# Exercise as it relates to Disease/Overcoming sedentary behaviour in combat veterans suffering PTSD through exercise
### Prevalence

Post traumatic stress disorder (PTSD) is prevalent in society at 6.4% of the population of Australia. When this is compared to those in the military it is higher, believed to be between 7-16%. Sedentary behavior within the military is unlikely to occur due to the values it places on being physically fit and active. It is suggested that as rank increases, the amount of time spent sedentary increases posing future health risks.

### What is PTSD

PTSD is a heightened state of stress and anxiety on an individual due to the occurrence of a traumatic event, such as combat or a car accident.

### What is sedentary behavior

Sedentary behavior is a distinctive set of behaviours which are shown by having little physical activity and a low energy expenditure.

## Effects on health

Sedentary behavior leads to the following:
* Body weight/BMI gain
* Being overweight/obese
* Waist gain
* Type 2 diabetes
* Cardiovascular disease risk
* Endometrial factors
* Mortality due to cardiovascular disease and cancer
PTSD often leads to sedentary behavior despite the known benefits of physical activity on both physical and mental self. When someone suffers PTSD they are known to go into isolation and resort from performing physical activity

## Current interventions
### PTSD

* Exercise/physical activity
* CBT
* Exposure therapy
* Hypnotherapy
* Trauma desensitization
* Relapse prevention therapy
* Interpersonal therapy
* Pharmacotherapy

### Sedentary behavior

Public health stance is to currently increase physical activity with little reference to decreasing the amount of sitting/screen time

## Exercise benefits on health

Exercise for PTSD sufferers looks to offer a distraction, taking the mind off of the symptoms, elevate mood levels, decrease anxiety and act as a stress buffer. Aerobic exercise has been shown to be beneficial as well as taking part in exercise with groups is shown to have greater effects.
Exercise to physical health helps to overcome many of the problems which are caused by sedentary behaviour.

## Exercise recommendations for improving health

Research has shown that there is no difference between high intensity, moderate intensity and low intensity exercise in helping combat veterans suffering PTSD Thus by meeting the physical activity guidelines for Australia would be enough to help. Physical activity guidelines for Australia:
* Accumulate 150–300 minutes of moderate intensity physical activity or 75–150 minutes of vigorous physical activity, or an equivalent combination of both each week.
* Perform muscle strength training activities on at least 2 days a week.
* Be active on most, preferably all days of the week
Sedentary behavior guidelines:
* Minimize the amount of time spent sitting
* Break up long periods of sitting as often as possible
As the military has a history of being physically active, by once again becoming physically active will become a saving grace for not only their physical self, but also their mental self as they will return to do something they were once passionate about. It will also improve their health as they will not be sedentary any longer.

## Further reading and support

For details of how exercise helps and for healthcare professionals on advice of how to prescribe exercise to PTSD sufferers http://www.unm.edu/~lkravitz/Article%20folder/PTSD.html
For more signs and symptoms of PTSD http://www.combatstress.org.uk/veterans/symptoms-of-trauma/
For help with PTSD from the governments and department of veterans affairs, a dedicated phone app to help http://at-ease.dva.gov.au/veterans/resources/mobile-apps/ptsd-coach/
The current Australian physical activity guidelines http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines

## References

* ↑ Australian Bureau Of Statistics (2007). National Survey of Mental Health and Wellbeing. Canberra, Australia.
* ↑ Richardson, L. K., Frueh, B. C., & Acierno, R. (2010). Prevalence estimates of combat-related post-traumatic stress disorder: critical review. Australian and New Zealand Journal of Psychiatry, 44(1), 4-19.
* ↑ Messinger, S. D. (2010). Getting Past the Accident. Medical anthropology quarterly, 24(3), 281-303.
* ↑ Kennedy-Armbruster, C., Evans, E. M., Sexauer, L., Peterson, J., & Wyatt, W. (2013). Association among functional-movement ability, fatigue, sedentary time, and fitness in 40 years and older active duty military personnel. Military medicine, 178(12), 1358-1364.
* ↑ Walker, S. (2010). Assessing the mental health consequences of military combat in Iraq and Afghanistan: a literature review. Journal of psychiatric and mental health nursing, 17(9), 790-796.
* ↑ Chinapaw, M. J. M., Proper, K. I., Brug, J., Van Mechelen, W., & Singh, A. S. (2011). Relationship between young peoples' sedentary behaviour and biomedical health indicators: a systematic review of prospective studies. Obesity Reviews, 12(7), 621-632.
* ↑ Proper, K. I., Singh, A. S., Van Mechelen, W., & Chinapaw, M. J. (2011). Sedentary behaviors and health outcomes among adults: a systematic review of prospective studies. American journal of preventive medicine, 40(2), 174-182.
* ↑ Rosenbaum, S., Tiedemann, A., Sherrington, C., & van der Ploeg, H. P. (2014). Assessing physical activity in people with posttraumatic stress disorder: feasibility and concurrent validity of the International Physical Activity Questionnaire-short form and actigraph accelerometers. BMC research notes, 7(1), 576.
* ↑ Imel, Z. E., Laska, K., Jakupcak, M., & Simpson, T. L. (2013). Meta-analysis of dropout in treatments for posttraumatic stress disorder. Journal Of Consulting And Clinical Psychology, 81(3), 394-404
* ↑ Dunstan, D. W., & Owen, N. (2012). New exercise prescription: don't just sit there: stand up and move more, more often: comment on “sitting time and all-cause mortality risk in 222 497 Australian adults”. Archives of internal medicine, 172(6), 500-501.
* ↑ Cohen, G.E. & Shamus, E. (2009). Depressed, low self-Esteem: What can exercise do for you? The Internet Journal of Allied Health Sciences and Practice, 7(2).
* ↑ Tsatsoulis, A. & Fountoulakis, S. (2006). The protective role of exercise on stress system dysregulation and comorbidities. Annals of the New York Academy of Sciences, 1083, 196-213.
* ↑ Fetzner, M. G., & Asmundson, G. J. (2014). Aerobic exercise reduces symptoms of posttraumatic stress disorder: a randomized controlled trial. Cognitive behaviour therapy, (ahead-of-print), 1-13.
* ↑ Stanton, R., & Reaburn, P. (2014). Exercise and the treatment of depression: a review of the exercise program variables. Journal of Science and Medicine in Sport, 17(2), 177-182.