The Role of Exercise in the Treatment of PTSD

Background: Estimates are that 20% of Service Members returning from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) will experience posttraumatic stress disorder (PTSD). One treatment for PTSD is exposure therapy where individuals actively visualize images of the trauma, with the assistance of a health care provider, until the images no longer cause severe anxiety. Although this therapy can elicit very strong reactions, exposure therapy is extremely effective. Various forms of exercise have been used to treat depression and anxiety disorders and exercise has been used with some success to treat individuals with PTSD. Considering the population of otherwise healthy and physically active Service Members suffering from symptoms of PTSD, it seems possible that exercise might serve as an outlet for the emotional reactions experienced during exposure therapy, serving as a powerful adjunct to treatment. 

Purpose: The purpose of this study to explore the role of exercise in the treatment of symptoms of PTSD, specifically determining ifthe efficacy of imaginal exercises can be improved by augmenting the therapy with aerobic exercise. 

Design: A 12-week experimental, repeated-measure clinical trial is proposed randomizing participants into one of four groups: 1) imaginal exercises of exposure therapy only, 2) aerobic exercise only, 3) imaginal exercises augmented with aerobic exercise, or 4) self-care control. Hypotheses. Both psychological and physiological measures will be collected to test four hypotheses. (1) Engaging in the imaginal exercises of exposure therapy will reduce symptoms of PTSD and psychological distress relative to not engaging in imaginal exercises. (2) Engaging in supervised aerobic exercise will reduce symptoms of PTSD and psychological distress relative to not engaging in aerobic exercise. (3) Combining the treatments will reduce the symptoms of PTSD and psychological distress more than self-care. (4) Combining the treatments will reduce the symptoms of PTSD and psychological distress more than either treatment alone. Framework. Roy Adaptation Model. 

Sample: Service Members with symptoms of PTSD resulting from duty in OIF or OEF. Primary Outcome Variable. PTSD and symptoms associated with PTSD. Plan for Analysis. 2 (imaginal exercises vs. no imaginal exercises) x 2 (aerobic exercise vs. no aerobic exercise) factorial design with repeated measures at 4, 8 and 12 weeks. 

Relevance to Military Nursing: The proposed study addresses the TSNRP priorities of military deployment health as well as generating & translating knowledge and research into practice in a military context by testing the role of exercise in the treatment of symptoms of PTSD and working towards an effective, evidence-based nursing intervention that our Service Members experiencing symptoms of PTSD can engage in as a part of their routine health promotion activities.

Final Report available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2019100...