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.

Pilot randomized controlled trial of exercise training for older veterans with PTSD.

Exercise training positively impacts mental health, yet remains untested in older adults with posttraumatic stress disorder (PTSD). We conducted a randomized controlled pilot trial to test the feasibility and acceptability of exercise training in older veterans with PTSD. Fifty-four veterans ≥ 60 years, with a DSM-V diagnosis of PTSD, were randomized to supervised exercise (n = 36) or wait-list (WL; n = 18). Primary outcomes included recruitment rates, attendance, satisfaction, and retention. Secondary outcomes included changes in PTSD symptoms, depression, health-related quality of life, and sleep quality; assessed at baseline and 12 weeks. There were no adverse events. Attrition was minimal (14%), and adherence to the exercise intervention was high (82%). Clinically significant improvements in PTSD and related conditions were observed following exercise (Cohen's d = 0.36-0.81). Exercise training is safe and acceptable in older adults with PTSD, may improve PTSD symptoms, and broadly impacts PTSD-related conditions. Future definitive trials are warranted.

Physical activity promotion in women with PTSD: What we need for progress.

OBJECTIVES: Researchers explore considerations for studying exercise promotion in women with post-traumatic stress disorder (PTSD). DESIGN: Researchers evaluated current studies on exercise promotion and PTSD. METHOD: Presents critical reflections on (1) the underrepresentation of women in health promotion and PTSD research, and (2) the impact women's trauma histories may have on exercise behavior. RESULTS: The underrepresentation of women in exercise trials leaves unanswered questions as to the generalizability of findings in women. Feasibility and acceptability of these programs among women with PTSD remains untested. Preliminary data indicate unique considerations may exist across the design and implementation domains. CONCLUSIONS: Increased studies examining population-specific considerations for women with PTSD are needed.

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.

Perceived Barriers and Benefits of Exercise Among Men with Histories of Sexual Violence: Impact of PTSD and Physical Activity Status.

This study reported on perceived benefits and barriers of exercise among men with histories of sexual violence (SV) and compared these perceptions by activity level and post-traumatic stress disorder (PTSD) status. An online, cross-sectional, survey of men with histories of SV (N = 198) was completed using Amazon Mechanical Turk. Inclusion criteria were identifying sex at birth as male, age between 18 and 65 years, self-reported history of SV, and living in the United States (U.S.). A total of 1,260 men were screened for the study, of which 316 met the inclusion criteria, and 198 met all data quality requirements and were included in the study. Sociodemographic information, exercise behavior, PTSD symptoms, and perceived exercise barriers/benefits were collected. Comparisons by activity and PTSD status were analyzed. Additionally, two open-ended qualitative research questions were included to provide nuance to perceived barriers/benefits of exercise. The most salient benefits included physical performance, psychological outlook, and preventative health. Open-ended responses also noted the mental and physical benefits of exercise. The most salient barrier was physical exercise, with open-ended responses emphasizing lack of time, chronic pain and health concerns, and poor mental health and lack of motivation as impediments to exercise. Significant differences were found in benefits (psychological outlook, physical performance) and barriers (exercise environment, high time expenditure, and family discouragement) between active and insufficiently active men with histories of SV (ps < .05; Cohen's ds = 0.32-0.57). Significant differences were found by PTSD status on benefits (physical performance, social interaction, and preventative health) and barriers (exercise milieu, time expenditure, hard physical exercise, family discouragement) (ps < .05; Cohen's ds = 0.40-1.10). Findings provide new gender-specific strategies for promoting exercise among men with histories of SV: integrating exercise physiologists into trauma recovery programs, psychoeducation, engaging friends and family members, peer-support, and building self-efficacy.

Perceived Barriers and Benefits of Exercise Among Women Survivors of Sexual Violence by Physical Activity Level and Posttraumatic Stress Disorder Status.

An online, cross-sectional survey of women survivors of sexual violence (SV; N = 355) gathered information on perceived barriers and benefits of exercise, along with exercise level and posttraumatic stress disorder (PTSD) symptoms. This study reports exercise perceptions and provides comparisons by exercise level and PTSD status. Differences by exercise level were found in life enhancement, physical performance, psychological outlook, and social interaction (ps < 0.05; rs = -0.04-0.25). Differences were found by PTSD status in physical performance, social interaction, and preventative health and exercise milieu, time expenditure, and family discouragement (ps < 0.05; rs = -0.39-0.21). Findings provide new information relevant for promoting exercise among women survivors of SV.

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.

Correlates and consequences of emotion regulation difficulties among OEF/OIF/OND veterans.

OBJECTIVE: This study examined trauma frequency, alcohol use, and posttraumatic stress disorder (PTSD) symptoms as predictors of emotion regulation (ER) difficulties among post-9/11 Veterans. METHOD: Seventy-four Veterans (95.5% male; mean age = 40; 45.9% Caucasian) completed questionnaires on demographics, PTSD symptoms, ER, trauma frequency, and drinking. RESULTS: Positive correlations were observed between PTSD symptom severity and ER difficulties (r = .6, p < .001) and drinking behavior and emotion dysregulation (r = .25, p < .05). PTSD symptoms above the clinical cutoff resulted in significantly higher ER difficulties than subclinical symptoms, t(66) = -2.975, p < .01). Linear regressions revealed that PTSD accounted for 37% of the variance in ER difficulties, F(1, 66) = 37.34, p < .05. Cluster C was the only significant predictor of Difficulties in Emotion Regulation Scale (DERS) total scores (B = 1.40, p < .05). Regression analyses on DERS subscales were also examined. Both PTSD Checklist-Specific (PCL-S) total and Cluster C significantly predicted the subscales of nonacceptance (PCL-S total, B = .30, p < .001; Cluster C, B = .45, p < .05) and clarity (PCL-S total, B = .12, p < .05; Cluster C, B = .31, p < .05). PCL-S total predicted strategies (PCL-S total, B = .43, p < .01). PCL-S total was the only significant predictor of the DERS subscales of goals (B = .21, p < .001) and impulse (B = .27, p < .001). There were no significant predictors for the subscale of awareness. CONCLUSION: The findings will aid the development of targeted intervention strategies in Veterans. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Impact of childhood maltreatment on psychosomatic outcomes among men and women with disabilities.

PURPOSE: This project examined the impact of childhood maltreatment types on psychosomatic outcomes among adults with a range of self-reported disabilities. MATERIALS AND METHODS: Participants (n = 643) were recruited using Amazon Mechanical Turk and Cloud Research. Single-item questions assessed sociodemographic information. The Childhood Trauma Questionnaire measured childhood maltreatment types (emotional, physical, and sexual abuse, and emotional and physical neglect) and the RAND-36 Item Health Survey evaluated physical functioning, pain, and energy/fatigue. Logistic regressions determined associations between childhood trauma and psychosomatic outcomes; stratified models compared men and women. RESULTS: Multivariate-adjusted models indicated physical abuse was positively associated with poor physical functioning (OR: 2.03; 95%CI: 1.35-3.06) with this relationship being stronger for men (OR: 3.25; 95%CI: 1.42-7.43) than women (OR: 1.91; 95%CI: 1.17-3.13). Adjusted models showed that physical neglect was protective against fatigue (OR: 0.58; 95% CI: 0.36-0.94), while emotional neglect increased the risk of fatigue (OR: 1.74; 95%CI: 1.02-2.95). Lastly, physical abuse was positively associated with pain (OR: 1.53; 95%CI: 1.01-2.33). This relationship was stronger in men (OR: 4.99; 95%CI: 1.91-12.99). CONCLUSIONS: Results improve our understanding of risk factors for poor physical health outcomes and can guide the development of trauma-sensitive rehabilitation services.Implications for RehabilitationIndividuals with disabilities who report childhood maltreatment may experience poor psychosomatic outcomes in adulthood.Consequences of experiencing childhood maltreatment may manifest differently between men and women over the course of the lifespan.It is essential to integrate trauma-informed principles into treatment plans for individuals with poor psychosomatic health.Rehabilitation professionals should screen for abuse and refer individuals to the appropriate mental and physical health services.

Patient-centered behavioral services for women veterans with mental health conditions.

The Veterans Health Administration (VHA) is undergoing a transformational shift from disease-focused care to a Whole Health model that emphasizes physical, mental, emotional, and spiritual health and well-being. As this shift is occurring, women veterans using VHA services face challenges navigating a system that has historically served a primarily male demographic, without consistent consensus on which services require specialization by gender. A quality improvement project was conducted to solicit feedback on VHA behavioral and wellness programs from women veterans enrolled in VHA mental healthcare services. A multi-disciplinary work group of clinical researchers and healthcare providers developed a needs assessment survey to assess patient needs and preferences for behavioral health services. A convenience sample of female veterans using VHA mental healthcare services within a comprehensive Women's Health Clinic were invited to complete this anonymous survey. 107 women Veterans 18-65+ years old (65.3% African American; 5.9% LatinX; 54.2% aged under 55) completed the survey. Over 50% of patients endorsed relationships, physical activity, sleep/nightmares, pain management, anger, or spiritual/moral pain as top wellness priorities. Programatic preferences included location (located at the main VA Hospital) and gender composition (female only group formats). Schedule conflicts were the most frequently cited barriers. Results from this quality improvement project highlight considerations for tailoring the content and delivery of behavioral services for women veterans with mental health conditions.

Warrior Wellness: A Randomized Controlled Pilot Trial of the Effects of Exercise on Physical Function and Clinical Health Risk Factors in Older Military Veterans With PTSD.

BACKGROUND: Military veterans living with post-traumatic stress disorder (PTSD) face significant physical and functional health disparities, which are often aggravated over time and in the context aging. Evidence has shown that physical activity can positively impact age-related health conditions, yet exercise trials in older adults with mental disorders are rare. Our study was a tailored and targeted pilot exercise intervention for older veterans with PTSD. METHODS: Fifty-four older veterans with PTSD (mean age = 67.4 years, 90.7% male, 85.2% non-white) were randomized to supervised exercise (n = 38) or wait-list usual care (n = 18) for 12 weeks. Physical activity (MET-min/wk) and aerobic endurance (assessed with the 6-minute walk test) were primary outcomes. Secondary outcomes were physical performance (strength, mobility, balance), cardiometabolic risk factors (eg, waist circumference), and health-related quality of life. RESULTS: At 12 weeks, a large effect of the intervention on physical activity levels (Cohen's d = 1.37) was observed compared to wait-list usual care. Aerobic endurance improved by 69 m in the exercise group compared to 10 m in wait-list group, reflecting a moderate between-group effect (Cohen's d = 0.50). Between-group differences on 12-week changes in physical performance, cardiometabolic risk factors, and health-related quality of life ranged from small to large effects (Cohen's d = 0.28-1.48), favoring the exercise arm. CONCLUSION: Participation in supervised exercise improved aerobic endurance, physical performance, and health-related clinical factors in older veterans with PTSD; a medically complex population with multiple morbidity. Group exercise is a low-cost, low-stigma intervention, and implementation efforts among older veterans with PTSD warrants further consideration.

Insights Following Implementation of an Exercise Intervention in Older Veterans with PTSD.

Individuals with post-traumatic stress disorder (PTSD) face numerous barriers to exercise. Little is known about behavioral strategies to promote participation in this population. This is a secondary analysis of individual barriers and goals, exercise prescription characteristics, and patient perceptions of a 12-week, community-based, randomized controlled exercise trial targeting older adults with PTSD, (N = 45; mean age = 68; male = 91%). The most common cited goals for participating included weight loss (65%) and increasing strength (65%). Exercise mode varied among those who completed the program (n = 37), with 14 (38%) using exclusively treadmill; eight (22%) using only bike, and 15 (41%) utilizing a combination. Patient-reported exercise duration and intensity progressively increased over the 12 weeks, and duration differed by mode of exercise. We observed high rates of attendance (84%) and completion (88%) to the program. Patient-reported barriers to attendance most often included health problems (62%) and medical appointments (55%). Participant responses to a program evaluation revealed high levels of satisfaction, preferences for group-based programs, and insights about the acceptability of the exercise environment (physical and social). This study is the first to report on goals, barriers, exercise prescription needs, and individual responses to supervised exercise training in a unique population, that is, older veterans with PTSD. Results of this study can inform future health promotion programs targeting older veterans with PTSD.

The Warrior Wellness Study: A Randomized Controlled Exercise Trial for Older Veterans with PTSD.

Posttraumatic stress disorder (PTSD) affects up to 30% of military veterans. Older veterans, many of whom have lived with PTSD symptoms for several decades, report a number of negative health outcomes. Despite the demonstrated benefits of regular exercise on physical and psychological health, no studies have explored the impact of exercise in older veterans with PTSD. This paper describes the development, design, and implementation of the Warrior Wellness exercise pilot study for older veterans with PTSD. Veterans aged ≥60 with a Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnosis of PTSD will be recruited and randomized to (a) Warrior Wellness, a 12-week supervised, facility-based exercise intervention, or (b) usual care for 12 weeks. Warrior Wellness is a theory- and evidence-based behavioral intervention that involves 3 sessions per week of multi-component exercise training that targets strength, endurance, balance, and flexibility. Warrior Wellness focuses on satisfaction with outcomes, self-efficacy, self-monitoring, and autonomy. Factors associated with program adherence, defined as the number of sessions attended during the 12 weeks, will be explored. Primary outcomes include PTSD symptoms and cardiovascular endurance, assessed at baseline and 12 weeks. Compared to those in usual care, it is hypothesized that those in the Warrior Wellness condition will improve on these efficacy outcomes. The Warrior Wellness study will provide evidence on whether a short-term exercise intervention is feasible, acceptable, and effective among older veterans with PTSD, and explore factors associated with program adherence. ClinicalTrials.gov Identifier: NCT02295995.