Exercise Intervention in PTSD: A Narrative Review and Rationale for Implementation.

Nicole J Hegberg,Jasmeet P Hayes,Scott M Hayes

doi:10.3389/fpsyt.2019.00133

Nicole J Hegberg, Jasmeet P Hayes + Show 1 more

Open Access

https://doi.org/10.3389/fpsyt.2019.00133

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Abstract

Posttraumatic stress disorder (PTSD) is a prominent mental health problem in veteran and community populations. There is accumulating evidence to suggest that aerobic exercise may serve as an effective treatment option for individuals with PTSD. The purpose of this review is to summarize the existing literature exploring aerobic exercise and PTSD and briefly discuss potential mechanisms of PTSD symptom reduction. A search of electronic databases and reference sections of relevant articles published through October 1, 2018 revealed 19 relevant studies that examined aerobic exercise and PTSD symptomatology. A narrative review of extant studies provides encouraging evidence that aerobic exercise interventions alone or as an adjunct to standard treatment may positively impact PTSD symptoms. Potential mechanisms by which aerobic exercise could exert a positive impact in PTSD include exposure and desensitization to internal arousal cues, enhanced cognitive function, exercise-induced neuroplasticity, normalization of hypothalamic pituitary axis (HPA) function, and reductions in inflammatory markers. Randomized clinical trials and translational neuroscience approaches are required to clarify the efficacy of exercise intervention for PTSD and elucidate potential mechanisms of exercise-induced PTSD symptom reduction.

Highlights

Posttraumatic stress disorder (PTSD) can develop after exposure to life-threatening and highly distressing events such as military combat, accidents, assault, or natural, or human-caused disasters
To identify studies examining the impact of aerobic exercise on PTSD symptoms, we completed a search of electronic databases (PubMed, Google Scholar, PsycINFO) for relevant studies published through October 1, 2018 using the search terms “PTSD” and “exercise’ or “physical activity” or “walking” or “cycling” or “high intensity interval training” or “aerobic fitness” or “cardiorespiratory fitness.”
The majority of studies assessed PTSD using DSM-IV criteria or using PTSD questionnaires that assess the three broad symptom clusters defined in the DSM-IV

Summary

Introduction

Posttraumatic stress disorder (PTSD) can develop after exposure to life-threatening and highly distressing events such as military combat, accidents, assault, or natural, or human-caused disasters. According to the DSM-5, the diagnosis of PTSD is characterized by four broad symptom clusters that include intense reliving of the traumatic event through disruptive memories and nightmares, avoidance of reminders of the event, negative cognitions and mood, and hyperarousal. In addition to the characteristic symptoms of PTSD, impaired cognitive performance [3, 4] and alterations in brain structure and function [5, 6] are well-documented. Individuals with PTSD have increased rates of health-care utilization, loss of productivity, and major chronic diseases [7, 8]. Individuals with PTSD have higher rates of diabetes, obesity, and metabolic syndrome [9,10,11,12]. Individuals with PTSD exhibit reduced participation in regular physical activity relative to pre-PTSD time periods [13], which likely contributes to the medical, cognitive, and neural comorbidities associated with sedentary behavior [14,15,16]

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