Top

Gepubliceerd in:

01-07-2019

Pilot randomized controlled trial of exercise training for older veterans with PTSD

Auteurs: Katherine S. Hall, Miriam C. Morey, Hayden B. Bosworth, Jean C. Beckham, Michelle M. Pebole, Richard Sloane, Carl F. Pieper

Gepubliceerd in: Journal of Behavioral Medicine | Uitgave 4/2020

Abstract

Exercise training positively impacts mental health, yet remains untested in older adults with posttraumatic stress disorder (PTSD). We conducted a randomized controlled pilot trial to test the feasibility and acceptability of exercise training in older veterans with PTSD. Fifty-four veterans ≥ 60 years, with a DSM-V diagnosis of PTSD, were randomized to supervised exercise (n = 36) or wait-list (WL; n = 18). Primary outcomes included recruitment rates, attendance, satisfaction, and retention. Secondary outcomes included changes in PTSD symptoms, depression, health-related quality of life, and sleep quality; assessed at baseline and 12 weeks. There were no adverse events. Attrition was minimal (14%), and adherence to the exercise intervention was high (82%). Clinically significant improvements in PTSD and related conditions were observed following exercise (Cohen’s d = 0.36–0.81). Exercise training is safe and acceptable in older adults with PTSD, may improve PTSD symptoms, and broadly impacts PTSD-related conditions. Future definitive trials are warranted.

vorige artikel Understanding the physical activity needs and interests of inactive and active rural women: a cross-sectional study of barriers, opportunities, and intervention preferences

volgende artikel Revising the bariatric psychological evaluation to improve clinical and research utility

Abrantes, A. M., Reddy, M. K., Farris, S. G., Greenberg, B. D., Spofford, C., & McLaughlin, N. (2017). Exercise preferences and perceived benefits and barriers of physical activity among US veterans with post-traumatic stress disorder. Journal of Behavioral Health,6, 111–119.

American College of Sports Medicine, Chodzko-Zajko, W. J., Proctor, D. N., Fiatarone Singh, M. A., Minson, C. T., Nigg, C. R., et al. (2009). American College of Sports Medicine position stand. Exercise and physical activity for older adults. Medicine and Science in Sports and Exercise,41, 1510–1530. https://doi.org/10.1249/mss.0b013e3181a0c95c CrossRef

Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.

Bouldin, E. D., & Reiber, G. E. (2012). Physical activity among veterans and nonveterans with diabetes. Journal of Aging Research. https://doi.org/10.1155/2012/135192 CrossRefPubMedPubMedCentral

Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., et al. (2016). Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders-fifth edition (PCL-5) in veterans. Psychological Assessment,28, 1379–1391. https://doi.org/10.1037/pas0000254 CrossRefPubMed

Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol use disorders identification test. Archives of Internal Medicine,158, 1789–1795.CrossRef

Buysse, D. J., Reynolds, C. F., 3rd, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research,28, 193–213.CrossRef

Campbell, D. G., Felker, B. L., Liu, C. F., Yano, E. M., Kirchner, J. E., Chan, D., et al. (2007). Prevalence of depression-PTSD comorbidity: Implications for clinical practice guidelines and primary care-based interventions. Journal of General Internal Medicine,22, 711–718. https://doi.org/10.1007/s11606-006-0101-4 CrossRefPubMedPubMedCentral

Chopra, M. P., Zhang, H., Pless Kaiser, A., Moye, J. A., Llorente, M. D., Oslin, D. W., et al. (2014). PTSD is a chronic, fluctuating disorder affecting the mental quality of life in older adults. The American Journal of Geriatric Psychiatry,22, 86–97. https://doi.org/10.1016/j.jagp.2013.01.064 CrossRefPubMed

Chwastiak, L. A., Rosenheck, R. A., & Kazis, L. E. (2011). Association of psychiatric illness and obesity, physical inactivity, and smoking among a national sample of veterans. Psychosomatics,52, 230–236. https://doi.org/10.1016/j.psym.2010.12.009 CrossRefPubMedPubMedCentral

Cook, J. M., Simiola, V., Hamblen, J. L., Bernardy, N., & Schnurr, P. P. (2017). The influence of patient readiness on implementation of evidence-based PTSD treatments in veterans affairs residential programs. Psychological Trauma,9, 51–58. https://doi.org/10.1037/tra0000162 CrossRefPubMed

Crombie, K. M., Brellenthin, A. G., Hillard, C. J., & Koltyn, K. F. (2018). Psychobiological responses to aerobic exercise in individuals with posttraumatic stress disorder. Journal of Traumatic Stress,31, 134–145. https://doi.org/10.1002/jts.22253 CrossRefPubMed

Crone, D., & Guy, H. (2008). ‘I know it is only exercise, but to me it is something that keeps me going’: A qualitative approach to understanding mental health service users’ experiences of sports therapy. International Journal of Mental Health Nursing,17, 197–207. https://doi.org/10.1111/j.1447-0349.2008.00529.x CrossRefPubMed

Davidson, C. L., Babson, K. A., Bonn-Miller, M. O., Souter, T., & Vannoy, S. (2013). The impact of exercise on suicide risk: examining pathways through depression, PTSD, and sleep in an inpatient sample of veterans. Suicide and Lifethreatening Behavior,43, 279–289.CrossRef

Davison, E. H., Kaiser, A. P., Spiro, A., 3rd, Moye, J., King, L. A., & King, D. W. (2016). From late-onset stress symptomatology to later-adulthood trauma reengagement in aging combat veterans: Taking a broader view. Gerontologist,56, 14–21. https://doi.org/10.1093/geront/gnv097 CrossRefPubMed

Dedert, E. A., Calhoun, P. S., Watkins, L. L., Sherwood, A., & Beckham, J. C. (2010). Posttraumatic stress disorder, cardiovascular, and metabolic disease: A review of the evidence. Annals of Behavioral Medicine,39, 61–78.CrossRef

Durai, U. N., Chopra, M. P., Coakley, E., Llorente, M. D., Kirchner, J. E., Cook, J. M., et al. (2011). Exposure to trauma and posttraumatic stress disorder symptoms in older veterans attending primary care: Comorbid conditions and self-rated health status. Journal of the American Geriatrics Society,59, 1087–1092. https://doi.org/10.1111/j.1532-5415.2011.03407.x CrossRefPubMed

Farr, O. M., Sloan, D. M., Keane, T. M., & Mantzoros, C. S. (2014). Stress- and PTSD-associated obesity and metabolic dysfunction: A growing problem requiring further research and novel treatments. Metabolism,63, 1463–1468. https://doi.org/10.1016/j.metabol.2014.08.009 CrossRefPubMedPubMedCentral

Goldstein, L. A., Mehling, W. E., Metzler, T. J., Cohen, B. E., Barnes, D. E., Choucroun, G. J., et al. (2018). Veterans group exercise: A randomized pilot trial of an integrative exercise program for veterans with posttraumatic stress. Journal of Affective Disorders,227, 345–352. https://doi.org/10.1016/j.jad.2017.11.002 CrossRefPubMed

Hall, K. S., Hoerster, K. D., & Yancy, W. S., Jr. (2015). Post-traumatic stress disorder, physical activity, and eating behaviors. Epidemiologic Reviews,37, 103–115. https://doi.org/10.1093/epirev/mxu011 CrossRefPubMed

Hall, K. S., Morey, M. C., Beckham, J. C., Bosworth, H. B., Pebole, M. M., Pieper, C. F., et al. (2018). The Warrior Wellness Study: A randomized controlled exercise trial for older veterans with PTSD. Translational Journal of the American College of Sports Medicine,3, 43–51. https://doi.org/10.1249/TJX.0000000000000056 CrossRefPubMedPubMedCentral

Harada, N. D., Wilkins, S. S., Schneider, B., Elrod, M., Hahn, T. J., Kleinman, L., et al. (2013). The influence of depression and PTSD on exercise adherence in older veterans. Military Behavioral Health,1, 146–151. https://doi.org/10.1080/21635781.2013.829400 CrossRef

Hegberg, N. J., Hayes, J. P., & Hayes, S. M. (2019). Exercise intervention in PTSD: A narrative review and rationale for implementation. Frontiers in Psychiatry,10, 133. https://doi.org/10.3389/fpsyt.2019.00133 CrossRefPubMedPubMedCentral

Imel, Z. E., Laska, K., Jakupcak, M., & Simpson, T. L. (2013). Meta-analysis of dropout in treatments for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology,81, 394–404. https://doi.org/10.1037/a0031474 CrossRefPubMedPubMedCentral

Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry,52, 1048–1060.CrossRef

Koffel, E., Khawaja, I. S., & Germain, A. (2016). Sleep disturbances in posttraumatic stress disorder: Updated review and implications for treatment. Psychiatric Annals,46, 173–176. https://doi.org/10.3928/00485713-20160125-01 CrossRefPubMedPubMedCentral

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine,16, 606–613.CrossRef

Kulka, R. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., et al. (1990). Trauma and the Vietnam war generation. New York: Brunner/Manzel.

Monson, C. M., Gradus, J. L., Young-Xu, Y., Schnurr, P. P., Price, J. L., & Schumm, J. A. (2008). Change in posttraumatic stress disorder symptoms: Do clinicians and patients agree? Psychological Assessment,20, 131–138. https://doi.org/10.1037/1040-3590.20.2.131 CrossRefPubMed

Najavits, L. M. (2015). The problem of dropout from “gold standard” PTSD therapies. F1000Prime Reports,7, 43. https://doi.org/10.12703/p7-43 CrossRefPubMedPubMedCentral

Pebole, M. M., & Hall, K. S. (2019). Physical activity promotion in women with PTSD: What we need for progress. Psychology of Sport and Exercise,41, 127–129.CrossRef

Penedo, F. J., & Dahn, J. R. (2005). Exercise and well-being: A review of mental and physical health benefits associated with physical activity. Current Opinion in Psychiatry,18, 189–193.CrossRef

Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society,23, 433–441.CrossRef

Phelan, E., Williams, B., Meeker, K., Bonn, K., Frederick, J., Logerfo, J., et al. (2010). A study of the diagnostic accuracy of the PHQ-9 in primary care elderly. BMC Family Practice,11, 63. https://doi.org/10.1186/1471-2296-11-63 CrossRefPubMedPubMedCentral

Physical Activity Guidelines Advisory Committee. (2018). 2018 Physical Activity Guidelines Advisory Committee scientific report. Retrieved January 5, 2019 from https://health.gov/paguidelines/second-edition/report/pdf/PAG_Advisory_Committee_Report.pdf

Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F. (2012a). Physical health conditions associated with posttraumatic stress disorder in U.S. older adults: Results from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of the American Geriatrics Society,60, 296–303.CrossRef

Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F. (2012b). Psychiatric comorbidity of full and partial posttraumatic stress disorder in the United States: Results from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. The American Journal of Geriatric Psychiatry,20, 380–390.CrossRef

Pless Kaiser, A., Seligowski, A., Spiro, A., III, & Chopra, M. (2016). Health status and treatment-seeking stigma in older adults with trauma and posttraumatic stress disorder. Journal of Rehabilitation Research and Development,53, 391–402. https://doi.org/10.1682/JRRD.2015.03.0039 CrossRefPubMed

Powers, M. B., Medina, J. L., Burns, S., Kauffman, B. Y., Monfils, M., Asmundson, G. J., et al. (2015). Exercise augmentation of exposure therapy for PTSD: Rationale and pilot efficacy data. Cognitive Behaviour Therapy,44, 314–327. https://doi.org/10.1080/16506073.2015.1012740 CrossRefPubMedPubMedCentral

Pratt, S. I., Jerome, G. J., Schneider, K. L., Craft, L. L., Buman, M. P., Stoutenberg, M., et al. (2016). Increasing US health plan coverage for exercise programming in community mental health settings for people with serious mental illness: a position statement from the Society of Behavior Medicine and the American College of Sports Medicine. Translational Behavioral Medicine,6, 478–481. https://doi.org/10.1007/s13142-016-0407-7 CrossRefPubMedPubMedCentral

Prins, A., Bovin, M. J., Smolenski, D. J., Marx, B. P., Kimerling, R., Jenkins-Guarnieri, M. A., et al. (2016). The primary care PTSD screen for DSM-5 (PC-PTSD-5): Development and evaluation within a veteran primary care sample. Journal of General Internal Medicine,31, 1206–1211. https://doi.org/10.1007/s11606-016-3703-5 CrossRefPubMedPubMedCentral

PTSD: National Center for PTSD. (1998). Retrieved January 5, 2019 from https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp

Rosenbaum, S., Sherrington, C., & Tiedemann, A. (2015a). Exercise augmentation compared with usual care for post-traumatic stress disorder: A randomized controlled trial. Acta Psychiatrica Scand.,131, 350–359. https://doi.org/10.1111/acps.12371 CrossRef

Rosenbaum, S., Vancampfort, D., Steel, Z., Newby, J., Ward, P. B., & Stubbs, B. (2015b). Physical activity in the treatment of post-traumatic stress disorder: A systematic review and meta-analysis. Psychiatry Research,230, 130–136. https://doi.org/10.1016/j.psychres.2015.10.017 CrossRefPubMed

Schuch, F. B., Vancampfort, D., Rosenbaum, S., Richards, J., Ward, P. B., Veronese, N., et al. (2016). Exercise for depression in older adults: A meta-analysis of randomized controlled trials adjusting for publication bias. Brazilian Journal of Psychiatry,38, 247–254. https://doi.org/10.1590/1516-4446-2016-1915 CrossRefPubMedPubMedCentral

Shivakumar, G., Anderson, E. H., Suris, A. M., & North, C. S. (2017). Exercise for PTSD in women veterans: A proof-of-concept study. Military Medicine,182, e1809–e1814. https://doi.org/10.7205/MILMED-D-16-00440 CrossRefPubMed

Skinner, H. A. (1982). The drug abuse screening test. Addictive Behaviors,7, 363–371.CrossRef

Smith, B. N., Tyzik, A. L., Neylan, T. C., & Cohen, B. E. (2015). PTSD and obesity in younger and older veterans: Results from the mind your heart study. Psychiatry Research,229, 895–900. https://doi.org/10.1016/j.psychres.2015.07.044 CrossRefPubMedPubMedCentral

Soundy, A., Faulkner, A., & Taylor, A. (2007). Exploring variability and perceptions of lifestyle physical activity among individuals with severe and enduring mental health problems: A qualitative study. Journal of Mental Health,16, 493–503. https://doi.org/10.1080/09638230701482345 CrossRef

Spira, A. P., Beaudreau, S. A., Stone, K. L., Kezirian, E. J., Lui, L. Y., Redline, S., et al. (2012). Reliability and validity of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in older men. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences,67, 433–439. https://doi.org/10.1093/gerona/glr172 CrossRef

The Management of Posttraumatic Stress Disorder Working Group. (2017). VA/DOD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder. Retrieved May 8, 2018 from https://www.healthquality.va.gov/guidelines/MH/ptsd/VADoDPTSDCPGFinal012418.pdf

van den Berk-Clark, C., Secrest, S., Walls, J., Hallberg, E., Lustman, P. J., Schneider, F. D., et al. (2018). Association between posttraumatic stress disorder and lack of exercise, poor diet, obesity, and co-occuring smoking: A systematic review and meta-analysis. Health Psychology,37, 407–416. https://doi.org/10.1037/hea0000593 CrossRefPubMedPubMedCentral

Ware, J. E., Jr. (2000). SF-36 health survey update. Spine (Phila Pa 1976),25, 3130–3139.CrossRef

Ware, J. E., Jr., & Kosinski, M. (2001). SF-36 physical and mental health summary scores: A manual for users of version 1 (2nd ed.). Lincoln, RI: QualityMetric Incorporated.

Weathers, F. W., Bovin, M. J., Lee, D. J., Sloan, D. M., Schnurr, P. P., Kaloupek, D. G., et al. (2018). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychological Assessment,30, 383–395. https://doi.org/10.1037/pas0000486 CrossRefPubMed

Wetherell, J. L., Petkus, A. J., Thorp, S. R., Stein, M. B., Chavira, D. A., Campbell-Sills, L., et al. (2013). Age differences in treatment response to a collaborative care intervention for anxiety disorders. British Journal of Psychiatry,203, 65–72. https://doi.org/10.1192/bjp.bp.112.118547 CrossRefPubMed

Whitworth, J. W., & Ciccolo, J. T. (2016). Exercise and post-traumatic stress disorder in military veterans: A systematic review. Military Medicine,181, 953–960. https://doi.org/10.7205/MILMED-D-15-00488 CrossRefPubMed

Whitworth, J. W., Craft, L. L., Dunsiger, S. I., & Ciccolo, J. T. (2017). Direct and indirect effects of exercise on posttraumatic stress disorder symptoms: A longitudinal study. General Hospital Psychiatry,49, 56–62. https://doi.org/10.1016/j.genhosppsych.2017.06.012 CrossRefPubMed

Windle, G., Hughes, D., Linck, P., Russell, I., & Woods, B. (2010). Is exercise effective in promoting mental well-being in older age? A systematic review. Aging & Mental Health,14, 652–669. https://doi.org/10.1080/13607861003713232 CrossRef

Wortmann, J. H., Jordan, A. H., Weathers, F. W., Resick, P. A., Dondanville, K. A., Hall-Clark, B., et al. (2016). Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychological Assessment,28, 1392–1403. https://doi.org/10.1037/pas0000260 CrossRefPubMed

Yudko, E., Lozhkina, O., & Fouts, A. (2007). A comprehensive review of the psychometric properties of the drug abuse screening test. Journal of Substance Abuse Treatment,32, 189–198. https://doi.org/10.1016/j.jsat.2006.08.002 CrossRefPubMed

Titel: Pilot randomized controlled trial of exercise training for older veterans with PTSD
Auteurs: Katherine S. Hall
Miriam C. Morey
Hayden B. Bosworth
Jean C. Beckham
Michelle M. Pebole
Richard Sloane
Carl F. Pieper
Publicatiedatum: 01-07-2019
Uitgeverij: Springer US
Gepubliceerd in: Journal of Behavioral Medicine / Uitgave 4/2020
Print ISSN: 0160-7715
Elektronisch ISSN: 1573-3521
DOI: https://doi.org/10.1007/s10865-019-00073-w

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Log in om toegang te krijgen

Andere artikelen Uitgave 4/2020

Longitudinal associations between gratitude and depression 1 year later among adult cystic fibrosis patients

Unique effects of religiousness/spirituality and social support on mental and physical well-being in people living with congestive heart failure

Defining picky eating and its relationship to feeding behaviors and weight status

Revising the bariatric psychological evaluation to improve clinical and research utility

Pain catastrophizing and distress intolerance: prediction of pain and emotional stress reactivity

Exploring the interconnectedness of fatigue, depression, anxiety and potential risk and protective factors in cancer patients: a network approach