Sex-specific associations between self-reported physical activity and PTSD among survivors of sexual violence.

This study examined sex-specific associations between sexual violence (SV) type and physical activity, and identified associations between PTSD symptoms and physical activity, all among cisgender men and women survivors of SV. Cross-sectional data from men (n = 197) and women (n = 356) survivors of SV were analyzed with stratified (men; women) hierarchical logistic regressions. Additionally, fully adjusted models for the total sample included interaction terms to further assess whether associations between SV type as well as PTSD symptoms (sum, clusters) and physical activity differed significantly by sex. Sexual assault was negatively associated with physical activity in the crude model among women (ORs: 0.58; p < 0.05). Harassment was positively associated with physical activity in the crude and adjusted models (ORs:1.92-2.16; ps<0.05) among women. Among men, there were no significant relationships. Regarding PTSD symptoms among women, crude and adjusted stratified models identified significant positive relationships with intrusion (ORs: 1.18-1.22; ps<0.05). Crude and adjusted models revealed significant positive relationships between avoidance and activity (ORs:1.38-1.41; ps<0.05) among men but not women. The interaction term for this difference in the association between avoidance and physical activity by sex was significant (OR: 0.65; 95%CI: 0.48-0.88; p < 0.01). Overall, findings provide evidence for sex-specific associations between SV and physical activity.

Barriers and Facilitators to Muscle-Strengthening Activity Among Latinas in the U.S.: Results From Formative Research Assessments.

BACKGROUND: Latinas are disproportionately affected by low physical activity (PA) levels and related health conditions (e.g., diabetes, obesity). Few Latinas in the U.S. (17%) meet the National PA Guidelines for both aerobic PA and muscle-strengthening activity (MSA), yet, research to date in this population has focused almost exclusively on aerobic PA. Performing regular MSA is linked with numerous health improvements and reduced mortality; thus, may be key to addressing health disparities in this community. This study examined perspectives on engaging in MSA among Latinas enrolled in two aerobic PA RCTs. METHODS: Brief quantitative surveys were conducted to assess interest in MSA among Latinas (N = 81), along with 19 follow-up in-depth semi-structured interviews on knowledge, barriers, and facilitators for engaging in regular MSA. Interview transcripts were analyzed by two independent bilingual researchers using a directed content analysis approach. RESULTS: Eighty-one Latinas (18-65 years) completed the survey. Most (91%) expressed interest in learning more about MSA and 60% reported not knowing how to do MSA as a substantial MSA barrier. Interview results indicated Latinas were aware of health benefits of MSA and motivated to engage in MSA but reported barriers (e.g., perception that MSA is for men, a taboo topic, and lack of knowledge on how to do MSA). CONCLUSION: This study contributes to a critical gap in PA research among Latinas. Findings will inform future culturally appropriate MSA interventions in this at-risk population. Addressing MSA and aerobic PA together in future interventions will provide a more comprehensive approach to reducing PA-related health disparities in Latinas than aerobic PA alone.

Exercise as Medicine for People with a Substance Use Disorder: An ACSM Call to Action Statement.

ABSTRACT: Over 20 million Americans are living with a substance use disorder (SUD) and nearly 100,000 die annually from drug overdoses, with a majority involving an opioid. Many people with SUD have co-occurring chronic pain and/or a mental health disorder. Exercise is a frontline treatment for chronic pain and is an effective strategy for reducing depression and anxiety and improving overall mental health. Several studies have shown that exercise improves SUD-related outcomes including abstinence; however, there is limited large-scale randomized clinical trial evidence to inform integration of exercise into practice. In this Call to Action, we aim to raise awareness of the specific issues that should be addressed to advance exercise as medicine in people with SUD including the challenges of co-occurring chronic pain, mental illness, and cardiopulmonary health conditions. In addition, specialized training for exercise professionals and other support staff should be provided on these issues, as well as on the multiple dimensions of stigma that can impair engagement in treatment and overall recovery in people with SUD.

Biological and psychological predictors of heart rate patterns during physical activity.

Objective: Latent class modeling (LCM) offers a promising approach for examining correlates of heart rate (HR) patterns over multiple exercise sessions. This research examined biological and psychological variables associated with different patterns of HR response to physical activity (PA). Methods: In a three-arm randomized controlled trial (exercise video games vs. standard exercise vs. non-exercise control), HR was recorded during PA sessions over a 12-week period. LCM identified three patterns of HR during PA across 189 participants in active arms: 1) high HR across sessions with low variability within sessions, 2) linear increase in HR across sessions with low variability within sessions, and 3) high variability in HR across all sessions. Associations with biological (resting heart rate, blood pressure, BMI, age, cholesterol, triglycerides, HbA1c) and psychological (depression, motivations for PA, PA-induced feelings) predictors of latent class membership were iteratively tested. Results: Psychological variables played as important a role in the final model as biological variables for predicting latent class membership. Few differences were found between LC1 and LC2, but LC3 differed from the other two groups in that participants were likelier to report that feel revitalized after PA (vs. LC1 and LC2), to be less motivated for PA (vs. LC1), reported greater depression (vs. LC1 and LC2), and were younger (vs. LC1). Conclusions: These findings demonstrate the potential of LCM to identify biological and psychological factors associated with chronotropic responses to PA, and advance understanding of the role of psychological factors in chronotropic PA outcomes.

Acute Psychological Effects of Resistance Exercise in Men With Symptoms of Muscle Dysmorphia: A Pilot Study.

ABSTRACT: SantaBarbara, NJ, Nosrat, S, Whitworth, JW, Ciccolo, JT. acute psychological effects of resistance exercise in men with symptoms of muscle dysmorphia: A pilot study. J Strength Cond Res 37(2): 277-283, 2023-This study tested the acute psychological effects of resistance exercise in men with symptoms of muscle dysmorphia. Twenty-one men completed 4 on-site sessions including a single session of moderate- (70% of 10 repetition maximum [RM]) and high- (100% of 10RM) intensity resistance exercise in a counter balanced order separated by at least 48 hours. State body image, perceived muscle size, exercise enjoyment, and ratings of perceived exertion (RPE) were assessed before, during, and after each session, and statistical significance was set a priori at p < 0.05. State body image significantly improve from pre to post during both sessions ( p < 0.01), with greater effect sizes seen for the high- ( d = 0.57) compared with the moderate- ( d = 0.39) intensity session. Perceived muscle size improved from pre to post during the high-intensity only ( p < 0.01, d = 0.66), and subjects enjoyed the high-intensity session significantly more than the moderate-intensity session ( p = 0.01), despite significantly higher RPE at each timepoint ( p < 0.01). Results contend with previous findings that show more positive psychological effects of moderate- compared with high-intensity resistance exercise. Education and client observation are essential to be aware of the potential for muscle dysmorphia. In instances where muscle dysmorphia is suspected, referral to qualified mental health professionals is recommended.

Resistance training for Black men with depressive symptoms: a pilot randomized controlled trial to assess acceptability, feasibility, and preliminary efficacy.

BACKGROUND: Depression is under-recognized in Black men, who are less likely to seek or have access to psychiatric treatment. Resistance training (RT; i.e., weight lifting) can improve depressive symptoms and may be more acceptable to Black men, but its effects have not been examined for Black men with depressive symptoms. METHODS: Fifty Black men with depressive symptoms were randomized to either (a) 12 weeks of RT (coupled with Behavioral Activation techniques to promote adherence) or (b) an attention-control group (Health, Wellness, and Education; HWE). Both groups met twice/week for 12 weeks, and follow-up assessments were done at end-of-treatment (EOT) and 6 months after enrollment. Changes in physical activity and muscular strength were collected as a manipulation check. The primary outcome was interviewer assessed symptoms of depression using the Quick Inventory of Depression Symptomology (QIDS). Secondary outcomes included self-reported depressive symptoms, anxiety, and stress. The association between change in QIDS from baseline to EOT and concurrent changes in physical activity and muscular strength in the RT group were explored as an initial assessment of mechanism. Longitudinal mixed effects regression models with subject-specific intercepts were used to examine intervention effects. RESULTS: A sample with high rates of medical comorbidities (e.g., 44% HIV positive), substance use (e.g., 34% smoking), and negative social determinates of health (e.g., 50% unemployed) was enrolled. Recruitment, engagement, and retention data indicate that the intervention and design were feasible. The RT group showed greater gains in self-reported exercise (b = 270.94, SE = 105.69, p = .01) and muscular strength (b = 11.71, SE = 4.23, p = .01 for upper body and b = 4.24, SE = 2.02, p = .04 for lower body) than the HWE group. The RT group had greater reductions in QIDS scores at both EOT (b = -3.00, SE = 1.34, p = .01) and 6 months (b = -2.63, SE = 1.81, p = .04). The RT group showed a greater reduction in anxiety at EOT (b = -2.67, SE = 1.06, p = .02). Findings regarding self-reported depressive symptoms and stress were non-significant, but in the expected direction with effect sizes in the small to medium range. In the RT group, improvement on the QIDS between baseline and EOT was associated with concurrent improvements in physical activity (b = 21.03, SE = 11.16, p = .02) and muscular strength (b = 1.27, SE = .44, p = .03 for upper body and b = .75, SE = .14, p = .03 for lower body). CONCLUSIONS: Results suggest that RT is feasible and may be efficacious for reducing depressive symptoms among underserved urban Black men. TRIAL REGISTRATION: ClinicalTrial.gov #: NCT03107039 (Registered 11/04/2017).

Early Adolescent Binge Drinking Increases Risk of Psychopathology in Post-9/11 Veterans and Mild Traumatic Brain Injury Exacerbates Symptom Severity.

AIMS: To demonstrate that early adolescent binge drinking (BD) increases the risk for and/or severity of psychopathology in post-9/11 Veterans and determine if mild traumatic brain injury (mTBI) modifies risk. METHODS: Post-9/11 Veterans (n = 375) were classified into two groups: 57 Veterans with a history of early adolescent BD (E-BD; age of onset <15) and 318 who did not BD until age 15 or older (late-BD or L-BD; age of onset ≥15). History of military mTBI and mental health disorders were also assessed following military service. RESULTS: Logistic regression and analysis of variance (ANOVA) analyses revealed that the E-BD's had significantly higher prevalence of alcohol use disorders (AUDs) and more severe symptoms of AUD, substance use disorder (SUD), depression and stress. Two-way ANOVAs showed that history of military mTBI was differentially associated with posttraumatic stress disorder (PTSD) incidence and severity among Veterans who had engaged in early adolescent BD. Specifically, Veterans with a history of both early adolescent BD and military mTBI were at greater risk for a PTSD diagnosis and had more severe symptoms of PTSD than those with only a history of adolescent BD. The greater PTSD symptom severity in the comorbid group was driven by hyperarousal symptoms. CONCLUSIONS: A history of BD during early adolescence is prevalent among Veterans and is related to higher risk for AUD and more severe AUD, SUD, mood and stress symptoms later in life. Veterans with early BD and military mTBI showed greater incidence and severity of PTSD, indicating that mTBI, a common comorbidity among post-9/11 Veterans, exacerbates risk.

Feasibility of Resistance Exercise for Posttraumatic Stress and Anxiety Symptoms: A Randomized Controlled Pilot Study.

Emerging evidence suggests that exercise may beneficially affect posttraumatic stress symptoms (PTSS), but few randomized trials exist. Additionally, the effects of resistance exercise (i.e., weight lifting or strength training) on PTSS have not been thoroughly examined. This study aimed to explore the feasibility of a brief high-intensity resistance exercise intervention for PTSS and related issues, such as anxiety, sleep, alcohol use, and depression, in non-treatment-seeking adults who screened positive for posttraumatic stress disorder (PTSD) and anxiety. The sample included 30 non-treatment-seeking, urban-dwelling adults (M age = 29.10 years, SD = 7.38; 73.3% female) who screened positive for PTSD and anxiety and were randomly assigned to either a 3-week resistance exercise intervention or a time-matched contact control condition. The results suggest the intervention was feasible, with 80.0% (n = 24) of participants completing the study, 88.9% of the resistance exercise sessions attended, and no adverse effects reported. Additionally, resistance exercise had large beneficial effects on symptoms of avoidance, d = 1.26, 95% CI [0.39, 2.14]; and hyperarousal, d = 0.90, 95% CI [0.06, 1.74], relative to the control condition. Resistance exercise also produced large improvements concerning sleep quality, d = 1.31, 95% CI [0.41, 2.21], and hazardous alcohol use, d = 0.99, 95% CI [0.13, 1.86], compared to the control condition. Overall, the findings suggest that 3 weeks of high-intensity resistance exercise is a feasible intervention for PTSS reduction in non-treatment-seeking adults who screen positive for PTSD and anxiety; additional research is needed to verify these preliminary findings.

Acute Effects of Resistance-Exercise Intensity in Depressed Black/African Americans Living With HIV: A Randomized Pilot Study.

Depressive symptoms and fatigue are prevalent among people living with human immunodeficiency virus. Resistance exercise is known to stimulate a positive affective response. OBJECTIVE: To examine the acute psychological effects of resistance-exercise intensity among Black/African-American people living with human immunodeficiency virus and experiencing depressive symptoms. METHODS: A total of 42 participants were randomized into a moderate- (n = 21) or high-intensity (n = 21) group. Assessments were collected before exercise (PRE), at the midpoint (MID), immediately following (POST) exercise, and 15 (DELAY 15) and 30 (DELAY 30) min after. RESULTS: In the moderate-intensity group, affect improved PRE to POST, PRE to DELAY 15 and DELAY 30, and perceived distress decreased from PRE to all time points. In the high-intensity group, affect declined PRE to MID, and perceived distress decreased PRE to DELAY 15 and DELAY 30. Perceived activation increased PRE to MID, and POST in both groups (ps < .01). CONCLUSIONS: The moderate-intensity group compared with the high-intensity group is more effective at improving affect and energy and at reducing distress.

A Systematic Review of the Effects of Resistance Training on Body Image.

The purpose of this systematic review was to identify and appraise the literature that has specifically tested the independent effects of resistance training (i.e., weightlifting) on body image in adults. A comprehensive search of electronic databases PubMed, Scopus, PsycNET, and Web of Science for relevant studies published in peer-reviewed journals through December 2016 was conducted, and PRISMA guidelines were followed. Inclusion criteria were that a study had to be (a) written in English, (b) published in a peer-reviewed journal, (c) conducted an assessment of body image using a validated scale before and after a stand-alone resistance training intervention (i.e., not coupled with another mode of treatment), and (d) excluded participants younger than 18 years. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. A total of 7,324 studies were identified, and 11 were included in this review. The majority (8 of 11) of studies concluded that resistance training can significantly improve multiple dimensions of body image, including body satisfaction, appearance evaluation, and social physique anxiety; however, only 3 studies were considered high quality based on their PEDro score, and several methodological limitations exist. Overall, resistance training seems to have the potential to improve body image in adults, but future high-quality studies with more rigorous testing methods and study designs are needed.

Acute effects of resistance exercise on affect, arousal, and urge to drink in temporarily abstinent young adult hazardous drinkers.

BACKGROUND AND OBJECTIVE: Young adults frequently engage in hazardous alcohol consumption, and many meet the diagnostic criteria for an alcohol use disorder. The urge to drink is a defining symptom of alcohol dependence, and it is closely tied to and exacerbated by negative affect. This study examined the acute effect of resistance exercise on affect, arousal, and drinking urges in young adult (ages 21-40) hazardous drinkers. METHODS: On two separate occasions, 14 participants underwent an 18-hour alcohol abstinence before completing, in a counter-balanced manner, a 20-minute session of resistance exercise and a 20-minute video control. RESULTS: Significant improvements in affect (t = 2.07, p = .04) and arousal (t = 4.09, p < .01), but not urge to drink, were found with exercise. CONCLUSION: Single sessions of resistance exercise can positively alter affect and arousal during alcohol abstinence. SCIENTIFIC SIGNIFICANCE: Practical exercise interventions designed to alter affect and arousal could potentially alter drinking. (Am J Addict 2016;25:623-627).

Traumatic Brain Injury and Posttraumatic Stress Disorder Are Associated with Physical Health Burden among Post-9/11 Women Veterans.

Background: Little research focuses on physical health outcomes of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) among post-9/11 women veterans (WVs). This study examined lifetime TBI, current PTSD, and their associations with biomarkers of cardiometabolic health, sleep, pain, and functional disability among post-9/11 WVs. Methods: WVs (n = 90) from the Translational Research Center for TBI and Stress Disorders longitudinal cohort study were included in this study. Gold standard clinician administered interviews assessed lifetime TBI (Boston Assessment of TBI-Lifetime) and current PTSD symptoms (Clinician-Administered PTSD Scale-IV). Objective measures of health included waist-hip ratio (WHR) and fasted blood biomarker (high density lipoprotein [HDL], low density lipoprotein [LDL], blood glucose, triglycerides) levels. Self-reported surveys assessed sleep, pain, and functional disability. Results: Just under two-thirds (58.9%) of WVs experienced a lifetime TBI, and just over half (53.3%) of this sample had a current PTSD diagnosis at the time of testing. Lifetime TBI was significantly associated with higher WHR, triglycerides levels, and worse pain and sleep (ps = <0.01 to 0.02; ds = 0.01 to 1.12). Current PTSD was significantly associated with higher WHR, lower HDL, and worse pain and sleep (ps = <0.01 to 0.02; ds = 0.009 to 1.19). PTSD was significantly associated with lower total functioning and each of its subdomains (ßs = -0.58 to 0.63; ps = <0.001 to 0.02). Lifetime TBI was significantly associated with total functioning, mobility, and life/work (ßs = -0.20 to 0.30; ps = <0.01 to 0.02). Conclusions: These findings highlight the importance of screening for lifetime TBI and cardiovascular disease for WVs and support transdiagnostic treatment approaches targeting physical health outcomes.

Associations Between Head Injury, Strangulation, Cardiometabolic Health, and Functional Disability Among Female Survivors of Intimate Partner Violence.

OBJECTIVE: Head injury and strangulation are highly prevalent in intimate partner violence (IPV) contexts, but there is little research examining the potential implications of these injuries on physical health and functional status. This pilot study explored the extent to which injury type (head injury, strangulation) and severity (no injury, subconcussive head injury, traumatic brain injury; no strangulation, strangulation, strangulation with loss of consciousness) were associated with biomarkers of cardiometabolic health and self-reported functioning among female survivors of IPV. METHODS: Participants were 51 individuals assigned female at birth who experienced IPV during their lifetime and screened positive for probable posttraumatic stress disorder (PTSD) on the PTSD Checklist for DSM-5 (average age = 32.6 years, SD = 7.1). RESULTS: Head injury was associated with statistically significant increases in blood glucose levels (p = .01, d = 1.10). Shifts toward more high-risk values with moderate-strong effect sizes were also found in high-density lipoprotein, low-density lipoprotein, and waist-to-hip ratio (ps: .06-.13; ds: 0.51-1.30). Strangulation was associated with increased cholesterol levels, with a moderate effect size (p = .20, d = 0.59). Regression models accounting for age, education, PTSD symptoms, childhood trauma, strangulation, and head injuries predicted functional disability status (R2 = 0.37, p < .01) and several of its associated domains: cognition (R2 = 0.34, F(8,42) = 2.73, p = .01), mobility (R2 = 0.47, F(8,42) = 4.82, p < .001), and participation in society (R2 = 0.33, F(8,42) = 2.59, p = .02). CONCLUSIONS: Findings suggest the need to develop integrated treatments that address physical health comorbidities among female survivors of IPV with a history of head injury to improve daily function and quality of life.

Impact of Military Affiliation on Exercise Perceptions Among Survivors of Sexual Violence.

INTRODUCTION: Military service members disproportionately experience sexual violence (SV) and its related health concerns. Although recent work has shown physical activity to be an effective strategy for improving physical and mental health among trauma-exposed military populations, little of this work has focused specifically on military service members with a history of SV. To address these gaps in knowledge and practice, this study identified the most salient perceived benefits/barriers of exercise among men and women survivors of SV with military affiliations. Additionally, these analyses explore willingness to engage in exercise programs, and preferences for the structure/content of these programs, among men and women survivors of SV with military affiliations. MATERIALS AND METHODS: An online, cross-sectional survey of women (n = 355) and men (n = 198) survivors of SV was completed using Amazon Mechanical Turk. Inclusion criteria were men and women, age between 18 and 65 years, self-reported history of SV, and located in the United States. Information on sociodemographics and post-traumatic stress disorder symptoms was collected alongside perceived barriers and benefits to exercise, willingness to engage in exercise programs, and preferences for the structure/content of these programs. Analyses were stratified by sex. Comparisons by history of military involvement (active duty military or veteran; no military involvement/civilian) were reported. RESULTS: Both military-involved men (n = 68) and women (n = 139) were more likely to prefer at-home and online exercise options when compared to civilians (Ps < .05; Cramer's Vs 0.19-0.36). Additionally, both men and women with military involvement reported strongly favoring exercising with an instructor over no instructor and preferred that this instructor identifies with their same gender (Ps < .01; Cramer's Vs 0.28-0.36). Women with military involvement also preferred shorter program durations and exercising alone or in a group online or in person, whereas men with military involvement were open to longer program durations, when compared to their civilian counterparts (Ps < .05; Cramer's Vs 0.19-0.37). Women and men with military involvement were more likely than their civilian counterparts to perceive that exercise benefits their psychological outlook and social interactions. They were also more likely than civilians to indicate poor exercise environment, high time expenditure, and family discouragement as perceived barriers to exercise (Ps < .05; Cohen's ds 0.21-0.97). Military-involved women were also more likely than civilian women to endorse the perceived barrier of hard physical exercise (P < .05; Cohen's d = 0.25). CONCLUSIONS: This study identified perceived benefits and barriers to exercise, along with willingness to engage in exercise programs, and exercise preferences among men and women survivors of SV with military involvement. Targeting these factors in intervention planning will be important for physical activity promotion and program engagement among veterans to reduce the disproportionate impact of SV and disease burden among U.S. service members and veterans.

Physical inactivity, cigarette smoking, and psychiatric comorbidity among veterans with posttraumatic stress disorder.

BACKGROUND: Posttraumatic stress disorder (PTSD) is associated with physical inactivity and cigarette smoking. However, little is known about the degree to which comorbid psychiatric conditions affect the odds of physical inactivity and smoking among individuals with PTSD. OBJECTIVE: To examine associations between PTSD, comorbid psychiatric conditions (depression, anxiety, or hazardous alcohol/substance use), physical inactivity and smoking among military veterans. METHOD: This was a cross-sectional analysis of data on U.S. veterans from Project VALOR (Veterans' After-discharge Longitudinal Registry; n = 1140). Logistic regressions examined associations between PTSD, comorbid psychiatric conditions, physical inactivity, and cigarette smoking. RESULTS: PTSD was associated with increased odds of being physically inactive (odds ratio [OR] = 2.08, p < .001) and a current smoker (OR = 1.39, p = .037), relative to no PTSD. PTSD with cooccurring depression was associated with increased odds for physical inactivity (OR = 2.68, p < .001) and smoking (OR = 1.78, p = .003), relative to PTSD only. PTSD with anxiety was associated with physical inactivity (OR = 2.17, p < .001), whereas cooccurring alcohol (OR = 1.60, p = .023) and substance use (OR = 2.00, p = .001) were associated with smoking. Additionally, numerous combinations of PTSD plus multiple conditions (e.g., PTSD + depression + anxiety) further increased the odds of physical inactivity and smoking (p < .05). CONCLUSIONS: Greater numbers of psychiatric comorbidities increase the odds of physical inactivity and cigarette smoking among veterans with PTSD. Physical inactivity and cigarette smoking are important predictors of cardiovascular and metabolic disease, and PTSD rarely occurs without psychiatric comorbidity. Thus, additional longitudinal research is needed to determine the impact of these associations, as they have clear physical and mental health implications. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Tai Chi and Qigong for trauma exposed populations: A systematic review.

Background: Trauma exposure and posttraumatic stress are highly prevalent and comorbid with health problems. Despite the apparent systemic nature of post-traumatic stress, recommended treatments neglect trauma's deleterious effects on health. Integrative mind-body treatments for posttraumatic stress, such as Tai Chi and Qigong (TCQ), may offer a promising adjunct to first-line treatments. Method: A systematic search was conducted to identify trials that examined Tai Chi and/or Qigong as treatments for trauma-exposed populations. Studies were examined for rigor; design, sample and intervention characteristics, dropout, attendance, satisfaction, acceptability, and key findings were systematically extracted. Results: The 6 studies included are all pilot or feasibility trials with descriptive or mixed-methods outcomes. No randomized trials or rigorous studies were identified. Dropout rates ranged widely, and adverse reactions were not evident. Reported satisfaction was high and benefits of relaxation, reductions in mental health symptoms, and improvements in pain and physical and cognitive functioning were noted. Limitations: All the studies were non-rigorous and relatively small, with no comparison groups, or follow-up assessments; in many cases, posttraumatic stress symptoms were not formally assessed. Conclusions: The paucity and lack of rigor of the studies identified for this review highlights the need for larger, methodologically sound clinical trials. The reviewed studies suggest that TCQ practices have the potential to reduce symptoms and improve functioning for individuals exposed to trauma and provide evidence that TCQ is feasible, acceptable, and low risk in these populations. Possible mechanistic pathways supporting TCQ as a treatment for posttraumatic stress are considered.

Cardiorespiratory Fitness Is Associated With Better Cardiometabolic Health and Lower PTSD Severity in Post-9/11 Veterans.

INTRODUCTION: Post-traumatic stress disorder (PTSD) is associated with an increased risk of cardiovascular and metabolic diseases and physical inactivity. Cardiorespiratory fitness (CRF), which is modifiable by physical activity, is a strong independent predictor of cardiometabolic health. However, the relationship between CRF and cardiometabolic health in veterans with PTSD is unknown. Thus, this study aimed to explore the cross-sectional relationships among CRF, indices of cardiometabolic health (ie, HbA1c, blood lipids, blood pressure, waist-hip ratio, and body mass index), and PTSD severity in veterans with PTSD. MATERIALS AND METHODS: This study was approved by the local Institutional Review Board. All participants were informed of the study risks and provided consent prior to participation. Participants (n = 13) completed a cardiopulmonary exercise test, a fasting blood draw, and the Clinician Administered PTSD Scale. Correlations between CRF and cardiometabolic health were examined with Spearman's rank correlations, and differences in PTSD symptom severity were explored as a function of CRF (ie, low-to-moderate vs. high CRF), using multiple linear regression. RESULTS: Peak oxygen uptake ($\dot{\mathrm{V}}$O2peak) was correlated with high-density lipoproteins rho = 0.60, P = 0.04 and diastolic blood pressure rho = -0.56, P = 0.05. Ventilatory threshold was correlated with HbA1c rho = -0.61, P = 0.03 and diastolic blood pressure rho = -0.56, P = 0.05. Higher CRF was associated with lower total PTSD severity standardized ß = -0.84, P = 0.01, adjusted R2 = 0.47, total Cluster C symptoms (avoidance/numbing) ß = -0.71, P = 0.02, adjusted R2 = 0.49, and total Cluster D symptoms (hyperarousal) ß = -0.89, P = 0.01, adjusted R2 = 0.41, while adjusting for age and smoking status. CONCLUSIONS: These preliminary findings suggest that CRF and by proxy physical activity may be important factors in understanding the increased risk of cardiovascular and metabolic disease associated with PTSD.

Moderated mediation for exercise maintenance in pain and posttraumatic stress disorder: A randomized trial.

This study utilizes the Science of Behavior Change (SOBC) experimental medicine approach to evaluate the effects of a 3-month, individually prescribed progressive exercise training program on neurobiological, cognitive and motivational mechanisms by which our exercise-training paradigm may foster exercise maintenance. We will investigate hypothesized relationships between exercise-training associated augmentation of neuropeptide Y (NPY) system function and improvements in self-regulation and reward sensitivity-cognitive control and motivational processes posited to promote self-efficacy and intrinsic motivation, which have been shown to predict exercise maintenance. This study will recruit Veterans with chronic low back pain and posttraumatic stress disorder (PTSD). Procedures include a baseline, acute cardiopulmonary exercise challenge assessment that will inform the exercise prescription for a 12-week progressive exercise training program comprised of three 45-minute aerobic exercise sessions per week-all of which will be supervised by an exercise physiologist. Additionally, a week-7 and week-14 exercise challenge assessment will track changes in NPY system function and the variables of interest. We hypothesize that increases in the capacity to release NPY in response to acute exercise testing will be associated with improvements in self-regulation and reward sensitivity, which will in turn be associated with self-efficacy and intrinsic motivation to maintain regular exercise. Ninety participants will be randomized either to the "active exercise training condition" or to the "wait list symptom monitoring condition". The study aims to demonstrate the feasibility of procedures and elucidate mechanisms relevant to developing individually prescribed, motivationally based exercise regimens to reduce negative consequences of PTSD and low back pain over the long-term. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Exercise and mental health of people living with HIV: A systematic review.

Objective Mental illness is highly prevalent among people living with HIV. Poor mental health is linked to HIV disease progression, making the treatment of mental illness alongside HIV essential. While the benefits of exercise on the physical health of people living with HIV are well established, the effect of exercise on mental health in this population is less examined. Therefore, this study aimed to conduct a systematic literature review of the effects of exercise on mental health in people living with HIV. Methods A search of electronic databases (PubMed, Web of Science, PsycINFO) through 30 November 2016 was completed. The methodological framework for scoping studies was used to conduct the review process. RISMA guidelines were used to report the results. Results The search resulted in 2273 articles and 52 were determined to be relevant. After review of the full text of potentially relevant studies, 24 studies were included for the analysis. Discussion Both aerobic and resistance exercise have independent and combined positive effects on various indicators of mental health in people living with HIV. Major limitations include high attrition rate, small sample size, and poor study designs. Higher quality studies with more diverse populations such as women, older adults, and transgender individuals are required.