Exploring the Effects of Exercise Training on PTSD Symptoms and Physical Health in Older Veterans with PTSD

探索运动训练对患有 PTSD 的老年退伍军人的 PTSD 症状和身体健康的影响

• 批准号: 10543092
• 负责人: Kathryn N Starr
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10543092
• 关键词: Acceleration; Aerobic; Aerobic Exercise; Affect; Afghanistan; Age Years; Aging; Area; Attenuated; Behavior Therapy; Behavioral; Bicycling; Biological; Caring; Chronic; Chronic Disease; Chronic Post Traumatic Stress Disorder; Cognition; Cognitive; Complex; Control Groups; Data; Disease Management; Educational Curriculum; Elderly; Electronic Mail; Elements; Equilibrium; Excess Mortality; Exercise; Future; Gait speed; General Population; Health; Health Promotion; Health Status; Health education; Health system; Impairment; Individual; Iraq; Joints; Learning; Leg; Linear Models; Literature; Measures; Mediating; Mental Depression; Mental Health; Mental disorders; Mission; Modeling; Monitor; Motivation; Muscle; Neck; Newsletter; Obesity; Outcome; Outcome Study; Participant; Pathway interactions; Patients; Personal Satisfaction; Physical Function; Physical Performance; Physical activity; Pilot Projects; Population; Post-Traumatic Stress Disorders; Prevention strategy; Protocols documentation; Publishing; Quality of life; Randomized; Randomized, Controlled Trials; Recording of previous events; Reporting; Research; Research Personnel; Risk; Risk Factors; Sampling; Series; Sleep; Specialist; Structure; Symptoms; Testing; Theoretical model; Time; Training; Training Programs; Veterans; Veterans Health Administration; Vietnam; Walking; Work; arm; attentional control; behavior change; cognitive function; cognitive performance; cohort; comorbidity; daily functioning; deconditioning; depressive symptoms; design; disability; effective therapy; endurance exercise; exercise capacity; exercise intervention; exercise prescription; exercise program; exercise training; experience; flexibility; follow-up; functional disability; functional outcomes; healthy aging; improved; improvement on sleep; interest; intervention effect; meter; military veteran; modifiable risk; mortality; patient oriented; patient population; patient retention; peer; physical conditioning; physically handicapped; post intervention; preference; primary outcome; programs; psychologic; psychosocial; randomized controlled design; randomized trial; recruit; resilience; secondary outcome; sedentary activity; service member; sleep quality; strength training; telehealth; therapy development; treadmill; treatment arm; two-arm study; webinar

Posttraumatic stress disorder (PTSD) is prevalent among military Veterans, and affects over 30% of older, Vietnam-era Veterans. These servicemembers have endured nearly 40 years with these symptoms, and as a result, have significantly poorer health, higher rates of chronic disease and obesity, and an excess mortality rate 3 times higher than the general population. Clearly PTSD is more than just a psychological disorder. There is evidence to suggest that the pathway from PTSD to poor health is mediated by behavioral risk factors, such as exercise. Structured exercise is a highly effective, pluripotent strategy for the prevention, treatment, and management of chronic physical and psychological health conditions in older adults. To date, only a few pilot studies of exercise and PTSD have been published, and all suffer a major limitation: a singular focus on outcomes “above the neck.” These studies do not report the impact of exercise on physical health- and mobility-related outcomes that contribute to long-term impairment and disability in Veterans with PTSD. There have been no studies of exercise and PTSD done in older adults, representing a significant research gap. This research examines a wellness-based approach to promoting health in older Veterans with PTSD, targeting exercise, a major modifiable risk factor. The objective of this study is to compare the impact of a supervised exercise program on PTSD symptoms and related health outcomes versus a healthy aging attention control group (HA-ATC). This study will be a randomized controlled trial of a 6-month, supervised exercise program among 188 Veterans ≥60 years of age with PTSD at the Durham VAHCS. Participants will be randomly assigned to Supervised Exercise or HA-ATC. The exercise arm will include 3 weekly exercise sessions, each one lasting approximately 60 minutes, led by an exercise specialist. The HA-ATC will receive a health education program and materials modeled on the 10 KeysTM to Healthy Aging curriculum and the National Council on Aging’s “Aging Mastery Program.” The HA-ATC will include an 8-week face-to-face group program followed by 4 monthly sessions, the latter of which will be further supplemented with mailed informational packets, email newsletters, webinars, and group video telehealth sessions. Participants in the Exercise intervention arm will receive an individualized exercise prescription based on the individual’s exercise history, current exercise capacity, personal preferences, and current health status. This will be a multicomponent program that includes a selection of 8 to 12 strengthening, balance, and flexibility exercises targeting the major muscle groups as well as primary joints. Participants will also be instructed in endurance exercise, including treadmill walking or recumbent bicycle. The exercise protocol will consist of a 5-10 minute warm-up, followed by a series of progressive aerobic and strengthening exercises, and will end with a 5 minute cool-down. The primary outcome for this study will be PTSD symptoms assessed with the CAPS-5. Physical function, another outcome of primary interest will be measured objectively with a Physical Performance Battery. This test battery assesses aspects of daily function including balance (single leg stance), gait speed (4 meter walk), and chair stands (# in 30 seconds). Aerobic endurance, the investigators’ primary functional outcome, will be assessed with the 6-minute walk test (6MWT). Secondary outcomes include depression, sleep, and cognitive function. Outcomes will be assessed at baseline, 3 months, and 6 months. Assessments will be repeated 12 weeks post-intervention (9 months) to examine whether any observed exercise intervention effects are maintained. Mixed linear models will be used to compare outcomes for the two study arms.

创伤后应激障碍 (PTSD) 在退伍军人中普遍存在，影响超过 30% 的老年人、 越战时期的退伍军人。这些军人已经忍受了近 40 年的这些症状，并且作为 结果，健康状况明显较差，慢性病和肥胖率较高，死亡率过高 比一般人群高出3倍。显然，创伤后应激障碍不仅仅是一种心理障碍。那里 有证据表明，从 PTSD 到健康状况不佳的途径是由行为风险因素介导的，例如 作为锻炼。结构化运动是一种高效、多能的预防、治疗和预防策略。 老年人慢性身心健康状况的管理。迄今为止，只有少数试点 关于运动和创伤后应激障碍的研究已经发表，但所有研究都存在一个重大局限性：单一关注 结果“高于颈部”。这些研究没有报告运动对身体健康的影响 导致患有创伤后应激障碍 (PTSD) 的退伍军人长期受损和残疾的与行动能力相关的结果。那里 目前还没有针对老年人进行运动和创伤后应激障碍（PTSD）的研究，这代表着巨大的研究空白。这 研究探讨了一种基于健康的方法来促进患有创伤后应激障碍 (PTSD) 的老年退伍军人的健康，目标是 运动，一个主要的可改变的风险因素。本研究的目的是比较受监督的影响 锻炼计划对 PTSD 症状和相关健康结果与健康老龄化注意力控制的影响 组（HA-ATC）。 这项研究将是一项随机对照试验，对 188 名受试者进行为期 6 个月的监督锻炼计划 达勒姆 VAHCS 中患有 PTSD 的 60 岁以上退伍军人。参与者将被随机分配到 监督运动或 HA-ATC。锻炼臂将包括每周 3 次锻炼，每次锻炼持续时间 大约 60 分钟，由运动专家指导。 HA-ATC 将接受健康教育计划 以及以 10 KeysTM to Healthy Aging 课程和国家老龄化委员会的课程为蓝本的材料 “衰老掌握计划”。 HA-ATC 将包括为期 8 周的面对面小组课程，随后是 4 周 每月一次的会议，后者将进一步补充邮寄的信息包、电子邮件 时事通讯、网络研讨会和团体视频远程医疗会议。运动干预组的参与者将 根据个人的运动历史、当前的运动情况获得个性化的运动处方 能力、个人喜好和当前的健康状况。这将是一个多组件程序，其中包括 针对主要肌肉群的精选 8 至 12 个强化、平衡和灵活性练习 以及主要关节。参与者还将接受耐力锻炼的指导，包括跑步机步行或 卧式自行车。锻炼方案将包括 5-10 分钟的热身，然后是一系列的 进行渐进式有氧运动和力量训练，并以 5 分钟的冷静期结束。初级 这项研究的结果将是使用 CAPS-5 评估 PTSD 症状。身体机能，另一种结果 主要兴趣将通过物理性能电池进行客观测量。本次测试电池 评估日常功能的各个方面，包括平衡（单腿站立）、步态速度（4 米步行）和椅子 站立（30 秒后#）。将评估研究人员的主要功能结果——有氧耐力 6 分钟步行测试 (6MWT)。次要结果包括抑郁、睡眠和认知功能。 将在基线、3 个月和 6 个月时评估结果。评估将每 12 周重复一次 干预后（9个月）检查是否维持任何观察到的运动干预效果。 将使用混合线性模型来比较两个研究组的结果。