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

创伤后应激障碍(PTSD)在退伍军人中很普遍，影响超过30%的老年人， 越战时代的退伍军人。这些军人已经忍受了近40年的这些症状，作为一名 结果，健康状况明显变差，慢性病和肥胖率较高，死亡率过高。 这一比率是普通人口的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，从创伤后应激障碍到健康不良的途径是由行为风险因素介导的，如 作为锻炼。有组织的锻炼是一种高效的、多功能的预防、治疗和 管理老年人的慢性身心健康状况。到目前为止，只有几个飞行员 关于锻炼和创伤后应激障碍的研究已经发表，但它们都面临着一个重大限制：单一关注 结果是“脖子以上”。这些研究没有报告锻炼对身体健康的影响--以及 导致患有创伤后应激障碍的退伍军人的长期损伤和残疾的与行动能力相关的结果。那里 还没有对老年人进行锻炼和创伤后应激障碍的研究，这是一个重大的研究缺口。这 研究检查了一种基于健康的方法来促进患有创伤后应激障碍的老年退伍军人的健康，有针对性 锻炼，这是一个主要的可改变的风险因素。这项研究的目的是比较受监督的 运动计划对创伤后应激障碍症状和相关健康结局的影响与健康老龄化注意力对照 组(HA-ATC)。 这项研究将是一项为期6个月的随机对照试验，在188人中进行监督锻炼 退伍军人≥60岁，患有创伤后应激障碍，在达勒姆精神病院。参与者将被随机分配到 监督运动或HA-ATC。运动手臂将包括每周3次运动，每次持续时间 大约60分钟，由运动专家带领。医管局-ATC将接受健康教育计划 和材料仿照健康老龄化的10个关键TM课程和国家老龄委员会的 “老龄化精通计划。”HA-ATC将包括为期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的信息包、电子邮件 时事通讯、网络研讨会和团体视频远程健康会议。运动干预臂的参与者将 根据个人的运动历史、当前运动 能力、个人偏好和当前健康状况。这将是一个多组件计划，包括 精选8至12种针对主要肌肉群的加强、平衡和柔韧性练习，如 以及主要关节。参与者还将接受耐力锻炼的指导，包括在跑步机上行走或 卧式自行车。锻炼计划将包括5-10分钟的热身，然后是一系列 循序渐进的有氧和力量运动，并将以5分钟的降温结束。初级阶段 这项研究的结果将是用CAPS-5评估创伤后应激障碍症状。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。这个测试电池 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秒内#)。研究人员将评估有氧耐力，这是研究人员的主要功能结果 进行6分钟步行试验(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个月进行评估。评估将重复12周 干预后(9个月)，检查是否保持了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分支的结果。

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.