The Warrior Wellness Study: A Randomized Controlled Exercise Trial for Older Veterans with PTSD

Katherine S Hall, Miriam C Morey, Jean C Beckham, Hayden B Bosworth, Michelle M Pebole, Carl F Pieper, Richard Sloane, Katherine S Hall, Miriam C Morey, Jean C Beckham, Hayden B Bosworth, Michelle M Pebole, Carl F Pieper, Richard Sloane

Abstract

Posttraumatic stress disorder (PTSD) affects up to 30% of military veterans. Older veterans, many of whom have lived with PTSD symptoms for several decades, report a number of negative health outcomes. Despite the demonstrated benefits of regular exercise on physical and psychological health, no studies have explored the impact of exercise in older veterans with PTSD. This paper describes the development, design, and implementation of the Warrior Wellness exercise pilot study for older veterans with PTSD. Veterans aged ≥60 with a Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnosis of PTSD will be recruited and randomized to (a) Warrior Wellness, a 12-week supervised, facility-based exercise intervention, or (b) usual care for 12 weeks. Warrior Wellness is a theory- and evidence-based behavioral intervention that involves 3 sessions per week of multi-component exercise training that targets strength, endurance, balance, and flexibility. Warrior Wellness focuses on satisfaction with outcomes, self-efficacy, self-monitoring, and autonomy. Factors associated with program adherence, defined as the number of sessions attended during the 12 weeks, will be explored. Primary outcomes include PTSD symptoms and cardiovascular endurance, assessed at baseline and 12 weeks. Compared to those in usual care, it is hypothesized that those in the Warrior Wellness condition will improve on these efficacy outcomes. The Warrior Wellness study will provide evidence on whether a short-term exercise intervention is feasible, acceptable, and effective among older veterans with PTSD, and explore factors associated with program adherence. ClinicalTrials.gov Identifier: NCT02295995.

Keywords: clinical trial; lifestyle; mental health; physical activity; posttraumatic stress disorder.

Conflict of interest statement

Conflict of Interest The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs and do not constitute endorsement by ACSM. None of the authors have any conflicts of interest to report.

Figures

Figure 1
Figure 1
Study design.
Figure 2
Figure 2
Warrior Wellness branding materials.

References

    1. Marmar CR, Schlenger W, Henn-Haase C, Qian M, Purchia E, Li M, et al. Course of posttraumatic stress disorder 40 years after the Vietnam war: findings from the National Vietnam Veterans Longitudinal Study. JAMA Psychiat. 2015;72(9):875–81.
    1. Dedert EA, Calhoun PS, Watkins LL, Sherwood A, Beckham JC. Posttraumatic stress disorder, cardiovascular, and metabolic disease: a review of the evidence. Ann Behav Med. 2010;39(1):61–78.
    1. Hall KS, Beckham JC, Bosworth HB, Sloane R, Pieper CF, Morey MC. PTSD is negatively associated with physical performance and physical function in older overweight military Veterans. J Rehabil Res Dev. 2014;51(2):285–95.
    1. Levine AB, Levine LM, Levine TB. Posttraumatic stress disorder and cardiometabolic disease. Cardiology. 2014;127(1):1–19.
    1. Pietrzak RH, Goldstein RB, Southwick SM, Grant BF. Physical health conditions associated with posttraumatic stress disorder in U.S. older adults: results from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. J Am Geriatr Soc. 2012;60(2):296–303.
    1. Rosenbaum S, Stubbs B, Ward PB, Steel Z, Lederman O, Vancampfort D. The prevalence and risk of metabolic syndrome and its components among people with posttraumatic stress disorder: a systematic review and meta-analysis. Metabolism. 2015;64(8):926–33.
    1. Hall KS, Hoerster KD, Yancy WS., Jr Post-traumatic stress disorder, physical activity, and eating behaviors. Epidemiol Rev. 2015;37:103–15.
    1. Vancampfort D, Stubbs B, Richards J, Ward PB, Firth J, Schuch FB, et al. Physical fitness in people with posttraumatic stress disorder: a systematic review. Disabil Rehabil. 2016:1–7.
    1. Whitworth JW, Ciccolo JT. Exercise and post-traumatic stress disorder in military veterans: a systematic review. Mil Med. 2016;181(9):953–60.
    1. Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;4:CD011279.
    1. Penedo FJ, Dahn JR. Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Curr Opin Psychiatry. 2005;18(2):189–93.
    1. Stonerock GL, Hoffman BM, Smith PJ, Blumenthal JA. Exercise as treatment for anxiety: systematic review and analysis. Ann Behav Med. 2015;49(4):542–56.
    1. Busch AM, Ciccolo JT, Puspitasari AJ, Nosrat S, Whitworth JW, Stults-Kolehmainen M. Preferences for exercise as a treatment for depression. Ment Health Phys Act. 2016;10:68–72.
    1. Hall KS, Gregg J, Bosworth HB, Beckham JC, Hoerster KD, Sloane R, et al. Physical activity counseling promotes physical and psychological resilience in older veterans with posttraumatic stress disorder. Ment Health Phys Act. 2016;11:53–9.
    1. Rosenbaum S, Tiedemann A, Ward PB, Curtis J, Sherrington C. Physical activity interventions: an essential component in recovery from mental illness. Br J Sports Med. 2015;49:1544–5.
    1. Lu MW, Carlson KF, Duckart JP, Dobscha SK. The effects of age on initiation of mental health treatment after positive PTSD screens among Veterans Affairs primary care patients. Gen Hosp Psychiatry. 2012;34(6):654–9.
    1. Rosenbaum S, Tiedemann A, Berle D, Ward PB, Zachary S. Exercise as a novel treatment option to address cardiometabolic dysfunction associated with PTSD. Metabolism. 2015;64(5):e5–6.
    1. Wolf EJ, Schnurr PP. PTSD-related cardiovascular disease and accelerated cellular aging. Psychiatr Ann. 2016;46:527–32.
    1. Zen AL, Whooley MA, Zhao S, Cohen BE. Post-traumatic stress disorder is associated with poor health behaviors: findings from the Heart and Soul Study. Health Psychol. 2012;31(2):194–201.
    1. Babson KA, Heinz A, Ramirez G, Puckett M, Irons JG, Bonn-Miller MO, et al. The interactive role of exercise and sleep on veteran recovery from symptoms of PTSD. Ment Health Phys Act. 2015;8:15–20.
    1. Manger TA, Motta RW. The impact of an exercise program on posttraumatic stress disorder, anxiety, and depression. Int J Emerg Ment Health. 2005;7(1):49–57.
    1. Rosenbaum S, Sherrington C, Tiedemann A. Exercise augmentation compared with usual care for post-traumatic stress disorder: a randomized controlled trial. Acta Psychiatr Scand. 2015;131(5):350–9.
    1. Maguen S, Hoerster KD, Littman AJ, Klingaman EA, Evans-Hudnall G, Holleman R, et al. Iraq and Afghanistan veterans with PTSD participate less in VA's weight loss program than those without PTSD. J Affect Disord. 2016;193:289–94.
    1. Weathers FW, Blake DD, Schnurr PP, Kaloupek DG, Marx BP, Keane TM. Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). National Center for PTSD: Boston (MA); 2013.
    1. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975;23(10):433–41.
    1. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Physical Activity Guidelines for Americans. Washington (DC): U.S. Department of Health and Human Services; 2008.
    1. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Prentice Hall: Englewood Cliffs (NJ); 1986.
    1. Firth J, Rosenbaum S, Stubbs B, Gorczynski P, Yung AR, Vancampfort D. Motivating factors and barriers towards exercise in severe mental illness: a systematic review and meta-analysis. Psychol Med. 2016;46(14):2869–81.
    1. Seime RJ, Vickers AJ. The challenges of treating depression with exercise: from evidence to practice. Clin Psychol. 2006;13(2):194–7.
    1. Buis LR, Kotagal LV, Porcari CE, Rauch SA, Krein SL, Richardson CR. Physical activity in postdeployment Operation Iraqi Freedom/Operation Enduring Freedom veterans using Department of Veterans Affairs services. J Rehabil Res Dev. 2011;48(8):901–11.
    1. Jay M, Mateo KF, Squires AP, Kalet AL, Sherman SE. Military service and other socioecological factors influencing weight and health behavior change in overweight and obese Veterans: a qualitative study to inform intervention development within primary care at the United States Veterans Health Administration. BMC Obes. 2016;3:5.
    1. Goodrich DE, Hall KS. Physical activity among military veterans. In: Bopp M, editor. Physical Activity in Diverse Populations: Evidence and Practice. London (England): Routledge; 2017.
    1. Michalek AK, Kan D, Prochaska J. Engaging veterans with substance abuse disorders into a research trial: success with study branding, networking, and presence. Transl Behav Med. 2015;5(2):167–76.
    1. Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD: Boston (MA); 2013.
    1. Bovin MJ, Marx BP, Weathers FW, Gallagher MW, Rodriguez P, Schnurr PP, et al. Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (PCL-5) in veterans. Psychol Assess. 2016;28(11):1379–91.
    1. Rikli RE, Jones CJ. The reliability and validity of a 6-minute walk test as a measure of physical endurance in older adults. J Aging Phys Act. 1998;6:363–75.
    1. Slade SC, Dionne CE, Underwood M, Buchbinder R. Consensus on Exercise Reporting Template (CERT): explanation and elaboration statement. Br J Sports Med. 2016;50:1428–37.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner