Mind–Body Exercises for PTSD Symptoms, Depression, and Anxiety in Patients With PTSD: A Systematic Review and Meta-Analysis

Abstract

ObjectivesThis study aims to systematically analyze the effects of mind–body exercises on post-traumatic stress disorder (PTSD) symptoms, depression, and anxiety in patients with PTSD. Furthermore, it intends to provide scientific evidence-based exercise prescriptions.MethodsChinese (i.e., China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, and Wanfang) and English (i.e., Web of Science, PubMed, the Cochrane Library, and EMBASE) databases were used as data sources to search for studies on the effects of mind–body exercises on symptoms associated with patients with PTSD from January 1980 to November 2020. After a rigorous screening, 16 eligible randomized controlled trials (RCTs) were included in the meta-analysis.ResultsMind–body exercises exerted a significant effect on PTSD symptoms [standard mean difference (SMD) = −0.41, 95% confidence interval (CI) −0.64 to −0.19, p < 0.001], depression (SMD = −0.35, 95% CI: −0.55 to −0.15, p < 0.001), and anxiety (SMD = −0.31, 95% CI: −0.74 to −0.12, p < 0.001) among patients with PTSD. Subgroup analysis demonstrated that 60–150 min per session for 8–16 weeks of mindfulness was more effective in improving symptoms in patients with PTSD under 45 years of age compared with other subgroups. For depression, 150–180 min of yoga exercises once per week was effective. For anxiety, the frequency, timing, duration, and type of mind–body exercises that are most effective in relieving anxiety in patients with PTSD cannot be determined at this time due to the limited number of eligible RCTs.ConclusionsMind–body exercises were found to be significantly effective in improving PTSD symptoms, depression, and anxiety in patients with PTSD. Therefore, they can be used as an adjunct to intervention for symptoms of patients with PTSD. However, this conclusion requires further confirmation through additional scientific and objective RCTs.Systematic Review Registration:Unique Identifier: INPLASY2020120072.

Comparative Effectiveness of Multiple Exercise Interventions in the Treatment of Mental Health Disorders: A Systematic Review and Network Meta-Analysis

“…Correspondingly, MBE was recommended as the most promising form of exercise based on the current ranking probability plot. In line with our findings, existing pairwise meta-analyses have demonstrated MBE to be an efficient adjuvant therapy in the improvement of PTSD-related symptoms, with effect sizes ranging from − 0.41 to − 0.39 [ 177 , 178 ]. Subgroup analyses in a previous meta-analysis indicated that 60–150 min of MBE 1–3 times per week over 8–16 weeks resulted in benefits to those experiencing PTSD symptoms [ 178 ].…”

Management of post-traumatic stress disorder symptoms by yoga: an overview

“…Close to ten years later, our overview included only SRs with RCTs, and additionally assessed quality of evidence using the AMSTAR-2 tool. The current overview highlights the fact that 3 SRs without meta-analysis [30][31][32] and 7 SRs with meta-analysis [3,[23][24][25][26][27]29] reported signi cant positive effects of yoga compared to control interventions in PTSD symptoms with small to moderate size effect, while one failed to report signi cant bene t of yoga [28]. The quality of the evidence was rated as very low to moderate in 4 SRs [23][24][25]27], and 6 SRs concluded that yoga could only be considered as an adjunctive treatment to conventional approach [3, 24-26, 29, 31].…”

“…SRs were published between 2015 and 2022, including 3 to 22 RCTs dated from 1985 to 2020. Eight SRs were supplemented by a meta-analysis [3,[23][24][25][26][27][28][29].…”

“…5/7 RCTs found signi cant resul favor of yoga compared to co §: children's samples did not concern yoga interventions; $: incomplete data; *: includes a three arms study; ¥: yoga is considered as meditation here; CI: con dence intervals; ES: effect-size; MA: meta-analysis; MS: multiple sclerosis; n.r: not reported; QOE: quality of evidence; QOL: quality of life; SR: systematic review; SMD: standardised mean difference. [3,24,25,[27][28][29][30] and sex ratio from 32.9-100% of women [24,25,[27][28][29][30][31] (concerns only the yoga group in the systematic review of Liu et al [31]). As regards trauma type, the population was heterogeneous with veterans and active military representing about the half of the trauma population in 6 SRs [23][24][25][26][27]31].…”

“…As regards trauma type, the population was heterogeneous with veterans and active military representing about the half of the trauma population in 6 SRs [23][24][25][26][27]31]. In the other 4 SRs, traumas were various in civilian sample population (victims of natural disasters, interpersonal violence, patients with treatment-resistant PTSD, inmates' wives, nurses, patients with multiple sclerosis and PTSD, in-patients in psychiatric unit) [3,28,30,32], and trauma type were not speci ed in one review [29]. Gallegos et al [26], Hilton et al [27], and Björkman and Ekblom [24] (9 RCTs including 4 of yoga) analyzed the in uence of veteran versus non-veteran population [24,26], and trauma type [27] on PTSD symptoms, and found no signi cant difference.…”