Aerobic exercise in the treatment of PTSD: An examination of preclinical and clinical laboratory findings, potential mechanisms, clinical implications, and future directions. (March 2023)

• Record Type: Journal Article
• Authors: Crombie, Kevin M.; Adams, Tom G.; Dunsmoor, Joseph E.; Greenwood, Benjamin N.; Smits, Jasper A.; Nemeroff, Charles B.; Cisler, Josh M.
• Is Part Of: Journal of anxiety disorders. Volume 94(2023)
• Publication Date: 2023-03
• Subjects: Fear extinction -- Exposure therapy -- Behavioral tagging -- Pattern separation -- Endocannabinoid system -- Brain derived neurotrophic factor; Anxiety -- Periodicals; Anxiety Disorders -- Periodicals; Angoisse -- Périodiques; Electronic journals; 616.8522
• DOI: 10.1016/j.janxdis.2023.102680
• Languages: English
• ISSNs: 0887-6185

Abstract

Abstract: Posttraumatic stress disorder (PTSD) is associated with heightened emotional responding, avoidance of trauma related stimuli, and physical health concerns (e.g., metabolic syndrome, type 2 diabetes, cardiovascular disease). Existing treatments such as exposure-based therapies (e.g., prolonged exposure) aim to reduce anxiety symptoms triggered by trauma reminders, and are hypothesized to work via mechanisms of extinction learning. However, these conventional gold standard psychotherapies do not address physical health concerns frequently presented in PTSD. In addition to widely documented physical and mental health benefits of exercise, emerging preclinical and clinical evidence supports the hypothesis that precisely timed administration of aerobic exercise can enhance the consolidation and subsequent recall of fear extinction learning. These findings suggest that aerobic exercise may be a promising adjunctive strategy for simultaneously improving physical health while enhancing the effects of exposure therapies, which is desirable given the suboptimal efficacy and remission rates. Accordingly, this review 1) encompasses an overview of preclinical and clinical exercise and fear conditioning studies which form the basis for this claim; 2) discusses several plausible mechanisms for enhanced consolidation of fear extinction memories following exercise, and 3) provides suggestions for future research that could advance the understanding of the potential importance of incorporating exercise into the treatment of PTSD. Highlights: Exposure-based therapies for PTSD are hypothesized to work via mechanisms of extinction learning. These gold standard treatments do not address physical health concerns often presented in PTSD. Exercise may improve physical health and enhance extinction learning that occurs during therapy sessions. This review provides an overview of preclinical and clinical studies that support this notion. Plausible mechanisms and suggestions for future research are discussed.