M. G., & Asmundson, G. J. G. (2015). Aerobic Exercise Reduces Symptoms of Posttraumatic Stress Disorder: A Randomized Controlled Trial. Cognitive Behaviour Therapy, 44(4), 301–313. https://doi.org/10.1080/16506073.2014.916745
Background
Evidence suggests aerobic exercise has anxiolytic effects; yet the treatment potential for posttraumatic stress disorder (PTSD) and responsible anxiolytic mechanisms have received little attention. Emerging evidence indicates that attentional focus during exercise may dictate the extent of therapeutic benefit. Whether benefits are a function of attentional focus toward or away from somatic arousal during exercise remains untested.
Method
Thirty-three PTSD-affected participants completed two weeks of stationary biking aerobic exercise (six sessions). To assess the effect of attentional focus, participants were randomized into three exercise groups: group 1 (attention to somatic arousal) received prompts directing their attention to the interoceptive effects of exercise, group 2 (distraction from somatic arousal) watched a nature documentary, and group 3 exercised with no distractions or interoceptive prompts.
Results
Hierarchal linear modeling showed all groups reported reduced PTSD and anxiety sensitivity (AS; i.e., fear of arousal-related somatic sensations) during treatment. Interaction effects between group and time were found for PTSD hyperarousal and AS physical and social scores, wherein group 1, receiving interoceptive prompts, experienced significantly less symptom reduction than other groups. Most participants (89%) reported clinically significant reductions in PTSD severity after the two-week intervention.
Conclusions
Findings suggest, regardless of attentional focus, aerobic exercise reduces PTSD symptoms.
Narita-Ohtaki, R., Hori, H., Itoh, M., Lin, M., Niwa, M., Ino, K., Imai, R., Ogawa, S., Sekiguchi, A., Matsui, M., Kunugi, H., Kamo, T., & Kim, Y. (2018). Cognitive function in Japanese women with posttraumatic stress disorder: Association with exercise habits. Journal of Affective Disorders, 236, 306–312. https://doi.org/10.1016/j.jad.2018.02.061
Background
Posttraumatic stress disorder (PTSD) has been associated with cognitive impairments, yet little is documented on the cognitive function of PTSD patients in Asian countries. It is shown that regular exercise can reduce PTSD symptoms, while no study has investigated the association between exercise and cognition in PTSD patients. This study aimed to examine cognitive functions of Japanese women with PTSD, and to explore the association between regular exercise and cognitive functions.
Method
Forty-two women with DSM-IV PTSD and 66 demographically matched healthy control women participated in this study. Most of the patients developed PTSD after experiencing interpersonal violence. Cognitive functions were assessed by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Regular exercise habit was assessed by a self-reported questionnaire.
Results
Compared to controls, PTSD patients performed significantly more poorly in all cognitive domains examined, including immediate memory, visuospatial construction, language, attention, delayed memory, as well as the total score of RBANS (all p < 0.001). Compared to PTSD patients without the habit of exercise, those who habitually exercised showed significantly better performance on delayed memory (p = 0.006), which survived after controlling for potentially confounding variables in a multiple regression model.
Conclusions
PTSD in Japanese women is associated with pervasively impaired cognitive functions, including notable impairments in verbal memory. Such memory deficits might be improved by regular exercise, although further studies are needed to investigate the causal relationship between exercise and cognition in PTSD.
Hall, K. S., Morey, M. C., Bosworth, H. B., Beckham, J. C., Pebole, M. M., Sloane, R., & Pieper, C. F. (2020). Pilot randomized controlled trial of exercise training for older veterans with PTSD. Journal of Behavioral Medicine, 43(4), 648–659. https://doi.org/10.1007/s10865-019-00073-w
Background
Exercise training positively impacts mental health yet remains untested in older adults with posttraumatic stress disorder (PTSD). We conducted a randomized controlled pilot trial to test the feasibility and acceptability of exercise training in older veterans with PTSD.
Method
Fifty-four veterans [greater than or equal to] 60 years, with a DSM-V diagnosis of PTSD, were randomized to supervised exercise (n = 36) or wait-list (WL; n = 18). Primary outcomes included recruitment rates, attendance, satisfaction, and retention. Secondary outcomes included changes in PTSD symptoms, depression, health-related quality of life, and sleep quality; assessed at baseline and 12 weeks.
Results
There were no adverse events. Attrition was minimal (14%), and adherence to the exercise intervention was high (82%). Clinically significant improvements in PTSD and related conditions were observed following exercise (Cohen’s d = 0.36-0.81).
Conclusions
Exercise training is safe and acceptable in older adults with PTSD, may improve PTSD symptoms, and broadly impacts PTSD-related conditions. Future definitive trials are warranted.