Exercise as it relates to Disease/Aerobic exercise and post traumatic stress disorder

What is the background to this research?
Aerobic exercise reduces symptoms of posttraumatic stress disorder: A Randomised Controlled Trial, (A research review) 

Posttraumatic Stress Disorder (PTSD)

•	Posttraumatic stress disorder better known by its abbreviation PTSD. It is a mental disorder that can occur in people that have experienced a traumatic event. These events can include war, a major accident, physical assault even a natural disaster could bring a person to show signs and symptoms of PTSD. These symptoms may be re-occurring dreams about an event, avoiding certain ques that may remind them of an event or they may even show signs of physical and mental stress (depression, anxiety, anger). Patients suffering from PTSD will also struggle with the concept of change (1). Benefits of Aerobic Exercise

•	Physical activity has many benefits for your health both mentally and physically. In studies it has been proven that using aerobic exercise to treatment symptoms of anxiety, depression, stress and PTSD have a high success rate. Aerobic exercise will release endorphins that will aid in making a person feel better and can actually slow down the ageing process and stimulate new brain cell growth (2). Endorphins have a close connection with the release of oxytocin, this is the hormone that your body will release when it is feeling relaxed (3).

Studies on PTSD patients show that they are unable to regulate the hormone adrenaline which will get released into the body at times of stress. These hormones are what will elicit the ‘fight or flight’ response (3). In regards to using aerobic exercise to try to alleviate the symptoms, because the body has been found not only offer stabilization of the regulation of hormones but also a mental distraction. Because attention will be drawn to the task at hand (i.e. where the limbs are, what the muscles and joints need to do next) a patient suffering from PTSD will find it hard to focus on any negative, depressive, fearful or distressing thoughts (4).

Where is the research from?
The purpose of this document is to analyse the research article Aerobic exercise reduces symptoms of posttraumatic stress disorder: A Randomised Controlled Trial by the authors Mathew G. Fetzner and Gordan J.G. Asmundson from the Department of Psychology, University of Regina, Regina, Canada. The work was then published in the 2015 issue 4, volume 44, Cognitive Behaviour Therapy. The authors state they have no conflicts to disclose and the research is funded by the Canadian Institute of Health Research Vanier Canada graduate scholarship and the presidents research chair of adult mental health at the University of Regina.

What kind of research was this?
The study that has been completed was a randomized control trial study and I believe the study to be valued and unbiased as it follows similar protocols as other studies (no psychiatric treatment, suicidal thoughts, violent/psychotic outbreaks or substances abuse). Many studies have been conducted to look into the benefits that aerobic exercise can have on your health. The majority of these studies will be carried out over an 8-12-week period and will focus on the arousal, attendance and cognitive response.

It has become quite well known for some time now that aerobic exercise can have increasing benefits on your mental health. I feel there are good correlations between multiple studies to say that the level of evidence is sufficient with the benefits of aerobic exercise in PTSD patients. The follow tables provide strong evidence-based results on some of the benefits. Table 1. characteristics of millennium cohort study participants by PTSD (5) Table 2. Mood and Pain Response to Aerobic Exercise (6)

What did the research involve?
The following table displays the selection process for the reviewed study.

(7) I don’t believe that the study size was near large enough, they had started with fifty-seven participants passing the online screening but once further screened and divided into their three exercise groups they were only left with eleven in each. The study group was not large enough to state fairly that any of the methods is the most effective but can act as a guide for the direction of further study. There was also the length of time with this trial taking place over a brief two-week period. When reflecting on the data provided you can see a certain correlation of benefits in the results although in saying that the study was completed over a 2-week period with a limit to no more than four exercise session a week. In this period all results showed a decrease but this was only within a week and a half. As the participants come into the end of the trail you can see there is then a definite rise.

What were the basic results?
The important findings to take from this research is that clinically each of the different methods will work to improve symptoms of PTSD which is supported by statements from the researchers. In saying that which one works the best according to the data of the study is the cognitive distraction. The only emphasis I felt that has been made in this research piece is that everyone should be participating in aerobic exercise which is support by other research (8).

What conclusions can we take from this research?
Multiple study have been conducted around the subject of PTSD and aerobic exercise as it is known to be a valid form of treatment and is also preferred over medications that are also available (fluoxetine, paroxetine, sertraline and venlafaxine) (3). Further studies also concluded that aerobic exercise of just thirty minutes a day at 70-70% maximum heartrate (MHR) ( 3) would give patients pain relief as well. This was due to the increase in N-arachidonylethanolamine (AEA), 2‐arachidonoylglycerol (2‐AG), and oleoylethanolamide (OEA) that would increase in circulation post aerobic exercise. I would like to make a note that this study as well pointed out that aerobic exercise benefits not overly people suffering from PTSD but also the general population as well. This was another study that used a randomized control trial although there seemed to be less restrictions on who was actually able to participate (3).

Practical advice
Aerobic exercise has been proven to treat the symptoms of PTSD (anxiety, depression, anger, etc) with just one hundred and fifty hours of moderate aerobic exercise a week being the bare minimum. An implication of this is time, a person would suffer from the symptoms will actually struggle to get up and actually have the motivation to start aerobic exercise and except a change. (9).

I find that this is something that is far more important to concentrate on now as ptsd has been link with sedentary behaviours. I feel that this can also be reflected in the critic articles results with two people in each sample dropping out of the program. One reason being they did not want to continue and another that they were to distressed to continue. Further readings that may be of interest can be found at the following links

PTSD support links
•	https://www.beyondblue.org.au/ •	https://www.healthdirect.gov.au/symptoms-of-ptsd

Aerobic exercise benefits link
•	https://www.heartfoundation.org.au/active-living/get-active •	https://www.ncbi.nlm.nih.gov/pubmed/2062750

Other papers of interest
•	Herring, M.P., O’Connor, P.J., & Dishman, R.K. (2010). The effects of exercise training on anxiety symptoms among patients: A systematic review. Archives of Internal Medicine, 170, 321 – 331 •	Broman-Fulks, J.J., & Storey, K.M. (2008). Evaluation of a brief aerobic exercise intervention for high anxiety sensitivity. Anxiety, Stress, Coping, 21, 117 – 128.

Reference list

 * 1) 	(https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml).
 * 2) 	(http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines).
 * 3) 	https://www.webmd.com/mental-health/what-are-treatments-for-posttraumatic-stress-disorder#2).
 * 4) 	Mathew G. Fetzner & Gordon J.G. Asmundson (2015) Aerobic Exercise Reduces Symptoms of Posttraumatic Stress Disorder: A Randomized Controlled Trial, Cognitive Behaviour Therapy, 44:4, 301-313
 * 5) 	(http://journals.sagepub.com.ezproxy.canberra.edu.au/doi/pdf/10.1177/003335491112600311
 * 6) 	https://onlinelibrary-wiley-com.ezproxy.canberra.edu.au/doi/epdf/10.1002/jts.22253
 * 7) 	Lauren M. Oppizzi & Reba Umberger (2018) The Effect of Physical Activity on PTSD, Issues in Mental Health Nursing, 39:2, 179-187
 * 8) 	Dolores Britvić, Dubravka Glučina, Vesna Antičevič, Vesna Kekez, Branka Lapenda, Varja Đogaš, Goran Dodig, Ivan Urlić, Iva Moro, Tanja Frančišković. (2012) Long-Term Improvement in Coping Skills Following Multimodal Treatment in War Veterans with Chronic PTSD. International Journal of Group Psychotherapy 62:3, pages 418-435