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）在退伍军人中很普遍，影响了超过30%的老年人，