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: 10322646
• 负责人: Katherine Shepherd Hall
• 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 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10322646
• 关键词: 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 behavior change; Health education; Impairment; Individual; Iraq; Joints; 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; Sleep disturbances; Specialist; Structure; Supervision; Symptoms; Testing; Theoretical model; Time; Training; Training Programs; Veterans; Veterans Health Administration; Vietnam; Walking; Work; arm; attentional control; base; 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; interest; intervention effect; meter; military veteran; modifiable risk; mortality; patient oriented; patient population; peer; physical conditioning; physically handicapped; post intervention; preference; primary outcome; programs; psychologic; psychosocial; randomized controlled design; randomized trial; recruit; resilience; secondary outcome; sedentary activity; sleep quality; strength training; stress related disorder; 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，影响了30％以上的年龄较大， 越南时代的退伍军人。这些符号已有将近40年的符号，作为一个 结果，健康状况明显较差，慢性疾病和肥胖的率更高，死亡率过高 比一般人群高3倍。显然，PTSD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。结构化锻炼是预防，治疗和 老年人的慢性身体和心理健康状况的管理。迄今为止，只有少数飞行员 锻炼研究和PTSD的研究已经发表，所有人都遭受了重大限制：对 结果“脖子上方”。这些研究没有报告运动对身体健康和身体健康的影响 与PTSD的退伍军人有助于长期障碍和残疾的与流动性相关的结果。那里 在老年人中没有对运动和PTSD进行的研究，这代表了显着的研究差距。这 研究考试是一种基于健康的方法，用于促进具有PTSD的老年退伍军人的健康，定位 锻炼，主要可修改的危险因素。这项研究的目的是比较受监督的影响 关于PTSD症状和相关健康结果的运动计划与健康衰老的注意力控制 组（HA-ATC）。 这项研究将是一项为期6个月的监督运动计划的随机对照试验 Durham VAHCS的PTSD年龄≥60岁的退伍军人。参与者将被随机分配给 监督运动或HA-ATC。运动臂将包括3个每周的练习，每一次持续 大约60分钟，由一名运动专家领导。 HA-ATC将获得健康教育计划 以及以10个KEYSTM为模型的材料，用于健康的老龄化课程和国家衰老理事会 “老化的精通计划。” HA-ATC将包括一个为期8周的面对面小组计划，然后是4 每月会议，后者将进一步补充邮寄信息包，电子邮件 新闻通讯，网络研讨会和团体视频远程医疗会议。运动干预部门的参与者将 根据个人的锻炼历史，当前的锻炼，获得个性化的锻炼处方 能力，个人喜好和当前的健康状况。这将是一个多组件程序，包括 针对主要肌肉群的8到12强，平衡和灵活性练习的选择 以及主要关节。参与者还将在耐力运动中进行指导，包括跑步机或 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 进行性有氧运动和增强运动，并以5分钟的冷却结束。主要 这项研究的结果将是用CAPS-5评估的PTSD症状。身体功能，另一个结果 主要感兴趣的人将通过物理性能电池客观地衡量。这个测试电池 评估日常功能的各个方面，包括平衡（单腿立场），速度（步行4米）和椅子 架子（＃在30秒内）。有氧耐力（研究人员的主要功能结果）将被评估 进行6分钟的步行测试（6MWT）。次要结果包括抑郁，睡眠和认知功能。 结果将在基线，3个月和6个月时进行评估。评估将重复12周 干预后（9个月），以检查是否维持任何观察到的运动干预效果。 混合线性模型将用于比较两个研究臂的结果。