The Role of Exercise in the Treatment of PTSD Symptoms

One of the signature injuries of combat operations following 9/11 is posttraumatic stress
disorder (PTSD). The most effective treatment for PTSD is exposure therapy where, under the
supervision of a trained therapist, individuals are exposed to prolonged and repeated
imagined images of the trauma until the images no longer cause severe anxiety. Various forms
of exercise have been used to treat a broad range of depression and anxiety disorders and
exercise has been used with some success to treat individuals with PTSD. Considering the
population of otherwise healthy and physically active Service Members suffering from
symptoms of PTSD, it seems possible that exercise might serve as an outlet for the emotional
reactions experienced during therapy, decreasing emotional distress, and increasing the
individual's tolerance to imaginal exposure serving as a powerful adjunct to exposure
therapy. The purpose of this study to explore the role of exercise in the treatment of
symptoms of posttraumatic stress disorder (PTSD), specifically determining if the efficacy
of imaginal exercises, part of exposure therapy for PTSD, can be improved by augmenting the
therapy with aerobic exercise. Towards this end, this 8-week experimental, repeated-measures
clinical trial will randomize 120 Service Members with symptoms of PTSD into one of four
groups: 1) imaginal exercises of exposure therapy only, 2) aerobic exercise only, 3)
imaginal exercises augmented with aerobic exercise, or 4) self-care.

Inclusion Criteria:

- be an Active Duty, Reserve, or National Guard Army, Air Force, Navy, or Marine
Veteran of Operation Iraqi Freedom (OIF) / Operation Enduring Freedom (OEF) eligible
for military medical care

- be at least 18 years old

- be able to read and speak English

- answer "no" to the seven questions of the Physical Activity Readiness Questionnaire
(PAR-Q), or have primary care provider approval to undertake an exercise program.

- score ≥25 on the PTSD CheckList - Stressor-Specific(PCL-S); participants scoring >50
on the PCL-S will be contacted weekly to ensure that their symptoms are under control
and they do not require a higher level of care.

- report on the PTSD Symptom Scale - Interview (PSS-I) an exposure to a traumatic event
(Criterion A), at least one re-experiencing symptom (Criterion B), and at least one
avoidance symptom (Criterion C)

- be stable on any prescribed psychotropic medications without change in type or dose
of medication for the 6-weeks preceding consent and baseline testing

- anticipate being in the area for at least three months to complete intervention and
13-week follow-up assessment

Exclusion Criteria:

- score <25 on the PTSD CheckList - Stressor Specific (PCL-S) (Those scoring <25 do not
have enough symptom severity to adequately test the study hypotheses

- have undergone exposure therapy for PTSD within the last year

- be taking benzodiazepines every day on a prescribed schedule (Individuals prescribed
and taking a benzodiazepine only as needed will not be excluded.)

- suicidal ideation with moderate to severe intent warranting intervention

- active psychosis or mania

- be on a medical profile that prohibits exercise