Qualitative Analysis of a Supervised Exercise Program for Older Veterans With PTSD

Multimodal exercise programs may improve posttraumatic stress disorders symptoms and quality of life in adults with PTSD: An overview of systematic reviews with meta-analysis

OBJECTIVE

This overview of reviews aimed to summarize the effectiveness of exercise, regular physical activity or mind-body exercises on posttraumatic stress disorder (PTSD) symptoms and comorbidities associated with PTSD (e.g. depression symptoms) among individuals without age, gender, race, ethnicity or setting restrictions.

DATA SOURCES

The CINAHL, Embase, PubMed and SPORTDiscus databases were searched from inception to November 16, 2023.

REVIEW METHODS

Systematic reviews with meta-analysis of randomized clinical trials evaluating exercise, regular physical activity or mind-body exercises were considered. Control groups and outcome measures were not restricted. AMSTAR 2 assessed the methodological quality of reviews. The overlap between reviews was calculated.

RESULTS

A total of 14 systematic reviews were included meta-analyzing 23 distinct randomized clinical trials. There was a very high overlap between reviews (corrected covered area = 16%). PTSD symptoms, depression symptoms, anxiety symptoms, sleep quality, substance abuse and quality of life were meta-analyzed. No reviews meta-analyzed the effects of regular physical activity. Overall, the meta-analyses found multicomponent exercise programs may have positive results in reducing PTSD symptoms and improving quality of life. In addition, the results of yoga were inconsistent across the meta-analyses for PTSD symptoms, and no differences between groups were found in favor of yoga for depression symptoms. Finally, no specific conclusions could be made about anxiety symptoms, sleep quality and substance abuse.

CONCLUSION

A multicomponent exercise program may be effective in improving PTSD symptoms and quality of life, whereas yoga may be ineffective for depression symptoms in adults with PTSD.

The use of co-design in developing physical activity interventions for older adults: a scoping review

BACKGROUND

Promoting physical activity (PA) participation in older adults is important for preserving quality of life and functional independence. Co-design has been shown to increase engagement of end-users in health-related policies and interventions. This scoping review aimed to examine how co-design has been used to develop PA interventions for older adults.

METHODS

We searched MEDLINE, EMBASE, AMED, and CINAHL. Peer-reviewed primary research studies that met the following criteria were included: had at least one participant aged ≥60 years involved in the co-design process and the intervention was delivered to individuals whose mean age was ≥60, used co-design methodologies, and any form of PA. After duplicate removal, two or more independent reviewers completed title and abstract and full text screening. Data were extracted from the included studies according to study aims.

RESULTS

Of the 29 included studies, 12 different terms were used to describe co-design with variable operational definitions that we consolidated into five proposed components. Fifteen studies engaged users in a consultative way, 13 studies using collaboration, and one study engaged end-users in consumer-control. No studies involved end-users in the dissemination phase. Further, no studies directly measured the effectiveness of the co-design process. Five categories of barriers and facilitators to co-design were identified including frameworks and methodologies, logistics, relationships, participation, and generalizability.

CONCLUSIONS

There is a large degree of variability in how co-design is used to develop PA interventions for older adults. Our findings can be used by researchers to improve rigor and standardization in this emerging field.

TRIAL REGISTRATION

osf.io/vsw2m.

Diet quality and exercise in older veterans with PTSD: a pilot study

Older veterans with posttraumatic stress disorder (PTSD) are at increased risk of obesity and cardiometabolic disease. Physical activity and healthy eating are two behaviors that impact health, functional independence, and disease risk in later life, yet few studies have examined the relationship between PTSD and diet quality. This secondary analysis aimed to: (a) characterize the diet quality of older veterans with PTSD in comparison to U.S. dietary guidelines and (b) explore if participation in a supervised exercise intervention spurred simultaneous changes in dietary behavior. Diet quality was assessed with the Dietary Screener Questionnaire (DSQ), which measures daily intake of fiber, calcium, added sugar, whole grain, dairy, and fruits/vegetables/legumes. The sample included 54 military veterans ≥ 60 years old with PTSD who participated in a randomized controlled pilot trial comparing 12 weeks of supervised exercise (n = 36) to wait-list usual care (n = 18). The DSQ was administered at baseline and 12 weeks. Consumption of added sugar exceeded U.S. dietary guideline recommendations and consumption of whole grains, fruits/vegetables/legumes, fiber, calcium, and dairy fell short. Participation in the supervised exercise intervention was not associated with changes in diet quality. Results revealed that the diet quality of older veterans with PTSD is poor, and while the exercise intervention improved health through exercise, it did not make veterans any more likely to adopt a more healthful diet. Interventions targeting diet, or diet + exercise, are needed to manage the increased risk of obesity and cardiometabolic disease present in older veterans with PTSD.