Evidence Profile: Note: the data extracted (apart from the quality appraisal) has been taken from the included papers and does not represent the opinions of the authors’ of this REA. Systematic Reviews Authors, year, country Study design and number of studies Quality Question Population Interventions Primary outcome measures Caddick et al (2014), UK Systematic Review (n = 11) Fair “What is the impact of and physical activity on the of combat veterans?” Brittain and Green (2012) Injured or disabled veterans reported on in the media (ages and gender unspecified) Burke and Utley (2013) 4 injured male veterans aged 22-44 years Carless et al. (2013) 11 male veterans aged 20-43 with either physical disability, chronic illness or mental health problems Cordova et al. (1998) 44 male disabled veterans (aged 19-70) Dustin et al. (2011) 10 male and 3 female veterans diagnosed with PTSD (ages unspecified) Hawkins et al. (2011) 9 male and 4 female injured combat veterans aged 20-40 Hyer et al. (1996) Brittain and Green (2012) Elite sport - Paralympics Burke and Utley (2013) 9 day climbing challenge on Mt. Kilimanjaro Carless et al. (2013) 5-day inclusive adapted sports and adventurous training course Cordova et al. (1998) National Disabled Veterans Winter Sports Clinic Dustin et al. (2011) 4 days ‘river running’ trip Hawkins et al. (2011) 3-day military sports camp Hyer et al. (1996) 5 days ‘Outward Bound Experience’ (outdoor adventure pursuits) Lundberg et al. (2011) 5-day adaptive sports and recreation program Otter and Currie (2004) The World Health Organisation defines Quality of Life (QoL), Psychological (PWB), Subjective well-being trial being being
examining the relationship between exercise and PTSD in military veterans. and Currie, 2004 14: 100.0% M, Australian Veterans 55.0 Arnson et al, 2007 55: 100.0% M, Israeli Veterans 49.7 Kozaric-Kovacic et al, 2009 478: 100.0% M, Croatian Veterans PTSD 41.4%; No PTSD 40.8% Chwastiak et al, 2011 501,161: 95.9% M, U.S. Veterans 64.1 LeardMann et al, 2011 38,883: 77.7% M, U.S. Veterans Not Reported Davidson et al, 2013 346: 81.0% M, U.S. Veterans 45.5 Keller-Ross et al, 2014 39: 100.0% M, U.S. Veterans 33.0 Talbot et al, 2014 736: 94.3% M, U.S. Veterans PTSD 58.0 (age); No PTSD 58.8 (age) Babson et al, 2015 217: 100.0% M, U.S. Veterans 52.2 Caddick et al. 2015 15: 100.0% M, British Veterans Not Reported Smith et al, 2015 735: 94.3% M, U.S. Veterans 58.5 Buckley et al, 2004 Exercise measure: Single item measure Key finding: 42.0% of the participants exercised 3 times a week for at least 20 minutes, although 26.0% exercised 1–2 days, and 33.0% reported no weekly exercise and Currie, 2004 Exercise measure: None Key finding: Participants reported reduced perceptions of stress and increase in activities of daily living, mental alertness, perceived health, social support, and motivation to be active Arnson et al, 2007 Exercise measure: Single item measure Key finding: Physical functioning and bodily point tenderness were significantly better in regular exercisers than non-exercisers Kozaric-Kovacic et al, 2009 Exercise measure: Unspecified measure Key finding: Significantly more veterans without PTSD reported engaging in weekly exercise than Axis I Disorders Clinical administered PTSD scale (CAPS), International Classification of Diseases, 10th revision (ICD-10), International Classification of Diseases, 9th revision, Clinical Modification PTSD checklist – military (PCL-M), PTSD checklist
Authors, year and country Study design Quality Population including no. of participants Intervention Primary outcome measures Gaddy et al. (2017), USA Cohort Poor Veterans with either a mood disorder, PTSD, substance use disorder, chronic pain, anxiety, personality disorder or psychotic disorder (n = 42) Integrative Medicine (IM) program ran over 4 consecutive weeks (hatha yoga, healing foods, guided imagery, Tai chi, creativity in recovery, sensory exploration, holistic pain management) Short Form 12-item Health Survey (SF-12), Semi-structured interview Findings: Consistent with hypotheses about SF-12 score changes, participants exhibited significant increases in both their physical competency scores (t = 4.9, p = .05, d = 0.76) and mental competency scores (t = 3.76, p = .05, d = 0.58) from pre- to post-IM program completion. Regarding changes in individual item scores, improvements were noted in several areas, including the extent to which pain interferes with daily life (0.67 point average increase on a 5-point scale, t = 4.79, p = .05), amount of time feeling calm (0.86 point average increase on a 6-point scale, t = 4.79, p = .05), amount of time having sufficient energy (0.69 point increase on a 6-point scale, t = 4.69, p = .05), improved mood (0.57 point increase on a 6-point scale, t = 2.37, p = .05), and extent to which physical or mental health issues interfere with social activities (0.74 point increase on a 5-point scale, t = 4.61, p = .05). There were no score changes reflecting worsened health for any composite or individual item score. Authors, year and country Study design Quality Population including no. of participants Intervention Primary outcome measures
Hull et al. (2015), USA Cohort Poor Veterans with a pain or mental health (n = 226) Complementary and alternative medicine (CAM) program (iRest yoga, articular acupuncture, individual acupuncture, integrative health classes, gentle yoga, Qigong). Yearlong trial. Veterans encouraged to attend as many sessions as they liked. Measure Yourself Medical, Outcome Profile-2, Medical Outcomes Study Short Form-36, Insomnia Severity Index Defense and Veteran Pain Rating Scales, Pain Disability Questionnaire, Perceived Stress Scale, Beck Depression IHW Program Demographics Questionnaire, Additional Electronic Medical Data Findings: The results have suggested that service users did not differ substantially from nonusers, although a higher proportion of females used services, and Marines were less well represented among service users. With respect to demographic factors associated with the number of sessions attended by service users, only age appeared to have an effect, in that older individuals attended more services. Over the course of the yearlong trial, 165 veterans attended more than one session. Symptom severity was not associated with a specific pattern of service use. In general, the current results have provided further support for the inference that CAM Program services are appealing to a broad cross-section of veterans, but no relationship existed between attendance at a CAM session and improved wellbeing. Authors, year and country design Quality Population including no. of participants Intervention Primary outcome measures Niles et al. (2016), USA Cohort Poor Veterans with PTSD (n = 17) 4 session Tai Chi protocol. Each session lasted 60 minutes and was conducted by 2 experienced Tai Chi instructors. Checklist for DSM-5 (PCL-5), Brief Pain Inventory—Short Form (BPI), Beck Depression Inventory II (BDI-II)
upper-body resistance, aerobic exercise and stretching (40-60 minutes); full-body resistance, aerobic exercise and stretching (40-60 minutes)(R+CV). Findings: The current indicates that an acute bout of exercise, regardless of the intervention, resulted in increased positive wellbeing for previously sedentary Vietnam Veterans, but these results were not statistically significant (p>0.05). The WBVT and R+CV groups both reporting improvements across all areas of the SEES. Unmonitored unsupervised physical activity Authors, year and country Study design Quality Population including no. of participants Intervention Primary outcome measures Bosch et al. (2017), USA Cohort Good Veterans with PTSD (n = 195) Self-report surveys taken at baseline and 12 month follow up to evaluate levels of exercise (vigorous, moderate or light) and sleep quality. PTSD checklist – military (PCL-M), The Pittsburg Sleep Quality Index (PSQI), The Michigan Alcohol Screening Test (MAST) Findings: of engagement in exercise and subsequent sleep quality and PTSD symptoms one year later among deployed veterans, all of whom reported clinically significant or subthreshold levels of PTSD, showed, via multiple regression analyses that exercise improved sleep quality (p<0.05). Results from the present study did not find a significant association between level of engagement in exercise at baseline and PTSD symptoms and improved sleep quality at one-year follow-up (p=0.57). Authors, year and country design Quality Population including no. of participants Intervention Primary outcome measures
Authors, year and country Study design Quality Population including no. of participants Intervention Primary outcome measures Lanning et al. (2013), USA Cohort Poor Combat Veterans with mental and physical health issues (n = 13) 24-consecutive week, THR program (1-2 hours once a week) (riding, grooming, interaction with horse accredited by the Professional Association of Therapeutic Horsemanship) 36-Item Short Form Health Survey version 2 (SF- 36v2); Beck Depression Inventory-2nd edition (BDI-II); post-intervention questions. Findings: Second, the participants who completed 12 sessions of THR reported an increase in scores over time in six of the health domains, which means that they were experiencing less physical and emotional limitations in those particular health domains over the 12 wk. Likewise, the participants who completed up to 24 THR sessions reported an increase in scores in seven of the eight health domains. Third, the participants indicated fewer depression symptoms over time, dropping almost 6 points. Authors, year and country Study design Quality Population including no. of participants Intervention Primary outcome measures Peacock et al. (2018), UK Qualitative Poor UK military veterans who participated in an adapted sport and adventurous training (ASAAT) program (n = unknown) program: 5 day course; challenged to complete appropriate, physically challenging tasks, received coaching throughout. Interviews veterans of their experience of the ASAAT program.