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，影响超过30%的老年人， 越战老兵这些军人已经忍受了近40年的这些症状，作为一个 结果，他们的健康状况明显较差，慢性病和肥胖症的发病率较高，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， 作为锻炼。有组织的运动是一种非常有效的，多能的预防，治疗和治疗策略。 老年人慢性身心健康状况的管理。到目前为止，只有少数飞行员 关于运动和创伤后应激障碍的研究已经发表，但都有一个主要的局限性： “脖子以上”的结果。这些研究没有报告运动对身体健康的影响， 与活动相关的结果，有助于长期损伤和残疾的退伍军人与创伤后应激障碍。那里 目前还没有在老年人中进行运动和创伤后应激障碍的研究，这代表了一个重大的研究空白。这 研究探讨了一种以健康为基础的方法，以促进患有创伤后应激障碍的老年退伍军人的健康， 运动是一个主要的可改变的风险因素。本研究的目的是比较监督的影响， 运动计划对创伤后应激障碍症状和相关健康结果与健康老龄化注意力控制的影响 HA-ATC组。 这项研究将是一项随机对照试验，在188名受试者中进行为期6个月的监督锻炼计划。 达勒姆VAHCS中年龄≥60岁且患有PTSD的退伍军人。参与者将被随机分配到 监督演习或HA-ATC。锻炼手臂将包括每周3次锻炼，每次持续 大约60分钟，由运动专家带领。HA-ATC将接受健康教育计划 和材料仿照10 KeysTM健康老龄化课程和国家老龄化理事会的 “衰老掌握计划”HA-ATC将包括一个为期8周的面对面小组课程， 每月的会议，后者将进一步补充邮寄的信息包，电子邮件 通讯、网络研讨会和小组视频远程保健会议。参与者在演习干预手臂将 接收基于所述个人的锻炼历史、当前锻炼 能力、个人偏好和当前健康状况。这将是一个多方面的计划，包括 选择8至12个针对主要肌肉群的强化，平衡和灵活性练习， 以及主要的关节。参与者还将接受耐力运动的指导，包括跑步机行走或 卧式自行车运动方案将包括5-10分钟的热身，然后是一系列的 渐进式有氧运动和强化运动，并将以5分钟的冷却结束。主 该研究的结果将是用CAPS-5评估的PTSD症状。生理功能，另一个结果 将使用身体机能成套测试客观地测量主要关注的问题。本系列测试 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 #30300;（30秒内）。有氧耐力，研究者的主要功能结果，将被评估 6分钟步行试验（6 MWT）次要结局包括抑郁、睡眠和认知功能。 将在基线、3个月和6个月时评估结局。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。 将使用混合线性模型比较两个研究组的结局。