The impact of an exercise training intervention on cortisol levels and post-traumatic stress disorder in juveniles from an Ugandan refugee settlement: Study protocol for a randomized control trial
Open accessAbstract
BACKGROUND: Latest research demonstrates a significant improvement in stress-related symptoms in psychological disorders as a result of exercise training (ET). Controlled clinical trials further validate the significance of ET by demonstrating lower salivary cortisol levels in patients with post-traumatic stress disorder (PTSD) after intervention. A significant change in cortisol and dehydroepiandrosterone (DHEA) levels can already be found after an 8-12-week ET program. The proposed study aims to investigate the impact of an 8-week ET on PTSD symptoms and changes in cortisol levels in a juvenile refugee sample from the Democratic Republic of the Congo (DRC) at an Ugandan refugee settlement. It is the first to implement an ET intervention in a resource-poor, post-conflict setting. METHODS/DESIGN: ) of > 60%, an Alternative Intervention (AI) group with low-level exercises, and a Waiting-list Control (WC) group. After the 8-week interventional phase, changes in cortisol awakening response (CAR) and DHEA in the ET group that correspond to an improvement in PTSD symptoms are expected that remain at follow-up after 3 months. DISCUSSION: To date, there is no controlled and reliable longitudinal study examining the effects of an ET program on symptom severity in individuals with PTSD that can be explained with a harmonization of cortisol secretion. The presented study design introduces an intervention that can be implemented with little expenditure. It aims to provide a promising low-threshold and cost-effective treatment approach for the application in resource-poor settings. TRIAL REGISTRATION: German Trials Register, ID: DRKS00014280 . Registered prospectively on 15 March 2018.
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Exercise training can impact cortisol levels and is a cost-efficient group intervention for PTSD.
“The study conducted by [27] presents several significant findings. First and foremost, it showcases exercise training’s capacity to impact cortisol levels. Furthermore, it presents a cost-efficient group intervention for individuals suffering from PTSD.”
From Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis. (2024) · cites this paper as [27]
The Discussion says the authors expect exercise training to change cortisol levels in young people with PTSD; this is a study protocol, not a reported finding. It also presents an intervention administered in groups as a promising low-cost approach, but explicitly says its cost-effectiveness has not been evaluated. The citing sentence overstates both points as established findings. (LLM, conf=0.88)
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Wegner, M., Amatriain‐Fernández, S., Kaulitzky, A., Murillo‐Rodríguez, E., Machado, S. E. D. C., & Budde, H. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00081 · Cited by 146 · see citing works
Benefits of physical activity and physical exercise in the time of pandemic.
Amatriain‐Fernández, S., Murillo‐Rodríguez, E., Gronwald, T., Machado, S. E. D. C., & Budde, H. (2020) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000643 · Cited by 122 · see citing works
Wu, C.-T., Pontifex, M. B., Raine, L. B., Chaddock, L., Voss, M. W., Kramer, A. F., & Hillman, C. H. (2011) · Neuropsychology · doi:10.1037/a0022167 · Cited by 88 · see citing works
Perspective of Dose and Response for Individualized Physical Exercise and Training Prescription
Gronwald, T., Törpel, A., Herold, F., & Budde, H. (2020) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk5030048 · Cited by 73 · see citing works
Herold, F., Törpel, A., Hamacher, D., Budde, H., Zou, L., Strobach, T., Müller, N. G., & Gronwald, T. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.682891 · Cited by 73 · see citing works
Heinze, K., Cumming, J., Dosanjh, A., Palin, S., Poulton, S., Bagshaw, A. P., & Broome, M. R. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.10.014 · Cited by 55 · see citing works
Herold, F., Törpel, A., Hamacher, D., Budde, H., & Gronwald, T. (2020) · Journal of Personalized Medicine · doi:10.3390/jpm10030055 · Cited by 47 · see citing works
Yalçın, M., Mundorf, A., Thiel, F., Amatriain‐Fernández, S., Kalthoff, I. S., Beucke, J., Budde, H., Garthus‐Niegel, S., Peterburs, J., & Relógio, A. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2022.873237 · Cited by 46 · see citing works
Gkintoni, E., Kourkoutas, E., Yotsidi, V., Stavrou, P. D., & Prinianaki, D. (2024) · Children · doi:10.3390/children11050579 · Cited by 37 · see citing works
“The study conducted by [27] presents several significant findings.”
BackgroundEffects of Different Types of Exercise Training on the Cortisol Awakening Response in Children
Wegner, M., Koutsandréou, F., Mueller‐Alcazar, A., Lautenbach, F., & Budde, H. (2019) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00463 · Cited by 34 · see citing works
Leite, M. N., Kamper, S. J., O'Connell, N. E., Michaleff, Z. A., Fisher, E., da Silva, P. V., Williams, C. M., & Yamato, T. P. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013527.pub2 · Cited by 29 · see citing works
Zhang, T., & Kong, J. (2025) · Frontiers in Physiology · doi:10.3389/fphys.2025.1567603 · Cited by 19 · see citing works
Gerber, M., Colledge, F., de Quervain, D. J. ‐., Filippou, K., Havas, E., Knappe, F., Ludyga, S., Meier, M., Morres, I. D., Panagos, A., et al. (2021) · Trials · doi:10.1186/s13063-021-05808-2 · Cited by 20 · see citing works
“Currently, there is one attempt being undertaken to assess the impact of exercise training in juveniles, aged between 13 and 16 years, from an Ugandan refugee settlement [22].”
Akko, D. P., Koutsandréou, F., Murillo‐Rodríguez, E., Wegner, M., & Budde, H. (2020) · Physiology & Behavior · doi:10.1016/j.physbeh.2020.113168 · Cited by 17 · see citing works
The Endocannabinoid System as Modulator of Exercise Benefits in Mental Health
Amatriain‐Fernández, S., Budde, H., Gronwald, T., Quiroga, C., Carreón, C., Viana-Torre, G., Yamamoto, T., Imperatori, C., Machado, S. E. D. C., & Murillo‐Rodríguez, E. (2020) · Current Neuropharmacology · doi:10.2174/1570159x19666201218112748 · Cited by 17 · see citing works
“Researchers suggest that after 8-week exercise, intervention promoted changes in the cortisol and endocannabinoid contents in juvenile subjects [193].”
BackgroundBudde, H., Wegner, M., Ahrens, C., Velasques, B., Ribeiro, P. F. M., Machado, S. E. D. C., Gronwald, T., Amatriain‐Fernández, S., Schaffarczyk, M., & Mueller‐Alcazar, A. (2025) · Sports Medicine - Open · doi:10.1186/s40798-025-00884-z · Cited by 16 · see citing works
Pathak, G. A., Singh, K., Choi, K. W., Fang, Y., Kouakou, M. R., Lee, Y. A., Zhou, X., Fritsche, L. G., Wendt, F. R., Davis, L. K., et al. (2023) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2023.4127 · Cited by 16 · see citing works
Austin, A., Potterton, R., Flynn, M., Richards, K. L., Allen, K. L., Grant, N., Glennon, D., Mountford, V. A., Franklin‐Smith, M., Schelhase, M., et al. (2021) · European Eating Disorders Review · doi:10.1002/erv.2819 · Cited by 16 · see citing works
Editorial: Neuromodulation of Exercise: Impact on Different Kinds of Behavior
Budde, H., Velasques, B., Ribeiro, P. F. M., & Soya, H. (2020) · Frontiers in Neuroscience · doi:10.3389/fnins.2020.00455 · Cited by 8 · see citing works
Liu, J., Zhao, J., & Wang, Z. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1567812 · Cited by 4 · see citing works
Sustained Effects of Animal-Assisted Crisis Response on Stress in School Shooting Survivors
Robino, A., Feldman, D., Stein, A. N., Schmaltz, M. A., Fitzpatrick, H. A., Tartar, J. L., Pizzo, F., Friedman, M., & Feldman, O. (2022) · Human-animal interaction bulletin · doi:10.1079/hai.2022.0019 · Cited by 5 · see citing works
“For example, therapeutic intervention has been shown to reduce cortisol levels in war-affected adolescents (Dajani et al., 2018) and adolescent refugees with PTSD (Budde et al., 2018).”
BackgroundInfluentialThe Effects of Acute Coordinative vs. Acute Endurance Exercise on the Cortisol ConcentrationPreprint
Budde, H., Wegner, M., Ahrens, C., Velasques, B., Ribeiro, P. F. M., Machado, S. E. D. C., Gronwald, T., Amatriain‐Fernández, S., Schaffarczyk, M., & Mueller‐Alcazar, A. (2024) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2024.03.25.586687 · Cited by 4 · see citing works
Eshaghi‐Gorji, R., Amiri, F. T., Mirzae, M., Shafia, S., & Akhoundzadeh, K. (2024) · The World Journal of Biological Psychiatry · doi:10.1080/15622975.2024.2382693 · Cited by 3 · see citing works
“Notably, the studies with different methodologies showed that exercise can lead to both elevated and depressed levels of cortisol (Budde et al. 2018; yakhkeshi et al. 2022), however, in our study reduction of corticosterone to the normal range was a desired outcome in the exercise group.”
Effect of Exercise with Mental Stress on Cortisol and Alpha-Amylase Changes in Young Men
Ameri, M., Ghazalian, F., Shakeri, N., & Akhoond, M. R. (2019) · Middle East Journal of Rehabilitation and Health Studies · doi:10.5812/mejrh.97587 · Cited by 3 · see citing works
Einführung in die methodischen und klinischen Aspekte der transkulturellen Psychotraumatologie
Weierstall‐Pust, R., & Pust, G. E. A. (2020) · Springer eBooks · doi:10.1007/978-3-662-45995-9_47-1
Moon, Y., Lee, E., Lee, S., Son, G.-I., Byeon, H., Shin, H.-R., & Baatar, B. (2023) · PLoS ONE · doi:10.1371/journal.pone.0284627
After Sexual Abuse or other Extreme Life Events
Wenzel, T. J., Chen, A. F., & Alksiri, R. (2023) · Springer eBooks · doi:10.1007/978-3-031-36864-6_8
Sustained Effects of Animal-Assisted Crisis Response on Stress in School Shooting Survivors
Robino, A. E., Feldman, D. M., Stein, A. N., Schmaltz, M. A., Fitzpatrick, H. A., Tartar, J. L., Pizzo, F., Friedman, M., & Feldman, O. (2024) · CABI eBooks · doi:10.1079/9781800626539.0003
Harerimana, A., Pillay, J. D., & Mchunu, G. G. (2025) · SSM - Mental Health · doi:10.1016/j.ssmmh.2025.100540
- Authors
- Budde, H., Akko, D. P., Ainamani, H. E., Murillo-Rodríguez, E., & Weierstall, R.
- Affiliations
- Reykjavík University (IS)
- MSH Medical School Hamburg – University of Applied Sciences and Medical University (DE)
- Bishop Stuart University (UG)
- Corresponding author
- Akko, Davin P.
- Venue
- Trials
- Published
- 2018-07-09
- Volume
- 19
- Issue
- 1
- Pages
- 364-364
- ISSN
- 1745-6215 (ISSN-L)
- PMC
- PMC6038242
- OpenAlex
- W2811999066
- Cited by
- 31
- References
- 62
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 2 · 2021: 3 · 2020: 10 · 2019: 2
- FWCI
- 4.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Trials (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Opin vísindi (Opin vísindi) (submittedVersion, cc-by)
- Funders
- Deutsche Forschungsgemeinschaft (BU 1837/5–1, BU 1837/5-2)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- exercise training, post-traumatic stress disorder, cortisol, cortisol awakening response, dehydroepiandrosterone, refugee youth, post-conflict societies, resource-limited settings, low-threshold intervention, cost-effective treatment, stress-related symptoms
- MeSH terms
- Adolescent, Dehydroepiandrosterone, Exercise Therapy, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Refugees, Research Design, Stress Disorders, Post-Traumatic, Exercise, Randomized Controlled Trials as Topic, Treatment Outcome, Ethics Committees, Clinical
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