Physical fitness in people with posttraumatic stress disorder: a systematic review

Abstract

Purpose: People with posttraumatic stress disorder (PTSD) have an increased risk of cardiovascular diseases (CVD). Physical fitness is a key modifiable risk factor for CVD and associated mortality. We reviewed the evidence-base regarding physical fitness in people with PTSD.

Methods: Two independent reviewers searched PubMed, CINAHL, PsycARTICLES, PEDro, and SPORTDiscus from inception until May 2016 using the key words “fitness” OR “exercise” AND “posttraumatic stress disorder” OR “PTSD”.

Results: In total, 5 studies involving 192 (44 female) individuals with PTSD met the inclusion criteria. Lower baseline physical fitness are associated with greater reductions in avoidance and hyperarousal symptoms, as well as with total, physical, and social symptoms of anxiety sensitivity. Rigorous data comparing physical fitness with age- and gender matched general population controls are currently lacking.

Conclusions: The research field regarding physical fitness in people with PTSD is still in its infancy. Given the established relationships between physical fitness, morbidity and mortality in the general population and the current gaps in the PTSD literature, targets for future research include exploring: (a) whether people with PTSD are at risk of low physical fitness and therefore in need of intensified assessment, treatment and follow-up, (b) the relationships among physical fitness, overall health status, chronic disease risk reduction, disability, and mortality in individuals PTSD, (c) psychometric properties of submaximal physical fitness tests in PTSD, (d) physical fitness changes following physical activity in PTSD, and (e) optimal methods of integrating physical activity programs within current treatment models for PTSD.

Implications for Rehabilitation

• People with PTSD should aim to achieve 150 minutes of moderate or 75 minutes vigorous physical activity per week while also engaging in resistance training exercises at least twice a week.

• Health care professionals should assist people with PTSD to overcome barriers to physical activity such as physical pain, loss of energy, lack of interest and motivation, generalized fatigue and feelings of hyperarousal.

Keywords:

• Stress
• trauma
• PTSD
• physical activity
• exercise
• physical fitness

Disclosure statement

All authors declare that they have no conflicts of interest relevant to the content of this review.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Davy Vancampfort has got support from the Research Foundation-Flanders (FWO-Vlaanderen). Simon Rosenbaum is funded by a Society for Mental Health Research (SMHR) Early Career Fellowship. Brendon Stubbs was supported by the Collaboration for Leadership in Applied Health Research and Care South London theme. No sources of funding were used to assist in the preparation of this article.