Physical Exercise as Treatment for PTSD: A Systematic Review and Meta-Analysis

Abstract

Introduction Post-traumatic stress disorder (PTSD) is a cluster of physical and psychiatric symptoms following military or civilian trauma. The effect of exercise on PTSD symptoms has previously been investigated in several studies. However, it has not been fully determined what type of exercise most impacts PTSD symptoms. The aim of the present study was to systematically review the effects of different types of exercise on PTSD symptom severity and symptoms of coexisting conditions in adults. Materials and Methods Electronic searches were conducted in the databases PubMed, APA PsycInfo, and SportDiscus, from database inception up until February 1, 2021. Inclusion criteria were randomized controlled trials published in English, participants having a PTSD diagnosis or clinically relevant symptoms, and participants randomly allocated to either a non-exercising control group or an exercise group. Data concerning the number of participants, age, exercise type and duration, PTSD symptom severity (primary outcome), and symptoms of coexisting conditions (secondary outcomes) were extracted. The subgroup analysis included high or low training dose, military trauma versus non-military trauma, the type of intervention (yoga versus other exercise), active or passive control condition, group training versus individual exercise, and study quality. The study quality and risk of bias were assessed using grading of recommendation assessment, development and evaluation (GRADE) guidelines. A meta-analysis was performed with a mixed-effects model and restricted maximum likelihood as model estimator, and effect size was calculated as the standardized difference in mean and 95% CI. Results Eleven studies were included in the present review. Results showed a main random effect of exercise intervention (0.46; 95% CI: 0.18 to 0.74) and a borderline significant interaction between more voluminous (>20 hours in total) and less voluminous (≤20 hours in total) exercise interventions (P = .07). No significant findings from the subgroup analysis were reported. The secondary outcome analysis showed a small but significant effect of exercise on depressive symptoms (0.20, 95% CI: 0.01 to 0.38), and a larger effect on sleep (0.51, 95% CI: 0.29 to 0.73). For substance use (alcohol and drugs combined) and quality of life, we found significant effects of 0.52 (95% CI: 0.06 to 0.98) and 0.51 (95% CI: 0.34 to 0.69), respectively. No significant effect was found for anxiety (0.18, 95% CI: −0.15 to 0.51), and no sign of publication bias was found. Conclusions Exercise can be an effective addition to PTSD treatment, and greater amounts of exercise may provide more benefits. However, as there were no differences found between exercise type, possibly due to the inclusion of a low number of studies using different methodologies, further research should aim to investigate the optimal type, dose, and duration of activity that are most beneficial to persons with PTSD.

Is exercise/physical activity effective at reducing symptoms of post-traumatic stress disorder in adults — A systematic review

“…These results were not sufficiently reliable to ensure stable long term benefit. A recent review confirmed these findings showing a small to medium effect (ES: 0.29, 95% CI: 0.10-0.49, P < 0.01) of exercise on PTSD symptom severity whereas a sub-group analysis showed no significant effect of exercise on anxiety and depression severity (Bjorkman and Ekblom, 2021). A previous Cochrane review (Lawrence et al, 2010) attempted to investigate the benefits of exercise in the context of sport and games for PTSD but found only five studies, none of which met the review inclusion criteria, suggesting more research is required to assess the effectiveness of exercise in alleviating symptoms of PTSD.…”

Promoting physical activity for mental health: an updated evidence review and practical guide

“…Anxiety and stress-related disorders A systematic review and meta-analysis of 13 RCTs investigating the anxiolytic effects of exercise for people with anxiety and related disorders found that exercise had a small, statistically significant effect on decreasing anxiety symptoms compared with control condition (SMD ¼ -0.43, 95% CI ¼ -0.67 to -0.17) [57]. A separate review of 11 studies looking specifically at post traumatic stress disorder (PTSD) identified a positive effect of exercise on PTSD symptom severity compared with nonactive treatment (SMD ¼ 0.46, 95% CI ¼ 0.18-0.74) [58], with evidence of a stronger effect with greater volumes of exercise. Proven strategies to reduce drop out include sessions delivered by an exercise professional and applying autonomous motivation strategies (P < 0.001) [59].…”

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

“…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].…”

“…[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]. 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].…”

“…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.…”