# Exercise as it relates to Disease/Effects of exercise on older military veterans With PTSD

This is a critical appraisal of the cited study below:
Hall K, Morey M, Beckham J, Bosworth H, Sloane R, Pieper C, Pebole M. Warrior Wellness: A Randomized Controlled Pilot Trial of the Effects of Exercise on Physical Function and Clinical Health Risk Factors in Older Military Veterans With PTSD [Internet]. OXFORD Academic. 2019 [cited 14 September 2021]. Available from: https://academic.oup.com/biomedgerontology/article/75/11/2130/5606340?login=true [1]

## What is the background to this research?

This study was an intervention for the group of veterans living with Post-Traumatic Stress Disorder (PTSD). [1] There is already some information about this, however further testing can increase accuracy and reliability. This is good to improve as the experiment is dealing with the physical and mental health of people.
This study is important because veterans live all over the world and it is respectful and shows appreciation to their sacrifices for society to understand the struggles they may be facing and how they can be helped to manage those problems. Knowing if something as simple as exercise could help them physically and perhaps mentally too then society would be able to implement services like active groups that are available.

## Where is the research from?

The study was done by seven individuals with advanced qualifications. Katherine Hall, Miriam Morey, Jean Beckham, and Hayden Bosworth all have a PhD. Richard Sloane has an MPH, Carl Pieper has a D.Ph. and Michelle Pebole has an MA. [1] These individuals are all based in North Carolina, USA. [1] The large military in the United states could be something that encouraged the study to take place.

## What kind of research was this?

This experiment was a randomized controlled trial. It randomly assigned participants to either a supervised exercise group or the usual wait-list care.
Other studies on similar topics have had similar findings in their results [2] [3] [4], strongly supporting that the results gained from the studies should be applied to help others.

## What did the research involve?

After the participants met eligibility for the study they were split into either a supervised exercise group or the usual wait-list care with a 2:1 ratio. The exercise group were supervised through three weekly 90 minute sessions including aerobic, resistance, flexibility and balanced based training. The wait-list group continued to go to their usual medical professional appointments however did not receive exercise training throughout the 12 week duration of the study. At the start and end of the 12 weeks all participants took place in a series of tests to compare progress afterwards. The primary outcomes included the self reported physical activity level, aerobic endurance. The secondary tests included physical performance, health-related quality of life and cardiometabolic risk factors. [1]This was an effective way to conduct this experiment. A limitation of this experiment, which is very difficult or even impossible to accomplish, would be to study the reaction of each individual's mental health to the prescribed exercise and find a way to measure his overall mental health and PTSD state, not just an estimation. This would help to know for sure the overall health of each individual.

## What were the basic results?

The study showed that the veterans in the exercise group exercised over 400% than they usually did, due to the supervised training sessions. They also had an increase of 15% on the aerobic test. [1] The wait-list group only increased in physical activity levels by only 90% during the study, and only had a 2% increase in their aerobic test results. Both of these are far less than the exercise groups results. [1] There were also significant changes cardiometabolic risk factors, physical performance and health-related quality of life all in the exercise groups favour. [1] The supervised exercise was showed to be highly beneficial and encouraged to all veterans suffering from PTSD not involved in a supervised training program. This was communicated clearly and concisely by the researchers. They showed they had a clear purpose, and set out to efficiently test what they wanted to prove, and they did that effectively.

## What conclusions can we take from this research?

The study was well done, providing a clear experiment with clear results, and this was seen in the concise nature of the conclusion. It also provides a next step of how the finding can be applied when it mentions exercising in groups being a good option for the future due to it's low cost and is beneficial to PTSD suffering veterans.
As this study is one of the most recent pieces of research in this field, it is difficult to show what newer experiments are being found. Some insight can still be gained from other studies from the same time and comparing results. As previously mentioned, some other studies from around the same time all have similar results, therefore giving confidence to their findings, and thus their applications moving forward. [2] [3] [4]

## Practical advice

The clear application of this study in the future is the implementation of active groups which either are welcome and adjusting for veterans or exclusive groups for veterans to exercise and have the benefit of being kept accountable. Due to most veterans in society today being older, exercise groups need to have different fitness levels, or be accountable to all. Aerobic exercises, balance exercises, controlled resistance exercises and flexibility exercises are encouraged to be included in these groups as they are less threatening of injury and still provide the benefits of exercising.
It is important that everyone completes a pre-exercise screening before engaging in physical activity.

## Further information/resources

Some similar studies are listed below:
* Ley C, Barrio M, Koch A. “In the Sport I Am Here”: Therapeutic Processes and Health Effects of Sport and Exercise on PTSD - Clemens Ley, María Rato Barrio, Andreas Koch, 2018 [Internet]. SAGE Journals. 2017 [cited 14 September 2021]. Available from: https://journals.sagepub.com/doi/full/10.1177/1049732317744533 [2]
* Babson K, Heinz A, Ramirez G, Puckett M, Irons J, Bonn-Miller M et al. The interactive role of exercise and sleep on veteran recovery from symptoms of PTSD [Internet]. ScienceDirect. 2021 [cited 14 September 2021]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1755296615000022casa_token=Hb5kYeBFStoAAAAA:yfya5VbQAg-hdFSWtZq6ORdvHXCV0jn8oyLhbDqkAH8qrJyqtONfmIcmsq6-SRn6lywWkRtIyQ0 [3]
* Stubbs B, Vancampfort D, Rosenbaum S, Firth J, Cosco T, Veronese N et al. An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis [Internet]. ScienceDirect. 2017 [cited 14 September 2021]. Available from: https://www.sciencedirect.com/science/article/pii/S016517811630909X [4]
Support services are also available for mental health. Below are some helplines in Australia:
* Beyond Blue: https://www.beyondblue.org.au/ [5]
* Better Help: https://www.betterhelp.com/ [6]
* Trusted Clinical Services: https://trustedclinicalservices.org.au/ [7]

## References

* Hall K, Morey M, Beckham J, Bosworth H, Sloane R, Pieper C, Pebole M. Warrior Wellness: A Randomized Controlled Pilot Trial of the Effects of Exercise on Physical Function and Clinical Health Risk Factors in Older Military Veterans With PTSD [Internet]. OXFORD Academic. 2019 [cited 14 September 2021]. Available from: https://academic.oup.com/biomedgerontology/article/75/11/2130/5606340?login=true
* Ley C, Barrio M, Koch A. “In the Sport I Am Here”: Therapeutic Processes and Health Effects of Sport and Exercise on PTSD - Clemens Ley, María Rato Barrio, Andreas Koch, 2018 [Internet]. SAGE Journals. 2017 [cited 14 September 2021]. Available from: https://journals.sagepub.com/doi/full/10.1177/1049732317744533
* Babson K, Heinz A, Ramirez G, Puckett M, Irons J, Bonn-Miller M et al. The interactive role of exercise and sleep on veteran recovery from symptoms of PTSD [Internet]. ScienceDirect. 2021 [cited 14 September 2021]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1755296615000022casa_token=Hb5kYeBFStoAAAAA:yfya5VbQAg-hdFSWtZq6ORdvHXCV0jn8oyLhbDqkAH8qrJyqtONfmIcmsq6-SRn6lywWkRtIyQ0
* Stubbs B, Vancampfort D, Rosenbaum S, Firth J, Cosco T, Veronese N et al. An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis [Internet]. ScienceDirect. 2017 [cited 14 September 2021]. Available from: https://www.sciencedirect.com/science/article/pii/S016517811630909X
* Beyond Blue [Internet]. Beyondblue.org.au. 2021 [cited 14 September 2021]. Available from: https://www.beyondblue.org.au/
* BetterHelp | Professional Counseling With A Licensed Therapist [Internet]. Betterhelp.com. 2021 [cited 14 September 2021]. Available from: https://www.betterhelp.com/
* Therapy Services And Clinical Support | Trusted Clinical Services [Internet]. Trusted Clinical Services. 2021 [cited 14 September 2021]. Available from: https://trustedclinicalservices.org.au/