Exercise to Reduce Posttraumatic Stress Disorder Symptoms in Veterans
Background: Physical exercise offers benefits for treating psychological disorders, particularly depression. Exercise is associated with reduction of posttraumatic stress disorder (PTSD) symptoms in civilians. Given the comorbidities and unique trauma experiences of the veteran population, the current work aims to estimate the effect of exercise on PTSD symptoms in veteran samples.
Observations: A systematic review identified 6 single-arm studies and 3 randomized controlled trials (RCTs) using exercise as an interventional treatment among veteran samples with full or subsyndromal PTSD. Most single-arm studies used yoga-based interventions, whereas RCTs showed more variety and included yoga, aerobic activity, and resistance exercises. Data synthesis of study results revealed a medium standardized mean difference for the single-arm trials (Hedges g, -0.60, P = .03) and a small-to-medium standardized mean difference for the RCTs (Hedges g , -0.40, P = .06). Single-arm studies were all rated at serious risk of bias. Only 1 RCT was rated at high risk of bias, although the remaining RCTs showed some concern of elevated bias .
Conclusions: There is preliminary evidence that exercise may be a useful treatment option for PTSD symptom reduction in veterans. Our review also highlights the need for additional high-quality randomized trials to confirm the benefits of exercise for PTSD symptom reduction in veterans.
Conclusions
Findings from both single-arm studies and RCTs suggest possible benefit of exercise on PTSD symptom reduction, although confirmation of findings is needed. No study found increased symptoms following exercise intervention. Thus, it is reasonable to consider physical exercise, such as yoga, as an adjunct, whole-health consistent treatment. HCPs working with veterans with past traumatic experiences should consider incorporating exercise into patient care. Enhanced educational efforts emphasizing the psychotherapeutic impact of exercise may also have value for the veteran population. Furthermore, the current risk of bias assessments highlights the need for additional high-quality RCTs evaluating the specific impact of exercise on PTSD symptom reduction in veterans. In particular, this field of inquiry would benefit from larger samples and design characteristics to reduce bias (eg, blinding when possible, use of CAPS vs only self-report symptom measures, reducing problematic attrition, corrections for missing data, etc).
Acknowledgments
This research is the result of work supported with resources and the use of facilities at the VA Eastern Kansas Healthcare System (Dwight D. Eisenhower VA Medical Center). It was also supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment, as well as the Rocky Mountain Mental Illness Research, Education, and Clinical Center. Since Dr. Reis and Dr. Gaddy are employees of the US Government and contributed to this manuscript as part of their official duties, the work is not subject to US copyright. This study was preregistered on PROSPERO (https://www.crd.york.ac.uk/prospero/; ID: CRD42020153419).
