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Does exercise improve intensive therapy for PTSD?

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Adding physical activity to intensive trauma therapy does not make it more effective, as patients in both exercise and creative activity groups improved significantly.

Source

Adding physical activity to intensive trauma-focused treatment for post-traumatic stress disorder: results of a randomized controlled trial

Voorendonk EM, Sanches SA, Tollenaar MS, et al. · Frontiers in psychology · 2023

doi.org/10.3389/fpsyg.2023.1215250Read the full paper ↗17 citationscc by

What they did

Researchers randomly split 119 patients with PTSD into different groups during an intensive 8-day therapy program consisting of prolonged exposure, EMDR, and psychoeducation. A group of 59 patients completed sessions of moderate-intensity physical activity, while a control group of 60 patients completed non-physical creative tasks. The researchers measured PTSD symptoms before treatment, immediately after treatment, and at 6 months follow-up.

What they found

Both groups showed a large reduction in PTSD symptoms, with 80.0% of the physical activity group and 82.7% of the non-physical group no longer meeting PTSD diagnostic criteria after treatment. There was no statistically significant difference in recovery rates between the groups, and both maintained their improvements at the 6 months follow-up. For those with Complex PTSD, 92.5% in the exercise group and 95.0% in the control group lost their diagnosis.

The limits

What it doesn't show

This study cannot rule out a ceiling effect, meaning the intensive trauma therapy itself was so highly effective that any extra benefit from exercise was impossible to detect. The trial also lacked an extra control group receiving only trauma therapy without any activities, meaning we cannot tell if either extra activity actually added value. Additionally, the sample was mostly Dutch females and the assessors were not blinded to the treatment groups, which could introduce bias.

Key terms

Trauma-Focused Treatment (TFT)
Therapy aimed at processing traumatic memories, often using techniques like prolonged exposure or EMDR.
EMDR
Eye Movement Desensitization and Reprocessing, a psychotherapy technique designed to alleviate the distress associated with traumatic memories.
Complex PTSD (CPTSD)
A severe form of PTSD arising from chronic, repeated trauma, characterized by additional issues like emotional dysregulation and relational difficulties.
Randomized Controlled Trial
An experimental study design where participants are randomly assigned to either an experimental group or a control group.
Ceiling Effect
A phenomenon where a treatment is so effective on its own that adding other interventions cannot show any further measurable improvement.
CAPS-5
The Clinician-Administered PTSD Scale for DSM-5, a structured interview used to diagnose and assess the severity of PTSD.

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What was the primary objective of this randomized controlled trial regarding PTSD treatment?

Common questions

Why did researchers think physical activity would help PTSD treatment?

Previous research suggested that exercise can reduce anxiety, stimulate brain growth, and help with emotional regulation, making it a promising add-on to talk therapies.

Did the physical activity group actually exercise harder than the control group?

Yes, the exercise group engaged in significantly more moderate-intensity physical activity and maintained higher heart rates than the creative control group during their sessions.

Does this mean people with PTSD shouldn't exercise?

No, exercise still has immense physical and mental health benefits; it just did not provide a unique therapeutic boost to this specific, highly intensive trauma program.

What did the control group do instead of exercising?

The control group engaged in guided, non-physical activities such as creative tasks and crafts to control for the social and distraction aspects of group activity.

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