Whether you're reviewing the scientific literature, reading a health magazine, or simply watching the news, it's hard not to hear something just about every day about the benefits of exercise, both on our physical and psychological health. Is it possible, then, that exercise could even make PTSD treatment more effective, particularly in a military population that places high value on physical fitness?

That is the question being explored by COL (Ret) Stacey Young-McCaughan, RN, PhD, of the University of Texas Health Science Center at San Antonio, who is leading a STRONG STAR-affiliated study on the role of exercise in the treatment of posttraumatic stress disorder.

The study combines components of one of the leading talk therapies for PTSD, called Prolonged Exposure (PE) therapy, with a supervised exercise program to see if participants do better with therapy alone, exercise alone, a combination of PE therapy and exercise, or self-care.

The treatment program

Prolonged Exposure has already been shown to be highly effective with civilians who have noncombat-related PTSD; the majority of those treated have recovered and not seen their symptoms return.

One component of PE is called "imaginal exposure," in which individuals actively visualize images of their trauma with the assistance of their mental health care provider until the images no longer cause significant physical, behavioral, or emotional reactions. These imaginal exposure exercises are usually considered the most difficult part of the PE treatment program, because the individual has to "tough it out" and experience these significant reactions until they subside. The reactions are thought to be similar to the "fight-or-flight" alarm reactions that occur when adrenaline is released into the body when individuals are exposed to actual dangerous situations. However, in this case, it is actually a false alarm, because these reactions are triggered not by exposure to true danger, but exposure to the individual's memory of the traumatic event.

The current study hypothesizes that allowing an individual to exercise during exposure to the traumatic memory will decrease the distress of the imaginal exposure procedure by allowing the individual to channel the fight-or-flight stress reaction into the physical exercise.

Research questions and expected outcomes

With a research grant from the Tri-Service Nursing Research Program and the collaboration of the STRONG STAR PTSD Research Consortium, Dr. Young-McCaughan designed a clinical trial to test this hypothesis. Participants who enroll will be randomly assigned to a course of treatment that includes exposure therapy only, aerobic exercise only, exposure therapy augmented with aerobic exercise, or self care.

Dr. Young-McCaughan and her team will then conduct an evaluation to answer the following questions:

• Are PTSD symptoms reduced by imaginal exposure alone?
• Are PTSD symptoms reduced by exercise alone?
• Are PTSD symptoms reduced by a combination of imaginal exposure and exercise?
• Does the combination of exercise and imaginal exposure produce a better outcome than either treatment alone?

It is hoped that study outcomes can be used in the development of an effective, evidence-based nursing intervention in which military personnel with PTSD symptoms can engage as part of their routine health promotion activities.