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Cited by 154Posttraumatic Stress Disorder ResearchPhysical Activity and HealthTraumatic Brain Injury Research

Exercise Intervention in PTSD: A Narrative Review and Rationale for Implementation

Open access
Hegberg, Nicole J., Hayes, Jasmeet P., Hayes, Scott M.·2019·Frontiers in Psychiatry
DOI 10.3389/fpsyt.2019.00133PMC PMC6437073
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Abstract

Posttraumatic stress disorder (PTSD) is a prominent mental health problem in veteran and community populations. There is accumulating evidence to suggest that aerobic exercise may serve as an effective treatment option for individuals with PTSD. The purpose of this review is to summarize the existing literature exploring aerobic exercise and PTSD and briefly discuss potential mechanisms of PTSD symptom reduction. A search of electronic databases and reference sections of relevant articles published through October 1, 2018 revealed 19 relevant studies that examined aerobic exercise and PTSD symptomatology. A narrative review of extant studies provides encouraging evidence that aerobic exercise interventions alone or as an adjunct to standard treatment may positively impact PTSD symptoms. Potential mechanisms by which aerobic exercise could exert a positive impact in PTSD include exposure and desensitization to internal arousal cues, enhanced cognitive function, exercise-induced neuroplasticity, normalization of hypothalamic pituitary axis (HPA) function, and reductions in inflammatory markers. Randomized clinical trials and translational neuroscience approaches are required to clarify the efficacy of exercise intervention for PTSD and elucidate potential mechanisms of exercise-induced PTSD symptom reduction.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review identified 19 studies (nine observational, 10 intervention) on aerobic exercise and PTSD and concluded that exercise alone or as an adjunct may reduce PTSD symptoms. The authors outline potential mechanisms—exposure/desensitization, cognitive improvement, neuroplasticity, HPA-axis normalization, and reduced inflammation—and call for randomized trials.

Key findings

  • The review found encouraging evidence that aerobic exercise, alone or combined with standard treatment, may positively impact PTSD symptoms across civilian and military samples.
  • In 38,883 U.S. veterans, vigorous exercise (≥20 min, ≥2 times/week) was associated with decreased odds of persistent PTSD symptoms at 3–5 year follow-up (OR 0.59, 95% CI 0.42–0.83); Harte et al. (N = 108) found vigorous exercise inversely related to hyperarousal (β = −0.22, p = 0.04).
  • Manger and Motta (N = 9) reported reduced PTSD after a 10-week aerobic exercise program (t(8) = 3.49, p = 0.008) and at 1-month follow-up (t(8) = 3.30, p = 0.011); Goldstein et al. (N = 47) found greater PTSD severity reduction versus waitlist (F(1, 35.3) = 4.64, p = 0.038), with hyperarousal benefiting (F(1, 35.2) = 4.40, p = 0.044).
  • Exercise plus standard treatment: Rosenbaum et al. (N = 81) found greater PCL-C reduction with exercise + usual care (mean difference = −5.4, 95% CI −10.5 to −0.3, p = 0.04); Powers et al. (N = 9) found greater reduction with exercise + prolonged exposure (d = 2.65).

Methods

  • Narrative review; searched PubMed, Google Scholar, and PsycINFO through October 1, 2018 using terms “PTSD” and “exercise” or “physical activity” or “walking” or “cycling” or “high intensity interval training” or “aerobic fitness” or “cardiorespiratory fitness,” plus reference sections.
  • Included studies with PTSD symptomatology assessment in trauma-exposed community or clinical samples and metrics of aerobic physical activity/exercise or an aerobic exercise intervention; combined aerobic + resistance training was included, while yoga and resistance training alone were excluded. The search yielded 19 relevant studies (nine observational, 10 intervention).
  • No quantitative meta-analysis was performed because of methodological heterogeneity and insufficient controlled studies.

Limitations

  • Stated: many studies had small samples, restricted age/ethnicity, single-sex samples, and convenience sampling; populations varied in PTSD severity, veteran status, and treatment-seeking; there was heterogeneity in PTSD measures and exercise protocols; many relied on retrospective self-report exercise; few had pre/post fitness assessments or control groups, and six of ten intervention studies lacked control groups.
  • Stated: many observational studies were cross-sectional, so directionality is unknown; several did not report time since trauma; no observational studies assessed cardiorespiratory fitness; no aerobic exercise studies in PTSD used cognitive outcome measures or brain structure/function measures.
  • Evident from text: the review is narrative rather than systematic/meta-analytic, and the authors note that heterogeneity and lack of adequate control groups prevented quantitative synthesis.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3389/fpsyt.2019.00133

Cites

129 of 129 references verified0 citation errors · 0 not checkable

Statistics

11 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Claims the paper makes

0 of 135 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    A search of electronic databases and reference sections of relevant articles published through October 1, 2018 revealed 19 relevant studies that examined aerobic exercise and PTSD symptomatology.

    “A search of electronic databases and reference sections of relevant articles published through October 1, 2018 revealed 19 relevant studies that examined aerobic exercise and PTSD symptomatology.”
    Quote in the paperSubstantial claim
  • Findingnone given

    No observational studies assessed cardiorespiratory fitness.

    “No observational studies assessed cardiorespiratory fitness.”
    Quote in the paperNot a substantial claim
  • Findingcitation

    In a larger study of male veterans in a 60- to 90-day residential treatment program, time spent cycling in a non-standardized group bicycling program reduced hyperarousal symptoms at discharge, but only for those who reported poor baseline sleep quality.

    “In a larger study of male veterans in a 60- to 90-day residential treatment program (N = 217; mean age = 52 years), time spent cycling in a non-standardized group bicycling program reduced hyperarousal symptoms at discharge (β = 0.24, p = 0.002), but only for those who reported poor baseline sleep quality”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [53] Babson, 2015, The interactive role of exercise and sleep on veteran recovery from symptoms of PTSD, Ment Health Phys Act. source

      Not checked in the free run.

  • Findingcitation

    Participants with lower fitness at baseline reported a greater reduction in PTSD symptoms compared to their higher-fit peers.

    “participants with lower fitness at baseline, measured using the YMCA ergometer bike test which assesses submaximal VO2 maximum, reported a greater reduction in PTSD symptoms compared to their higher-fit peers (β = 0.10, p < 0.10).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [57] LeBouthillier, 2016, Lower cardiorespiratory fitness is associated with greater reduction in PTSD symptoms and anxiety sensitivity following aerobic exercise, Ment Health Phys Act. source

      Not checked in the free run.

  • Findingcitation

    In the same randomized veteran study, hyperarousal symptoms were the only cluster that benefitted significantly from the exercise intervention.

    “Further, hyperarousal symptoms were the only cluster that benefitted significantly from the exercise intervention [F(1, 35.2) = 4.40, p = 0.044].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] Goldstein, 2018, Veterans group exercise: a randomized pilot trial of an integrative exercise program for veterans with post-traumatic stress, J Affect Disord. source

      Not checked in the free run.

  • May combine two claims. 42
  • Classified as probably not a substantial claim. 7

  • May combine two claims.

    Findingcitation

    In a community sample, six 20-minute moderate-intensity aerobic exercise sessions over 2 weeks reduced total self-reported PTSD symptoms on the PCL-C, driven by reductions in avoidance symptoms, regardless of attentional focus.

    “The results indicated that the aerobic exercise training, regardless of attentional focus, reduced total self-reported PTSD symptoms on a questionnaire (PCL-C; p < 0.01), which was driven by reductions in avoidance symptoms (p < 0.01).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [55] Fetzner, 2015, Aerobic exercise reduces symptoms of posttraumatic stress disorder: a randomized controlled trial, Cogn Behav Ther. source

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    Positive effects of exercise on PTSD were observed in both civilian and military populations, as well as in both predominately female and male study samples.

    “The results are encouraging as positive effects were observed in both civilian and military populations, as well as in both predominately female and male study samples.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In the same inpatient study, the exercise group had greater reductions on measures of depression, anxiety, stress, weight, percent body fat, and waist circumference compared to the care-as-usual group.

    “as well as greater reductions on measures of depression, anxiety, stress, weight, percent body fat, and weight circumference compared to the “care as usual” group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [68] Rosenbaum, 2015, Exercise augmentation compared with usual care for post-traumatic stress disorder: a randomized controlled trial, Acta Psychiatr Scand. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    The authors are not aware of any negative effects of exercise on PTSD symptoms.

    “Nevertheless, we are not aware of any negative effects of exercise on PTSD symptoms.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Exercise has no negative effects on PTSD symptoms.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Potential mechanisms by which aerobic exercise could exert a positive impact in PTSD include exposure and desensitization to internal arousal cues, enhanced cognitive function, exercise-induced neuroplasticity, normalization of HPA function, and reductions in inflammatory markers.

    “Potential mechanisms by which aerobic exercise could exert a positive impact in PTSD include exposure and desensitization to internal arousal cues, enhanced cognitive function, exercise-induced neuroplasticity, normalization of hypothalamic pituitary axis (HPA) function, and reductions in inflammatory markers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Moderate-intensity activity alone was not associated with total PTSD symptoms or any of the symptom clusters at follow-up.

    “Moderate-intensity activity alone was not associated with total PTSD symptoms or any of the symptom clusters at follow-up.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] Whitworth, 2017, Direct and indirect effects of exercise on posttraumatic stress disorder symptoms: a longitudinal study, Gen Hosp Psychiatry. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Taken together, the findings suggest that those with low levels of PTSD who engage in vigorous-intensity activity may see the most profound effects on hyperarousal symptoms, whereas there may be more widespread symptom effects as PTSD severity increases.

    “Taken together, the findings suggest that those with low levels of PTSD who engage in vigorous-intensity activity may see the most profound effects on hyperarousal symptoms, whereas there may be more widespread symptom effects as PTSD severity increases.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Aerobic exercise may be comparable or superior to other common treatments, such as psychotherapy and pharmacology, for depression, anxiety, and schizophrenia.

    “and may be comparable or superior to other common treatments, such as psychotherapy and pharmacology (37–39).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [37] Carek, 2011, Exercise for the treatment of depression and anxiety, Int J Psychiatry Med. source

      Not checked in the free run.

    • cites [38] Petruzzello, 1991, A meta-analysis on the anxiety-reducing effects of acute and chronic exercise. Outcomes and mechanisms, Sports Med. source

      Not checked in the free run.

    • cites [39] Wipfli, 2008, The anxiolytic effects of exercise: a meta-analysis of randomized trials and dose-response analysis, J Sport Exerc Psychol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Aerobic exercise, which improves cardiorespiratory fitness, is an effective treatment for depression, anxiety, and schizophrenia through both physiological and psychological mechanisms.

    “research suggests aerobic exercise, which improves cardiorespiratory fitness, is an effective treatment for depression, anxiety, and schizophrenia (32–36) through both physiological and psychological mechanisms”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [32] Asmundson, 2013, Let's get physical: a contemporary review of the anxiolytic effects of exercise for anxiety and its disorders, Depress Anxiety. source

      Not checked in the free run.

    • cites [33] Dunn, 2001, Physical activity dose-response effects on outcomes of depression and anxiety, Med Sci Sports Exerc. source

      Not checked in the free run.

    • cites [34] Firth, 2017, Aerobic exercise improves cognitive functioning in people with schizophrenia: a systematic review and meta-analysis, Schizophr Bull. source

      Not checked in the free run.

    • cites [35] Herring, 2012, Feasibility of exercise training for the short-term treatment of generalized anxiety disorder: a randomized controlled trial, Psychother Psychosom. source

      Not checked in the free run.

    • cites [36] Schuch, 2016, Exercise as a treatment for depression: a meta-analysis adjusting for publication bias, J Psychiatr Res. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Exercise is broadly accessible, low-cost, and could avoid the negative connotations associated with traditional mental health treatment approaches.

    “it is one intervention that is broadly accessible, low-cost, and could avoid the negative connotations associated with traditional mental health treatment approaches (19).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Dickstein, 2010, Targeting self-stigma in returning military personnel and veterans: a review of intervention strategies, Mil Psychol. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    A single-item measure does not capture frequency, intensity, time (duration), and type of exercise, and therefore may not be adequate to assess behaviors that promote alterations in cardiorespiratory fitness or the effectiveness of aerobic exercise.

    “A single-item measure does not capture frequency, intensity, and time (duration) and type of exercise, and therefore may not be adequate to assess behaviors that promote alterations in cardiorespiratory fitness or the effectiveness of aerobic exercise.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Regular physical activity and/or exercise tailored to improve cardiorespiratory fitness has significant health benefits such as reducing the risk of cardiovascular disease, diabetes, and obesity.

    “Regular physical activity and/or exercise that is tailored to improve cardiorespiratory fitness, such as walking, dancing, or cycling, has significant health benefits such as reducing the risk of cardiovascular disease, diabetes, and obesity (28).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Warburton, 2006, Health benefits of physical activity: the evidence, CMAJ. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Methodological limitations may explain inconsistencies in findings on exercise and PTSD; studies that failed to detect a significant association measured exercise with a single-item questionnaire or variable, whereas studies that found significant effects used validated, multiple-item exercise assessment measures.

    “methodological limitations may explain these inconsistencies. For example, studies that failed to detect a significant association measured exercise with a single-item questionnaire or variable (e.g., assessing engagement in exercise or not, or number of days per week of exercise), whereas studies that have found significant effects used validated, multiple-item exercise assessment measures.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Despite no main effect of exercise on PTSD severity in PTSD treatment-seeking veterans, among veterans who endorsed high levels of pain severity and pain interference, those who reported being physically active reported fewer PTSD symptoms than those who reported being inactive.

    “Despite no main effect of exercise on PTSD severity in PTSD treatment-seeking veterans (N = 239; mean age = 50; 91.1% male; 87.5% white), among veterans who endorsed high levels of pain severity (β = −0.031, p = 0.031) and pain interference (β = −0.142, p = 0.025), those who reported being physically active reported fewer PTSD symptoms than those who reported being inactive”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [43] Bourn, 2016, Physical activity moderates the association between pain and PTSD in treatment-seeking veterans, Pain Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    At 1 month follow-up after the 8 week program, PTSD symptomatology increased but did not revert to baseline level.

    “at 1 month follow-up, PTSD symptomatology increased but did not revert to baseline level”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [59] Newman, 2007, The effects of arobic exercise on childhood PTSD, anxiety, and depression, Int J Emerg Ment Health.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Only three participants remained at the facility at 1 month follow up and all continued to report significantly less PTSD symptoms and trauma symptom severity compared to baseline.

    “Only three participants remained at the facility at 1 month follow up and all continued to report significantly less PTSD symptoms and trauma symptom severity compared to baseline.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Diaz, 2008, The effects of an aerobic exercise program on posttraumatic stress disorder symptom severity in adolescents, Int J Emerg Ment Health.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Vigorous-intensity exercise may allow for exposure and desensitization to arousal cues, thereby reducing the heightened response to these cues often seen in hyperarousal.

    “it may be that vigorous-intensity exercise allows for exposure and desensitization to arousal cues, thereby reducing the heightened response to these cues often seen in hyperarousal.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The observational research provides promising support for the association between exercise and PTSD along with indications of some variables that could influence this association.

    “The observational research provides promising support for the association between exercise and PTSD along with indications of some variables that could influence this association.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Several observational studies did not report time since the traumatic event, and thus the extent to which chronicity of PTSD symptoms relates to the benefits of exercise is unknown.

    “Several studies did not report time since the traumatic event, and thus the extent to which chronicity of PTSD symptoms relates to the benefits of exercise is unknown.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A 12 week exercise program plus inpatient care as usual produced greater reduction in PTSD symptoms than inpatient care as usual alone, with groups not differing in fitness level post intervention.

    “Greater reduction in PTSD sxs; groups did not differ in fitness level post intervention (no pre- to post-intervention fitness analyses)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [61] Rosenbaum, 2015, Physical activity in the treatment of post-traumatic stress disorder: a systematic review and meta-analysis, Psychiatry Res. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    An 8-week aerobic exercise program reduced PTSD symptoms compared to baseline and resulted in fewer individuals meeting criteria for PTSD in institutionalized female adolescents.

    “Reduced PTSD sxs compared to baseline;fewer individuals met criteria for PTSD”
    • Also stated in: § Intervention Research · plain
      “reported reduced PTSD symptomatology after the intervention [t(10) = 23.56, p < 0.001] such that fewer individuals met full criteria for PTSD (59).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [59] Newman, 2007, The effects of arobic exercise on childhood PTSD, anxiety, and depression, Int J Emerg Ment Health.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    These intervention studies suggest that exercise may be effective as a stand-alone treatment or as an augmentation to traditional PTSD treatment.

    “These studies suggest that exercise may be effective as a stand-alone treatment or as an augmentation to traditional PTSD treatment (see Table 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The effect of exercise on PTSD may vary by disorder severity and/or co-morbid health concerns, which might also serve as a marker for disorder severity.

    “These studies suggest that the effect of exercise may vary by disorder severity and/or co-morbid health concerns, which might also serve as a marker for disorder severity.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Existing research on exercise-related exposure has focused on anxiety disorders, and this effect has been largely unexplored in individuals with PTSD.

    “However, existing research has focused on this mechanism in anxiety disorders and this effect has been largely unexplored in individuals with PTSD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    PTSD is associated with reduced learning and memory, including reduced encoding of specific episodic details, increased false memory, and reduced extinction learning.

    “In addition to impairments in cognitive control, PTSD is also associated with reduced learning and memory. In particular, individuals with PTSD show reduced encoding of specific episodic details, including autobiographical memories, as well as increased false memory and reduced extinction learning”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Six of the ten intervention studies lack control groups and thus do not account for other variables that may contribute to symptom improvement.

    “In addition, six of the ten intervention studies lack control groups, and thus do not account for other variables that may contribute to symptom improvement.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: In some cases, symptoms of PTSD resolve without intervention, and only a percentage of the population requires treatment for PTSD symptom resolution.

  • May combine two claims.

    Premisecitation

    Repeated exposure to physiological cues such as rapid heartbeat in the context of exercise may increase tolerance of and facilitate desensitization to physiological sensations.

    “Research suggests that repeated exposure to these physiological cues, such as rapid heartbeat, in the context of exercise may increase tolerance of and facilitate desensitization to the physiological sensations”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [32] Asmundson, 2013, Let's get physical: a contemporary review of the anxiolytic effects of exercise for anxiety and its disorders, Depress Anxiety. source

      Not checked in the free run.

    • cites [69] Anderson, 2013, Effects of exercise and physical activity on anxiety, Front Psychiatry. source

      Not checked in the free run.

    • cites [70] Broman-Fulks, 2008, Evaluation of a brief aerobic exercise intervention for high anxiety sensitivity, Anxiety Stress Coping. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Gray matter changes associated with PTSD include reduced volume in the hippocampus and anterior cingulate, and reduced volume or cortical thickness in the precuneus, insula, and ventromedial and lateral prefrontal cortex.

    “For instance, gray matter changes associated with PTSD include reduced volume in the hippocampus and the anterior cingulate (84–86), reduced volume or cortical thickness in the precuneus, insula, and ventromedial and lateral prefrontal cortex (87, 88).”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [84] Hayes, 2017, Automated measurement of hippocampal subfields in PTSD: evidence for smaller dentate gyrus volume, J Psychiatr Res. source

      Not checked in the free run.

    • cites [85] Logue, 2018, Smaller hippocampal volume in posttraumatic stress disorder: a multisite ENIGMA-PGC study: subcortical volumetry results from posttraumatic stress disorder consortia, Biol Psychiatry. source

      Not checked in the free run.

    • cites [86] O'Doherty, 2015, A systematic review and meta-analysis of magnetic resonance imaging measurement of structural volumes in posttraumatic stress disorder, Psychiatry Res. source

      Not checked in the free run.

    • cites [87] Karl, 2006, A meta-analysis of structural brain abnormalities in PTSD, Neurosci Biobehav Rev. source

      Not checked in the free run.

    • cites [88] Shin, 2006, Amygdala, medial prefrontal cortex, and hippocampal function in PTSD, Ann N Y Acad Sci. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Half of the intervention studies were conducted in residential treatment programs, suggesting participants were likely constituents who would benefit from treatment to promote symptom reduction.

    “However, half of these studies were conducted in the context of residential treatment programs suggesting the participants were likely constituents that would, in fact, benefit from treatment to promote symptom reduction.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Extant research among healthy older adults suggests that cardiorespiratory fitness and aerobic exercise positively affect executive function and episodic memory.

    “For instance, extant research among healthy older adults suggests that cardiorespiratory fitness and aerobic exercise positively affect executive function (78, 79) and episodic memory (80–83)—the same cognitive functions negatively impacted by PTSD.”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [78] Colcombe, 2003, Fitness effects on the cognitive function of older adults: a meta-analytic study, Psychol Sci. source

      Not checked in the free run.

    • cites [79] Guiney, 2013, Benefits of regular aerobic exercise for executive functioning in healthy populations, Psychon Bull Rev. source

      Not checked in the free run.

    • cites [80] Cox, 2016, Relationship between physical activity and cognitive function in apparently healthy young to middle-aged adults: a systematic review, J Sci Med Sport. source

      Not checked in the free run.

    • cites [81] Hayes, 2015, Physical activity is positively associated with episodic memory in aging, J Int Neuropsychol Soc source

      Not checked in the free run.

    • cites [82] Hayes, 2016, Cardiorespiratory fitness is associated with cognitive performance in older but not younger adults, J Gerontol B Psychol Sci Soc Sci. source

      Not checked in the free run.

    • cites [83] Smith, 2010, Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials, Psychosom Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    After an aerobic exercise program, older adults demonstrated an approximately 2% increase in hippocampal volume, whereas a decrease of roughly 1.4% was observed in the stretching control group.

    “After participation in an aerobic exercise program in another study, older adults demonstrated an approximately 2% increase in hippocampal volume, whereas a decrease of roughly 1.4% was observed in the stretching control group”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [96] Erickson, 2011, Exercise training increases size of hippocampus and improves memory, Proc Natl Acad Sci USA. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Functional brain alterations have been associated with aerobic fitness, and aerobic exercise has been shown to impact activation in many of the same regions implicated in PTSD.

    “Functional brain alterations have also been associated with aerobic fitness (103–105), and aerobic exercise has been shown to impact activation in many of the same regions implicated in PTSD (93, 106, 107).”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [103] Hayes, 2017, FMRI activity during associative encoding is correlated with cardiorespiratory fitness and source memory performance in older adults, Cortex. source

      Not checked in the free run.

    • cites [104] Prakash, 2011, Cardiorespiratory fitness and attentional control in the aging brain, Front Human Neurosci. source

      Not checked in the free run.

    • cites [105] Wong, 2015, Brain activation during dual-task processing is associated with cardiorespiratory fitness and performance in older adults, Front Aging Neurosci. source

      Not checked in the free run.

    • cites [93] Hayes, 2013, A review of cardiorespiratory fitness-related neuroplasticity in the aging brain, Front Aging Neurosci. source

      Not checked in the free run.

    • cites [106] Smith, 2013, Semantic memory functional MRI and cognitive function after exercise intervention in mild cognitive impairment, J Alzheimers Dis. source

      Not checked in the free run.

    • cites [107] Voss, 2010, Plasticity of brain networks in a randomized intervention trial of exercise training in older adults, Front Aging Neurosci. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Acute and regular aerobic exercise exert positive effects on the HPA axis, which may promote normalization and reduction in PTSD symptoms.

    “In fact, acute and regular aerobic exercise exert positive effects on the HPA axis, which may promote normalization and reduction in PTSD symptoms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Individuals with PTSD tend to express low basal cortisol levels, associated with increased CRH and an exaggerated HPA axis negative feedback loop, while peripheral and central catecholamine levels are increased.

    “More specifically, a recent review of the neuroendocrine characteristics of PTSD indicated that individuals with PTSD tend to express low basal cortisol levels, which is associated with increased levels of CRH, and an exaggerated HPA axis negative feedback loop, while peripheral and central catecholamine levels are increased”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [108] Daskalakis, 2016, Endocrine aspects of PTSD: Hypothalamic-Pituitary-Adrenal (HPA) axis and beyond, Compr Guide Post-Traum Stress Disord. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    The majority of the existing intervention studies failed to implement rigorous pre- and post-intervention fitness assessments, and few included a control group.

    “In addition, the majority of the existing intervention studies failed to implement rigorous pre- and post- intervention fitness assessments and few included a control group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Many of the reviewed studies had small sample sizes, restricted age ranges and/or ethnicities, focused on either females or males, and/or relied on convenience sampling for recruitment.

    “For instance, many of the studies had small sample sizes, restricted age ranges and/or ethnicities (many predominantly white samples), focused on either females or males, and/or relied on convenience sampling for recruitment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Pro-inflammatory cytokines that are modulated by exercise play a crucial role in sleep regulation, with low concentrations of IL-1 and TNF-α associated with enhanced non-REM sleep and high levels linked to sleep disorders.

    “Pro-inflammatory cytokines that are modulated by exercise play a crucial role in sleep regulation, with low concentrations of IL-1 and TNF-α associated with enhanced non-REM sleep (128–130), and high levels linked to sleep disorders.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [128] Santos, 2007, Exercise, sleep and cytokines: is there a relation?, Sleep Med Rev. source

      Not checked in the free run.

    • cites [129] Krueger, 2001, The role of cytokines in physiological sleep regulation, Ann N Y Acad Sci. source

      Not checked in the free run.

    • cites [130] Rockstrom, 2017, Tumor necrosis factor alpha in sleep regulation, Sleep Med Rev.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    While these factors limit the generalizability of each study to dissimilar populations, the positive association between exercise and PTSD across these variable samples provides some evidence for the generalizability of the findings.

    “While these factors limit the generalizability of each study to dissimilar populations, the positive association between exercise and PTSD across these variable samples provides some evidence for the generalizability of the findings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Inflammatory alterations might partly explain the effect of exercise on sleep quality, which has been shown to both moderate and mediate the association between aerobic exercise and PTSD.

    “There is also evidence to suggest that inflammatory alterations might partly explain the effect of exercise on sleep quality (128), which has shown to both moderate and mediate the association between aerobic exercise and PTSD”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [128] Santos, 2007, Exercise, sleep and cytokines: is there a relation?, Sleep Med Rev. source

      Not checked in the free run.

    • cites [49] Whitworth, 2017, Direct and indirect effects of exercise on posttraumatic stress disorder symptoms: a longitudinal study, Gen Hosp Psychiatry. source

      Not checked in the free run.

    • cites [53] Babson, 2015, The interactive role of exercise and sleep on veteran recovery from symptoms of PTSD, Ment Health Phys Act. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    PTSD was assessed using many different self-report measures of PTSD symptoms, and only select studies reported on time since traumatic event, which could impact the benefits of exercise on PTSD.

    “In terms of measurement, PTSD was assessed using many different self-report measures of PTSD symptoms and only select studies reported on time since traumatic event, which could impact the benefits of exercise on PTSD.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    To date, the precise mechanisms by which the beneficial effects of exercise may influence PTSD are unknown.

    “To date, the precise mechanisms by which the beneficial effects of exercise may influence PTSD are unknown.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    The populations from the reviewed studies are variable in severity of PTSD symptoms, veteran status, and whether they are seeking treatment.

    “In addition, the populations from these studies are quite variable in terms of severity of PTSD symptoms (ranging from inpatient to trauma-exposed without PTSD), veteran status, and whether they are seeking treatment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Aerobic exercise is a low-cost, widely accessible activity known to provide multiple health benefits, including cardiovascular health and musculoskeletal health, as well as reduced rates of co-morbidity and mortality.

    “Aerobic exercise is a low-cost, widely accessible activity known to provide multiple health benefits, including cardiovascular health and musculoskeletal health, as well as reduced rates of co-morbidity and mortality”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Warburton, 2006, Health benefits of physical activity: the evidence, CMAJ. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Regular aerobic exercise can increase factors involved in immunomodulatory function and diminish pro-inflammatory signaling through downstream anti-inflammatory effects of acute production of IL-6.

    “For example, regular aerobic exercise can increase factors involved in immunomodulatory function and diminish pro-inflammatory signaling, through downstream anti-inflammatory effects of acute production of IL-6”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [124] Archer, 2011, Influence of physical exercise on neuroimmunological functioning and health: aging and stress, Neurotox Res. source

      Not checked in the free run.

    • cites [125] Gleeson, 2011, The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease, Nat Rev Immunol. source

      Not checked in the free run.

    • cites [126] Kasapis, 2005, The effects of physical activity on serum C-reactive protein and inflammatory markers: a systematic review, J Am Coll Cardiol. source

      Not checked in the free run.

    • cites [127] Walsh, 2011, Position statement part one: immune function and exercise, Exerc Immunol Rev.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Our review of the literature suggests aerobic exercise may also reduce PTSD symptomatology across a variety of populations, providing evidence for the clinical utility of exercise as a form of treatment.

    “Our review of the literature suggests aerobic exercise may also reduce PTSD symptomatology across a variety of populations providing evidence for the clinical utility of exercise as a form of treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The favorable effects of exercise on inflammation and the role of inflammation in sleep regulation support the notion that exercise may be an effective tool for improving PTSD symptoms but requires additional study to directly test this assertion.

    “Taken together, the favorable effects of exercise on inflammation and the role of inflammation in sleep regulation support the notion that exercise may be an effective tool for improving PTSD symptoms but requires additional study to directly test this assertion.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    There is evidence of increased CRP, decreased anti-inflammatory markers such as IL-8 and IL-2, and alterations in cell function and genes related to inflammation in populations with PTSD.

    “There is also evidence to suggest that there is increased c-reactive protein (CRP), decreased anti-inflammatory markers (e.g., interleukin-8 [IL-8], interleukin-2 [IL-2]) as well as alterations in cell function and genes related to inflammation in populations with PTSD”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [119] Michopoulos, 2016, Inflammation in fear-and anxiety-based disorders: PTSD, GAD, and beyond, Neuropsychopharmacology. source

      Not checked in the free run.

    • cites [121] Altemus, 2006, Immune function in PTSD, Ann N Y Acad Sci. source

      Not checked in the free run.

    • cites [122] Groer, 2015, Relationship of PTSD symptoms with combat exposure, stress, and inflammation in american soldiers, Biol Res Nurs. source

      Not checked in the free run.

    • cites [123] Plantinga, 2013, Association between posttraumatic stress disorder and inflammation: a twin study, Brain Behav Immun. source

      Not checked in the free run.

47 of 47

  • The paper relies on this without support.

    PTSD is a distinct disorder from depression and anxiety disorders in terms of etiology, symptomatology, and neurobiological correlates.

    “Although PTSD shares some symptomatic overlap with depression and anxiety disorders, there is consensus that PTSD is a distinct disorder, in terms of etiology, symptomatology, and neurobiological correlates.”

  • The paper relies on this without support.

    Treatments that are highly efficacious for the treatment of depression may be less effective in PTSD treatment.

    “Treatments that are highly efficacious for the treatment of depression may be less effective in PTSD treatment.”

  • The paper relies on this without support.

    In some cases, symptoms of PTSD resolve without intervention, and only a percentage of the population requires treatment for PTSD symptom resolution.

    “This is important to note given that in some cases symptoms of PTSD resolve without intervention and only a percentage of the population requires treatment for PTSD symptom resolution.”

  • The paper relies on this without support.

    Exercise has no negative effects on PTSD symptoms.

    “Nevertheless, we are not aware of any negative effects of exercise on PTSD symptoms.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

  • Inconsistent p-value: F(2, 12) = 9.42, p = .03

    Minor

    The paper reports p = .03 here; recomputing from the test statistic and its degrees of freedom gives p = .003. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .03 · recomputed p = .003

  • Inconsistent p-value: F(1, 35.2) = 4.40, p = .044

    Minor

    The paper reports p = .044 here; recomputing from the test statistic and its degrees of freedom gives p = .043. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .044 · recomputed p = .043

  • Inconsistent p-value: t(8) = 3.07, p = .002

    Minor

    The paper reports p = .002 here; recomputing from the test statistic and its degrees of freedom gives p = .015 (two-tailed). The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .002 · recomputed p = .015

3 of 3

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upt(8) = 3.07reported p = .002 · recomputed p = .015

    “t(8) = 3.07, p = .002”

  • Doesn’t add upF(2, 12) = 9.42reported p = .03 · recomputed p = .003

    “F(2, 12) = 9.42, p = .03”

  • Doesn’t add upF(1, 35.2) = 4.4reported p = .044 · recomputed p = .043

    “F(1, 35.2) = 4.40, p = .044”

  • Consistentt(8) = 3.49reported p = .008 · recomputed p = .008

    “t(8) = 3.49, p = .008”

  • Consistentt(8) = 3.3reported p = .011 · recomputed p = .011

    “t(8) = 3.30, p = .011”

  • Consistentt(8) = 4.26reported p = .003 · recomputed p = .003

    “t(8) = 4.26, p = .003”

  • Consistentt(8) = 3.05reported p = .016 · recomputed p = .016

    “t(8) = 3.05, p = .016”

  • Consistentt(8) = 2.31reported p = .05 · recomputed p = .050

    “t(8) = 2.31, p = .050”

  • Consistentt(10) = 23.56reported p < .001 · recomputed p < .001

    “t(10) = 23.56, p < .001”

  • Consistentz = -2.395reported p = .017 · recomputed p = .017

    “z = −2.395, p = .017”

  • ConsistentF(1, 35.3) = 4.64reported p = .038 · recomputed p = .038

    “F(1, 35.3) = 4.64, p = .038”

11 of 11

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Intervention table cites a review instead of the trial

    Minor

    Table 3 identifies its 81-participant Rosenbaum intervention as reference 61, but reference 61 is a systematic review and meta-analysis. The text cites reference 68 for the 81-participant trial.

  • Harte sample ethnicity differs between text and table

    Minor

    The text describes the Harte et al. sample as 81.7% white, but Table 2 reports 92% white.

  • Lower confidence limit differs between text and table

    Minor

    For the odds of developing new PTSD symptoms, the text gives a lower 95% confidence limit of 0.49, while Table 2 gives 0.049.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Blake, 1997, Clinician Administered PTSD Scale (revised).
  2. Saigh, 1998, Children's PTSD Inventory (DSM-IV Version)
  3. Briere, 1996, Trauma Symptom Checklist for Children (TSCC): Professional manual

Cited by

Sorted by citations

Related

Authors
Hegberg, N. J., Hayes, J. P., & Hayes, S. M.
Affiliations
  • Boston University (US)
  • The Ohio State University (US)
Corresponding author
Hayes, Scott M.
ORCID
Venue
Frontiers in Psychiatry
Publisher
Frontiers Media SA
Published
2019-03-21
Volume
10
Pages
133-133
ISSN
1664-0640 (ISSN-L)
DOI
10.3389/fpsyt.2019.00133
PMC
PMC6437073
OpenAlex
W2925299885
Cited by
154
References
129
Citations by year
2026: 21 · 2025: 29 · 2024: 21 · 2023: 22 · 2022: 23 · 2021: 22 · 2020: 14 · 2019: 2
FWCI
2.41
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
National Institute on Aging
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords
post-traumatic stress disorder, aerobic exercise, exercise intervention, PTSD symptom reduction, veterans, cognitive function, neuroplasticity, hypothalamic-pituitary-adrenal axis, inflammation, desensitization, adjunctive therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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