The interactive role of exercise and sleep on veteran recovery from symptoms of PTSD

doi:10.1016/j.mhpa.2014.12.002

Mental Health and Physical Activity

Volume 8, March 2015, Pages 15-20

https://doi.org/10.1016/j.mhpa.2014.12.002 Get rights and content

Highlights

•
Sleep and exercise interacted to predict changes in PTSD hyperarousal symptoms.
•
Exercise was associated with reduced hyperarousal among veterans with poor sleep.
•
Those who cycled the most miles had the greatest reduction in hyperarousal.

Abstract

Introduction

Posttraumatic Stress Disorder (PTSD) is prevalent among military veterans and is associated with a number of negative outcomes. Despite available treatments, rates of recovery are poor and many symptoms persist post-treatment. Previous research suggests that exercise functions to reduce symptoms of anxiety and improve sleep quality, though its effects are understudied among those with PTSD.

Method

We sought to assess the extent to which exercise and sleep interactively impact changes in PTSD severity. Participants were 217 veterans in residential PTSD treatment who were offered the opportunity to participate in a bike-exercise program. Data were collected at treatment intake and discharge.

Results

Exercise (defined as total volume of cycling completed over the course of treatment) was associated with greater reductions in PTSD hyperarousal symptoms at discharge only among veterans with poor intake sleep quality.

Conclusions

Overall, exercise may be a beneficial adjunctive treatment for reducing hyperarousal symptoms among individuals with PTSD and poor sleep.

Section snippets

Participants

Participants were 217 male military veterans (M_age = 52.18 years, SD = 7.06; Range 24–70 years) admitted to a 60–90-day VA residential rehabilitation program for PTSD, during which time individuals participated in cognitive behavioral therapy (CBT) for PTSD. Exclusion criteria for enrollment in the program included: (a) illicit substance and/or alcohol use during treatment, and (b) medical conditions with high probabilities of significantly interfering with or preventing psychological treatment

Results

Independent samples t-tests demonstrated that individuals who engaged in the cycling group reported lower depression symptoms at treatment intake (M = 19.96, SD = 3.26) and discharge (M = 17.24, SD = 4.33) compared to those who did not cycle (M = 26.15, SD = 9.88; M = 21.14, SD = 12.14, respectively). There were no differences in age, intake or discharge PTSD symptoms, or sleep quality, between those who did and did not engage in the cycling group (p's range from .09–.96). In terms of relations

Discussion

The objective of the present study was to determine the effects of sleep and exercise (defined as miles cycled over the course of treatment) on PTSD symptom severity among U.S. military veterans engaged in residential PTSD treatment. Neither sleep nor exercise were directly associated with changes in total PTSD symptom severity or symptom clusters of re-experiencing or avoidance/numbing; however, sleep and exercise interacted to predict changes in PTSD hyperarousal symptoms. Exercise was

References (35)

American Psychological Association
Diagnostic and statistical manual of mental disorders
(2013)
A. Arent et al.
The effects of exercise on mood in older adults: a meta-analytic review
Journal of Aging and Physical Activity
(2000)
G. Asmundson et al.
Let's get physical: a contemporary review of the anxiolytic effects of exercise for anxiety and its disorders
Depression and Anxiety
(2013)
A. Beck et al.
Manual for the beck depression inventory-II
(1996)
S. Brand et al.
High exercise levels are related to favourable sleep patterns and psychological functioning in adolescents: a comparison of athletes and controls
Journal of Adolescent Health
(2010)
L. Buis et al.
Physical activity in postdeployment operation iraqi freedom/operation enduring freedom veterans using department of veterans affairs services
Journal of Rehabilitation Research & Development
(2011)
D. Buysse et al.
Circadian patterns of sleep, sleepiness, and performance in older and younger adults
Sleep
(2005)
D. Buysse et al.
The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research
Psychiatry Research
(1989)
J. Cohen et al.
Applied multiple regression/correlation analysis for the behavioral sciences
(2003)

G. Cooney et al.

Exercise for depression

(2013)

E. Foa et al.

A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female sexual assault victims

Journal of Clinical and Counseling Psychology

(1999)

A. Germain

Sleep disturbances as the hallmark of PTSD: where are we now?

American Journal of Psychiatry

(2013)

B. Green et al.

Trauma, posttraumatic stress disorder, and health status

J. Irons et al.

Contingency management to induce exercise among college students

Behavior Change

(2013)

R. Kessler

Posttraumatic stress disorder: the burden to the individual and to society

Journal of Clinical Psychiatry

(2000)

R. Kessler et al.

Posttraumatic stress disorder in the National Comorbidity Survey

Archives of General Psychiatry

(1995)

Cited by (35)

Exploring moderate to vigorous physical activity for women with post-traumatic stress disorder: A scoping review
2022, Mental Health and Physical Activity
Citation Excerpt :
Activities that require energy expenditure at a rate above 7 kcal/min would thus be defined as vigorous PA. MVPA is widely recommended to improve overall health and is well cited in academic literature to improve mental and physical health outcomes in those with and without psychiatric disorders (Babson et al., 2015; Björkman & Ekblom, 2021; Bull et al., 2020; Goldstein et al., 2018). A review of the available research reveals that engagement in PA has the potential to decrease depression, anxiety, sleep disturbances, and other health morbidities and symptomologies associated with PTSD (Goldstein et al., 2018; Oppizzi & Umberger, 2018).
The impact of physical activity on mental health outcomes is well-established. Researchers have suggested that engagement in physical activity may have benefits for people with post-traumatic stress disorder (PTSD). In particular, moderate to vigorous physical activity (MVPA) is theorized to reduce PTSD symptomology and improve treatment outcomes. While there are evident sex and gender differences in the biology and etiology of PTSD, significant gaps remain in the analysis of sex- and gender-based factors in physical activity interventions. The purpose of this scoping review was to: (1) explore the study parameters (i.e. research design, intervention, measures, and sex and gender considerations), (2) present the types of outcomes found in studies investigating MVPA as an adjunctive strategy to support women with PTSD, and (3) assess researcher engagement with trauma-informed approaches. Guided by Arksey and O'Malley's scoping review framework, we systematically searched four databases, yielding 615 results that underwent through two levels of screening: title and abstract, and full text. Twelve papers met the specified criteria, which included a focus on, or inclusion and analysis, of female participant data in studies investigating the therapeutic potential of PA as an adjunctive strategy to address PTSD. Analysis of selected articles revealed commonly employed study characteristics and parameters; the diversity of PTSD and PA measures used for inclusion and outcome measurement, respectively; the biological and psychological outcomes and identified limitations; and, how and if the impacts of trauma on the accessibility of research participation were considered. Overall, we found that MVPA should be further investigated as a potential intervention for women with PTSD and careful consideration of the study measures employed is critical when designing population- and gender-tailored interventions. Based on the findings, we highlight the need for a trauma- and violence-informed approach to address the acceptability and feasibility of physical activity interventions.
A significant U-shaped association between physical activity level and posttraumatic stress disorder in U.S. military Veterans: Results from the 2019–2020 National Health and Resilience in Veterans Study
2022, Mental Health and Physical Activity
The present study sought to extend previous research by examining associations between physical activity levels, PTSD, and PTSD symptom clusters in a large, independent, nationally representative sample of U.S. military veterans.
Using data from the 2019–2020 National Health and Resilience in Veterans Study (NHRVS), we examined relations between a comprehensive self-report measure of physical activity that reflects public health guidelines and a self-report measure of DSM-5-defined PTSD and a 7-factor model of PTSD symptom dimensions. A total of 3,875 participants completed all study measures. Post-stratification weights were applied to all analyses (weighted n = 3,732).
Quadratic logistic regression revealed a significant (p < .05) U-shaped association between physical activity levels (insufficient, moderate, and active) and a positive PTSD screen. A moderate activity level was associated with the lowest likelihood of PTSD (3.8% adjusted probability) while an active level was associated with the highest likelihood of PTSD (7.8% adjusted probability). Multinomial logistic regression suggested that more severe posttraumatic intrusive symptoms, particularly nightmares, and anhedonic symptoms were associated with a significantly decreased probability of a moderate activity level (ps ≤ .05, false discovery rate corrected).
Findings suggest that a moderate physical activity level is associated with a lower likelihood of PTSD but that specific PTSD symptoms may be differentially associated with exercise behaviors. Candidate mechanisms and clinical implications of these findings are discussed.
Prior short-term exercise prevents behavioral and biochemical abnormalities induced by single prolonged stress in a rat model of posttraumatic stress disorder
2022, Behavioural Brain Research
Citation Excerpt :
Recent studies highlight the impact of exercise on the prevention and treatment of different psychopathological abnormalities and several epidemiological studies have shown significant cross-sectional correlations between mental health and exercise [94]. Similarly, many animal [72,80] and human studies [21,31,33,8] have confirmed the positive effects of exercise on brain health. In other words, regular physical activity and an active lifestyle are effective ways to improve physiological and mental health [1,23,35].
Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs following exposure to somatic or psychotic trauma. Physical activity is known to improve symptoms of certain neuropsychiatric disorders. However, the role of exercise on acquired PTSD-like phenotype was not examined. The present study investigated the effects of prior moderate treadmill exercise on anxiety-like behaviors, serum corticosterone and BDNF levels, hippocampal BDNF and mRNA expression of apoptotic - related proteins in the single prolonged stress (SPS) as an animal model of PTSD in rats. Male and female rats underwent a regular treadmill exercise regimen (4 weeks, 5 days per week). Following the exercise, rats were exposed to SPS (restraint for 2 h, forced swimming for 20 min and ether anesthesia), and then they were kept undisturbed for 14 days. After testing anxiety-like behaviours in the elevated plus maze, the levels of corticosterone and BDNF in serum and BDNF and apoptosis markers (Bax, Bcl-2, and Caspase) in hippocampus were measured. Sedentary male and female SPS rats significantly (Ps ranging <0.05 to <0.0001) exhibited increased anxiety levels in the elevated plus maze, enhanced serum corticosterone, reduced serum and hippocampal BDNF and enhanced hippocampal apoptosis than the corresponding control group. Prior exercise significantly (Ps ranging <0.05 to <0.001) alleviated all SPS-induced behavioral and biochemical alterations as compared with the sedentary SPS rats. There were no significant differences in serum and hippocampal BDNF and serum corticosterone levels and hippocampal apoptotic markers between male and female rats in all of groups. Our findings strongly support that short term prior exercise training can prevent the harmful effects of traumatic events, and the resulting trauma-related disorders in both sexes.
Qualitative Analysis of a Supervised Exercise Program for Older Veterans With PTSD
2021, American Journal of Geriatric Psychiatry
Citation Excerpt :
Additionally, a recent review identified 10 studies that examined exercise programs for persons with PTSD and reported overall benefits on PTSD symptoms when delivered alone or in combination with standard treatments.14 Of these 10 studies, three were conducted with US veterans,8,15,16 all of which demonstrated improved PTSD symptoms. Yet, none of these studies examined the impact of an exercise intervention in older adults, thereby precluding conclusions as to the effectiveness of such programs for this population.
Older veterans with post-traumatic stress disorder (PTSD) experience substantial physical and mental health challenges. Given the well-known and wide-reaching benefits of exercise, exploring the impact of interventions designed specifically for this population would be valuable. As such, the present study explored perspectives from older veterans with PTSD who participated in Warrior Wellness, a 12-week supervised exercise intervention designed for older veterans with PTSD. This study was aimed at evaluating 1) facilitators of engagement, 2) perceived benefits from the intervention, and 3) recommendations about possible modifications to the intervention.
Qualitative study.
Face-to-face semistructured interviews conducted after the Warrior Wellness trial was completed.
Fifteen veterans (100% male, 93% African American or Black, 100% non-Hispanic or Latinx, average age = 68.7 years) who completed the Warrior Wellness exercise program.
Semistructured interviews were conducted using an interview guide that assessed veterans’ experience in Warrior Wellness and recommendations for future intervention modifications. Interviews were subsequently transcribed and analyzed by thematic analysis.
Shared experience, program features, camaraderie during workouts, and accountability emerged as facilitators of engagement. Perceived benefits spanned physical health, mental health, and behavioral domains. Finally, veterans provided several suggestions for modifying the intervention such as increasing its duration, adding a nutritional component, and including significant others in enrollment.
This study offers valuable insights into the intervention and interpersonal factors that veterans view as important for their engagement in exercise, the perceived benefits of exercise, and the ways in which interventions designed for this population can be refined.
Physical interventions for the treatment of trauma and stressor-related disorders: A comprehensive systematic review
2021, Mental Health and Physical Activity
Cognitive behavioral therapies for posttraumatic stress disorder (PTSD) are evidence-based and effective for many. However, the reach and impact of these interventions are limited. Physical interventions hold potential to bridge a gap in the unmet treatment of trauma and stressor-related disorders.
This systematic review examined 84 studies from four decades of research on physical interventions for trauma and stressor-related disorders to: 1) describe the state of the field and 2) summarize the best available evidence. Reviewed studies were described in terms of measured sample characteristics and assessed outcomes. Treatment effect patterns were analyzed by intervention content and study design.
The majority of studies (65.9%) reported statistically significant reductions in posttraumatic stress symptoms; 40.9% used a randomized controlled trial (RCT) design. Among RCTs, one performed rigorous, statistically powered analyses in an intention-to-treat sample.
High variability in reporting strategies among reviewed studies precludes analysis of variables such as intervention length, frequency, and dropout.
Preliminary evidence for the efficacy of physical interventions for trauma and stressor-related disorders is promising. Larger scale RCTs powered and designed to identify mediators and moderators of these interventions are warranted.
Trauma-informed approaches to physical activity: A scoping study
2020, Complementary Therapies in Clinical Practice
Citation Excerpt :
Physical activity is defined as being inclusive of all muscular movement with an increase in energy expenditure [2]; whereas leisure-time physical activity (i.e., behaviour consciously aimed at improving physical fitness) is typically considered sport and exercise [3]. The literature suggests engaging in regular physical activity can improve mental health, decrease depression, anxiety, sleep disturbances, and these and other health conditions associated with post-traumatic stress disorder (PTSD) [4,5]. This may be of particular importance to people who have experienced high levels of trauma and violence as physical activity may be a useful adjunct to usual care (e.g., talk therapy, medications) to improve health outcomes for individuals with PTSD; or for individuals who do not have diagnoses (or who do not actually align with the notion of PTSD).

View all citing articles on Scopus

View full text

Published by Elsevier Ltd.

The interactive role of exercise and sleep on veteran recovery from symptoms of PTSD

Highlights

Abstract

Introduction

Method

Results

Conclusions

Section snippets

Participants

Results

Discussion

Diagnostic and statistical manual of mental disorders

The effects of exercise on mood in older adults: a meta-analytic review

Journal of Aging and Physical Activity

Let's get physical: a contemporary review of the anxiolytic effects of exercise for anxiety and its disorders

Depression and Anxiety

Manual for the beck depression inventory-II

High exercise levels are related to favourable sleep patterns and psychological functioning in adolescents: a comparison of athletes and controls

Journal of Adolescent Health

Physical activity in postdeployment operation iraqi freedom/operation enduring freedom veterans using department of veterans affairs services

Journal of Rehabilitation Research & Development

Circadian patterns of sleep, sleepiness, and performance in older and younger adults

Sleep

The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research

Psychiatry Research

Applied multiple regression/correlation analysis for the behavioral sciences

Exercise for depression

A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female sexual assault victims

Journal of Clinical and Counseling Psychology

Sleep disturbances as the hallmark of PTSD: where are we now?

American Journal of Psychiatry

Trauma, posttraumatic stress disorder, and health status

Contingency management to induce exercise among college students

Behavior Change

Posttraumatic stress disorder: the burden to the individual and to society

Journal of Clinical Psychiatry

Posttraumatic stress disorder in the National Comorbidity Survey

Archives of General Psychiatry