Testing the role of aerobic exercise in the treatment of posttraumatic stress disorder (PTSD) symptoms in U.S. active duty military personnel: a pilot study.

The purpose of this pilot study was to determine if the efficacy of imaginal exposure for symptoms of posttraumatic stress disorder (PTSD) could be improved by adding aerobic exercise. We hypothesized that aerobic exercise would enhance the efficacy of exposure therapy. Active duty service members with clinically significant symptoms of posttraumatic stress (PTSD Checklist-Stressor-Specific Version, [PCL-S], ≥25) were randomized into one of four conditions: exercise only; imaginal exposure only; imaginal exposure plus exercise; no exercise/no exposure therapy (control). Participants (N = 72) were primarily male, Army, noncommissioned officers ranging in age from 22 to 52. PTSD symptom severity decreased over time (p < .0001); however, there were no significant differences between the experimental conditions. The prediction that imaginal exposure augmented with aerobic exercise would be superior to either imaginal exposure alone or aerobic exercise alone was not supported, suggesting that engaging in exercise and imaginal exposure simultaneously may not be any better than engaging in either activity alone. A better understanding of individually administered and combined exercise and exposure therapy interventions for PTSD is warranted.

Scrambler Therapy Treatment: The Importance of Examining Clinically Meaningful Improvements in Chronic Pain and Quality of Life.

INTRODUCTION: Calmare Scrambler Therapy (ST) interferes with pain signal transmission by using nerve fibers to convey a message of normality to the central nervous system. This prospective, double-blinded, randomized trial had three aims. First, we tried to determine ST's effectiveness in reducing chronic neuropathic pain symptoms and analgesic medication use in military service members, when compared to sham treatment. Next, we examined its effect on reported mental and physical health-related quality of life. Finally, we sought to describe participant perceptions of treatment effectiveness. MATERIALS AND METHODS: Forty-seven subjects were randomized to receive ten 30-minute active ST or sham treatments. Data were collected at baseline, posttreatment, and 1-month follow-up. RESULTS: The groups showed no statistically significant differences in pain scores, medication use, or mental or physical health-related quality of life with active versus sham treatment. However, both produced clinically meaningful reductions in pain and improvements in physical health-related quality posttreatment that was sustained at 1-month follow-up. Ninety percent of the blinded sample described the treatment intervention as a partial or complete success. CONCLUSION: ST is no better than sham treatment in decreasing pain. Yet, patient perceptions of treatment effectiveness are equally important in chronic pain treatment.

Phytochemicals to optimize cognitive function for military mission-readiness: a systematic review and recommendations for the field.

Context: Optimizing cognitive performance and preventing cognitive impairments that result from exposure to high-stress situations are important to ensure mission-readiness for military personnel. Objective: This systematic review assesses the quality of the evidence for plant-based foods and beverages, or their phytochemical constituents, across various outcomes related to cognitive function in healthy adult populations to develop research recommendations for the military. Data Sources: PubMed, CINAHL, Embase, PsycInfo, and the Cochrane Library were searched. Study Selection: Peer-reviewed randomized controlled trials published in the English language were eligible. Data Extraction: Twenty-five trials were included and assessed for methodological quality, and descriptive data were extracted. Data Synthesis: The acceptable (n = 16) to high-quality (n = 4) studies produced either no statistically significant effect or mixed results for enhancing cognitive function. Conclusions: The evidence suggested that healthy populations do not experience significant changes in cognitive performance when consuming soy- and non-soy-sourced isoflavones or cocoa. Heterogeneity among other interventions precluded reaching formal conclusions surrounding the evidence. Research recommendations are offered, including conducting more studies on the effect of plant-based interventions on populations reflective of military populations when exposed to military-like situations.

Caffeine to optimize cognitive function for military mission-readiness: a systematic review and recommendations for the field.

Context: In 2001 the Institute of Medicine (IOM) released a report on the use of caffeine during sustained military operations in which recommendations for research and practice were made. Objective: This systematic review serves as an update on the current quality of the evidence and addresses gaps in the current literature surrounding the effects of caffeinated foods and beverages on cognitive functioning in healthy adult populations exposed to military-like moderators. Data Sources: PubMed, CINAHL, Embase, PsycInfo, and the Cochrane Library were searched. Study Selection: Peer-reviewed randomized controlled trials published in the English language since 1998 were eligible. Data Extraction: Twenty-five trials were included and assessed for methodological quality, and descriptive data were extracted according to each military-like moderator identified. Data Synthesis: Moderators included sleep deprivation (n = 17), physical or mental exertion (n = 4), sleep deprivation combined with a sustained military operation (n = 3), and physical exertion combined with low ambient temperature (n = 1). Conclusions: The effects of caffeine supplementation on cognitive functioning in sleep-deprived subjects included improvements in attention and vigilance, complex reaction time, and problem solving and reasoning in the trials reviewed. These findings are consistent with the conclusions reached in the 2001 IOM report. This review contributes to the field by addressing gaps outlined in the IOM report.

Omega-3 polyunsaturated fatty acids to optimize cognitive function for military mission-readiness: a systematic review and recommendations for the field.

Context: There has been interest in identifying whether nutrients might help optimize cognitive performance, especially for the military tasked with ensuring mission-readiness. Objective: This systematic review assesses the quality of the evidence for n-3 polyunsaturated fatty acids (PUFAs) across various outcomes related to cognitive function in healthy adult populations in order to develop research recommendations concerning n-3 PUFAs for mission-readiness. Data Sources: PubMed, CINAHL, Embase, PsycInfo, and the Cochrane Library were searched. Study Selection: Peer-reviewed randomized controlled trials published in the English language were eligible. Data Extraction: Thirteen included trials were assessed for methodological quality, and descriptive data were extracted. Data Synthesis: Of the acceptable-quality (n = 8) and high-quality (n = 1) studies, 2 produced no statistically significant results, 5 produced mixed results, and 2 did not report between-group results. Conclusions: Results indicate that ingestion of n-3 PUFAs does not significantly alter cognitive performance in cognitively healthy persons. Studies exposing subjects to adverse circumstances that would be most relevant for drawing conclusions specifically for the military population are lacking. Several research recommendations are offered to enhance understanding of the role of fatty acids on cognitive functioning.

Whole dietary patterns to optimize cognitive function for military mission-readiness: a systematic review and recommendations for the field.

Context: Optimizing cognitive performance, particularly during times of high stress, is a prerequisite to mission-readiness among military personnel. It has been of interest to determine whether such performance could be enhanced through diet. Objective: This systematic review assesses the quality of the evidence for whole dietary patterns across various outcomes related to cognitive function in healthy adult populations to develop research recommendations for the military. Data Sources: PubMed, CINAHL, Embase, PsycInfo, and the Cochrane Library were searched. Study Selection: Peer-reviewed randomized controlled trials published in the English language were eligible. Data Extraction: Fifteen included trials were assessed for methodological quality, and descriptive data were extracted. Data Synthesis: Of the 6 acceptable-quality studies, 1 demonstrated statistically nonsignificant results, whereas the other 5 showed conflicting results across the cognitive outcomes assessed. Conclusions: Due to the heterogeneity across the included studies, no recommendations could be reached concerning whether certain whole dietary patterns have an effect on cognitive outcomes in healthy populations. Specific recommendations for future research are offered.

The effect of pulsed electromagnetic frequency therapy on health-related quality of life in military service members with chronic low back pain.

BACKGROUND: In the U.S. military, chronic low back pain is among the most frequent complaints for medical visits, lost work time, and attrition from active duty and the deployed setting by service members. PURPOSE: The aim of this pilot study was to determine whether adjunctive treatment with pulsed electromagnetic frequency (PEMF) produced significant variability in chronic low back pain symptoms and secondary health-related quality of life, mental health and disability outcomes. METHODS: Prospective, randomized pilot study with repeated measures at baseline, post-treatment, and 1 month follow-up for two groups: usual care (UC) vs. UC + PEMF. FINDINGS: In a convenience sample of 75 service members, health-related quality of life mental and physical component scores were significant: F(2, 104) = 4.20, p = .018 (η2 = .075) and F(2, 104) = 4.75, p = .011 (η2 = .084), respectively; as was anxiety symptom severity: F(2, 104) = 5.28, p = .007 (η2 = .092). DISCUSSION AND RECOMMENDATIONS: Adjunctive treatment with PEMF demonstrated improvements in service members' overall physical health-related quality of life with expected, yet statistically nonsignificant improvements in reported pain and LBP-related disability. There were significant between group differences in anxiety symptom severity with higher symptoms reported by the UC + PEMF group, surprising findings that warrant further investigation.

Exercise intervention research for patients with cancer on treatment.

OBJECTIVES: To review the literature and summarize the findings of exercise intervention research for patients with cancer undergoing treatment. DATA SOURCES: Electronic databases of the Ovid Medline and CINAHL from 1980 to present. Reference lists from retrieved articles were reviewed and relevant articles included. CONCLUSION: Exercise programs have been primarily aerobic. Participants exercised anywhere from 3 to 7 days a week, for 2 to 52 weeks, 10 to 45 minutes per session, at 50% to 85% of heart rate reserve. Exercise has shown to improve almost all aspects of physiologic and psychological functioning. IMPLICATIONS FOR NURSING PRACTICE: Nurses can confidently suggest exercise as part of a patient's therapy and guide the patient to a safe program.

Research and commentary: Change in exercise tolerance, activity and sleep patterns, and quality of life in patients with cancer participating in a structured exercise program.

PURPOSE/OBJECTIVES: To investigate the feasibility of an exercise program patterned after a phase II cardiac rehabilitation program to improve selected physiologic and psychological parameters of health in patients with cancer. DESIGN: Prospective, repeated measures study. SETTING: Two major military medical centers in the southwestern United States. SAMPLE: 62 patients diagnosed with cancer within the previous two years. Ages ranged from 24-83 (meanX = 59). Half of the participants were male and half were female. Minorities made up 29% of the sample. Participants had a wide range of cancer diagnoses and all stages of cancer. Fifteen subjects were undergoing treatment when they enrolled in the study. More than half of the subjects exercised prior to their cancer diagnoses, but fewer than half were able to resume an exercise routine following their cancer diagnoses. METHODS: Subjects met two days each week for 12 weeks for exercise and education. MAIN RESEARCH VARIABLES: Exercise tolerance as measured with a graded exercise test, activity and sleep patterns as measured with a wrist actigraph, and quality of life (QOL) as measured with the Cancer Rehabilitation Evaluation System-Short Form. FINDINGS: Significant improvements were observed over time in exercise tolerance, selected activity and sleep patterns, and QOL among the 46 (74%) subjects who completed the program. CONCLUSIONS: Patients with various types and stages of cancer can safely exercise using a cardiac rehabilitation model and can realize significant improvements in exercise tolerance, selected activity and sleep patterns, and QOL. IMPLICATIONS FOR NURSING: Most people are aware that regular exercise is part of a healthy lifestyle. After cancer diagnosis and treatment, patients experience uncertainty regarding how to resume exercise or how to begin an exercise program as part of their rehabilitation. Participation in a structured exercise program can provide patients with a safe environment within which to exercise at an intensity appropriate to their individual needs.