Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm 114 86, Sweden.
Mil Med. 2022 Aug 25;187(9-10):e1103-e1113. doi: 10.1093/milmed/usab497.
Post-traumatic stress disorder (PTSD) is a cluster of physical and psychiatric symptoms following military or civilian trauma. The effect of exercise on PTSD symptoms has previously been investigated in several studies. However, it has not been fully determined what type of exercise most impacts PTSD symptoms. The aim of the present study was to systematically review the effects of different types of exercise on PTSD symptom severity and symptoms of coexisting conditions in adults.
Electronic searches were conducted in the databases PubMed, APA PsycInfo, and SportDiscus, from database inception up until February 1, 2021. Inclusion criteria were randomized controlled trials published in English, participants having a PTSD diagnosis or clinically relevant symptoms, and participants randomly allocated to either a non-exercising control group or an exercise group. Data concerning the number of participants, age, exercise type and duration, PTSD symptom severity (primary outcome), and symptoms of coexisting conditions (secondary outcomes) were extracted. The subgroup analysis included high or low training dose, military trauma versus non-military trauma, the type of intervention (yoga versus other exercise), active or passive control condition, group training versus individual exercise, and study quality. The study quality and risk of bias were assessed using grading of recommendation assessment, development and evaluation (GRADE) guidelines. A meta-analysis was performed with a mixed-effects model and restricted maximum likelihood as model estimator, and effect size was calculated as the standardized difference in mean and 95% CI.
Eleven studies were included in the present review. Results showed a main random effect of exercise intervention (0.46; 95% CI: 0.18 to 0.74) and a borderline significant interaction between more voluminous (>20 hours in total) and less voluminous (≤20 hours in total) exercise interventions (P = .07). No significant findings from the subgroup analysis were reported. The secondary outcome analysis showed a small but significant effect of exercise on depressive symptoms (0.20, 95% CI: 0.01 to 0.38), and a larger effect on sleep (0.51, 95% CI: 0.29 to 0.73). For substance use (alcohol and drugs combined) and quality of life, we found significant effects of 0.52 (95% CI: 0.06 to 0.98) and 0.51 (95% CI: 0.34 to 0.69), respectively. No significant effect was found for anxiety (0.18, 95% CI: -0.15 to 0.51), and no sign of publication bias was found.
Exercise can be an effective addition to PTSD treatment, and greater amounts of exercise may provide more benefits. However, as there were no differences found between exercise type, possibly due to the inclusion of a low number of studies using different methodologies, further research should aim to investigate the optimal type, dose, and duration of activity that are most beneficial to persons with PTSD.
创伤后应激障碍（PTSD）是在经历军事或民间创伤后出现的一系列身体和精神症状。先前已有多项研究探讨了运动对 PTSD 症状的影响。然而，哪种类型的运动对 PTSD 症状的影响最大，尚未完全确定。本研究的目的是系统地综述不同类型的运动对成年人 PTSD 症状严重程度和并存疾病症状的影响。
在 PubMed、APA PsycInfo 和 SportDiscus 数据库中进行电子检索，检索时间从数据库建立之初至 2021 年 2 月 1 日。纳入标准为发表于英文期刊、参与者有 PTSD 诊断或临床相关症状、且被随机分配至非运动对照组或运动组的随机对照试验。提取参与者数量、年龄、运动类型和持续时间、PTSD 症状严重程度（主要结局）和并存疾病症状（次要结局）的数据。亚组分析包括高或低训练剂量、军事创伤与非军事创伤、干预类型（瑜伽与其他运动）、主动或被动对照条件、小组训练与个体运动，以及研究质量。使用推荐评估、制定与评价（GRADE）指南对研究质量和偏倚风险进行评估。采用混合效应模型和最大似然法作为模型估计值进行荟萃分析，计算效应大小为均值的标准化差异和 95%置信区间。
本综述纳入了 11 项研究。结果显示，运动干预的主要随机效应为 0.46（95%CI：0.18 至 0.74），且更大量（总计>20 小时）和更少量（总计≤20 小时）运动干预之间存在边缘显著的交互作用（P=0.07）。亚组分析未报告有显著结果。次要结局分析显示，运动对抑郁症状有较小但显著的影响（0.20，95%CI：0.01 至 0.38），对睡眠有较大的影响（0.51，95%CI：0.29 至 0.73）。对于物质使用（酒精和药物合并）和生活质量，我们发现有显著影响的效应量分别为 0.52（95%CI：0.06 至 0.98）和 0.51（95%CI：0.34 至 0.69）。对焦虑症（0.18，95%CI：-0.15 至 0.51）无显著影响，且未发现发表偏倚的迹象。
运动可以作为 PTSD 治疗的有效辅助手段，更多的运动可能会带来更大的益处。然而，由于纳入的使用不同方法的研究数量较少，运动类型之间没有差异，因此，进一步的研究应该旨在调查对 PTSD 患者最有益的活动类型、剂量和持续时间。
