# Exercise as it relates to Disease/Can exercise be an alternative treatment for PTSD?

The following is a critique of the research article Exercise for PTSD in Women Veterans: A Proof-of-Concept Study published in Military Medicine, 2017

## What is the Background to this research?

Post-traumatic stress disorder (PTSD) is a group of stress reactions that can develop after witnessing a traumatic event. Soldiers are at an increased risk for developing PTSD depending on the severity of combat exposure and whether they have a genetic predisposition for developing PTSD. Physical activity has been found to have a positive impact on mental health and psychological well-being. It has been found to have an impact on depression and anxiety and could potentially be used as a treatment alternative to pharmacotherapy.
Over the years there has been an increase in the number of women joining the defence. There has also been an increase in the number of roles in which women can work within the defence, with 88% of job categories open to women. The Australian defence force has a 14.2% participation of women in both permanent and reserve forces. Additionally, the number of women being deployed has increased, thus increasing the number of Female veterans with mental health diagnoses.

## Where is the research from?

This study was conducted in America within the Dallas VA Medical Centres kinesiotherapy clinic. The research was published in the Journal of Military Medicine in 2017. The sample of female veterans that was used for this study were recruited through flyers and posters as well as clinical referrals. A selection and exclusion criteria were provided to select participants that matched requirements of the study. Numerous other studies have been conducted on the correlation between PTSD symptoms and physical exercise.

## What kind of research was this?

This research is classified as an observational study as researchers did not intervene with participants, but made observations through subjective self-questionaries. This study is also a prospective study as it has a baseline collected at the beginning of the study and at various points over time during the study. This studies structure is used to determine the relationship between physical activity and PTSD.

## What did the research involve?

The study intervention consisted of a 12-week aerobic exercise program, the exercise sessions took place at a kinesiotherapy clinic. Participants completed 30/40 min of brisk walking, 4 days a week for a total of 12-weeks. Each exercise session consisted of a 3-5 min warmup, before advancing into the walking pace. Participants completed 2 home-based sessions per week.
Participants were instructed to document their exercise duration and intensity in an exercise log, which was reviewed by a research staff weekly. Participants were also wearing pedometers during waking hours to monitor general activity level. Exercise intensity was measured using a subjective scale, the Borg Rating of Perceived Exertion (RPE) measure. Participants were asked to rate their level of exertion using RPE for each exercise session. At baseline, participants were administered the CAPS to confirm the diagnosis of PTSD and measure symptom severity. Participants were re-administered the CAPS, PCL, IDS-SR, Q-LES-Q, and pain measure one month after the 12-week exercise protocol.

## What were the basic results?

The authors found that the exercise completers had significant improvement in their overall PTSD symptoms. The table below shows a summary of the PTSD symptoms throughout the 12-week exercise program:

#### Mean ± SEM (95% CI) for Secondary Clinical Outcomes in Exercise Completers Group (N = 16)

| | Baseline | Week 6 | Week 12 | F | df | p Value |
| PCL | 59.43 ± 2.30 (54.5, 64.4) | 44.86 ± 5.02 (34, 55.7) | 46.71 ± 4.03 (38, 55.4) | 9.42 | (2, 12) | 0.03 |
| IDS-SR | 43.22 ± 3.40 (36, 50) | 21.22 ± 4.51 (21.4, 41) | 28.93 ± 5.43 (17, 40.6) | 7.58 | (2, 12) | 0.07 |
| Q-LES-Q | 46.78 ± 3.24 (39.7, 53.7) | 53.57 ± 5.57 (41.5, 65.6) | 54.00 ± 4.48 (44.3, 63.7) | 2.45 | (2, 12) | 0.12 |
| Pain | 33.69 ± 5.98 (20.6, 46.7) | 29.84 ± 4.42 (20.2, 39) | 27.00 ± 5.27 (15.5, 38.5) | 0.48 | (2, 11) | 0.63 |
CAPS - Clinical administered PTSD Scale, PCL - PTSD Checklist, IDS-SR - Inventory of Depressive Symptomatology, Q-LES-Q - Quality of Life Enjoyment and Satisfaction Questionnaire.
According to the results it would indicate that exercise had a significant impact on all PTSD symptoms. It was found that the depression symptoms of PTSD was most significantly impacted by the exercise program.

## What conclusions can we take from this research?

Based on the evidence provided by the authors exercise has been found to be effective in the treatment of PTSD in female veterans. It has also shows that exercise had the most significant impact on the depression symptoms associated with PTSD. The results of this study found results similar to those achieved by others conducting studies into the effect of physical activity and PTSD.
Despite evidence that exercise reduces symptoms of PTSD, further investigation is needed to explore the efficacy of exercise in a larger and more generalisable study sample and in randomised controlled trials. Further research should also be conducted to investigate the optimal exercise activity for reducing PTSD symptoms.

## Practical advice

Whilst the optimal exercise activity is unknown, any form of exercise within the current physical activity guidelines will likely be able to decrease PTSD symptoms. As PTSD has a broad range of symptoms it is often treated with a combination of psychological and physical treatments. The addition of exercise into PTSD treatment plans, is inexpensive and may help decrease the depressive symptoms associated with PTSD. It is important to develop an exercise program with the help of an exercise professional, in order to reduce the risk of injury.
If you or someone you know has served in the military and/or has been suffering from PTSD, there are many support services to provide the help needed. Talking to your GP can help create a treatment plan and begin to manage the symptoms of PTSD. Below are a couple of links to support service that can provide help to those that are suffering from PTSD.

## Further information/resources

* Post Traumatic Stress Disorder (PTSD)
* Beyond Blue Women
* Defence Mental Health
* Defence Wellbeing Booklet

## References

* ↑ Shivakumar, G. et al. (2017) ‘Exercise for PTSD in Women Veterans: A Proof-of-Concept Study’ Military Medicine vol 182(11-12) pp 1809-1814
* 1 2 Friedman, M. et al. (1994) ‘Post-Traumatic Stress Disorder in the Military Veteran’ Psychiatric clinics of North America vol 17(2) pp265-277
* ↑ Fontaine, K. (2000) ‘Physical activity improves mental health’ The Physician and Sportsmedicine vol 28(10) pp 83-84
* 1 2 Manger, T. et al. (2005) ‘The impact of an exercise program on posttraumatic stress disorder, anxiety, and depression’ International Journal Emergency Mental Health vol 7(1) pp 49-57
* 1 2 Parliament of Australia. (2021) ‘Women in the armed forces: the role of women in the Australian Defence Force’ Available at:https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/Publications_Archive/archive/womenarmed
* ↑ Babson, K. et al. (2015) ‘The interactive role of exercise and sleep on veteran recovery from symptoms of PTSD’ Mental Health and Physical Activity vol 8 pp 15-20