The therapeutic potential of exercise in post-traumatic stress disorder and its underlying mechanisms: A living systematic review of human and non-human studies [version 3; peer review: 1 approved, 2 approved with reservations]
Background Exercise for post-traumatic stress disorder (PTSD) is a potentially effective adjunct to psychotherapy. However, the biopsychosocial mechanisms of exercise are not well understood. This co-produced living systematic review synthesizes evidence from human and non-human studies. Methods We...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wellcome
2025-04-01
|
| Series: | Wellcome Open Research |
| Subjects: | |
| Online Access: | https://wellcomeopenresearch.org/articles/9-720/v3 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850264556037734400 |
|---|---|
| author | David Gilbert Thomy Tonia Edoardo G. Ostinelli Toshi A. Furukawa Hossein Dehdarirad Emily Sena Fiona Ramage Spyridon Siafis Virginia Chiocchia Claire Stansfield Simonne Wright Francesca Tinsdeall Claire Friedrich James Thomas Charlotte Austin Malcolm Macleod Georgia Salanti Jaycee Kennett Soraya Seedat Olufisayo Elugbadebo Andrea Cipriani Ouma Simple Jennifer Potts |
| author_facet | David Gilbert Thomy Tonia Edoardo G. Ostinelli Toshi A. Furukawa Hossein Dehdarirad Emily Sena Fiona Ramage Spyridon Siafis Virginia Chiocchia Claire Stansfield Simonne Wright Francesca Tinsdeall Claire Friedrich James Thomas Charlotte Austin Malcolm Macleod Georgia Salanti Jaycee Kennett Soraya Seedat Olufisayo Elugbadebo Andrea Cipriani Ouma Simple Jennifer Potts |
| author_sort | David Gilbert |
| collection | DOAJ |
| description | Background Exercise for post-traumatic stress disorder (PTSD) is a potentially effective adjunct to psychotherapy. However, the biopsychosocial mechanisms of exercise are not well understood. This co-produced living systematic review synthesizes evidence from human and non-human studies. Methods We Included controlled human and non-human studies involving searches of multiple electronic databases (until 31.10.23). Records were screened, extracted, assessed for risk of bias, and reconciled by two independent reviewers. The primary outcome for human studies was PTSD symptom severity, while outcomes of interest for non-human studies included freezing behaviour, fear memory, fear generalization, startle response, and locomotion. Data were synthesised with random-effects meta-analysis. Results Eleven human studies met the eligibility criteria. Overall, exercise was not associated with symptom severity improvement compared to control (standardized mean difference [SMD] -0.08, 95% confidence interval [CI] -0.24 to 0.07; 8 studies, one at low risk of bias). High-intensity exercise reduced PTSD symptoms scores more than moderate-intensity exercise. There was insufficient data to examine the effects of exercise on functional impairment, PTSD symptom clusters, and PTSD remission. Only three studies, all at high risk of bias, examined mechanisms of exercise with inconclusive results. Exercise was associated with improvement in all behavioural outcomes, including locomotor activity (SMD 1.30, 95% CI 0.74 to 1.87, 14 studies), and changes in several neurobiological markers, including increase in brain-derived neurotrophic factor (SMD 1.79, 95% CI 0.56 to 3.01). Conclusions While non-human studies provide compelling evidence for the beneficial effects of exercise, human trials do not. Evidence from non-human studies suggest that exercise might increase the levels of brain-derived neurotrophic factor, enhance cognitive appraisal, and improve perceived exertion. Overall, the paucity of data on the effectiveness of exercise in PTSD and mechanisms of action underscore the need for rigorous trials. Registration The protocol was registered with PROSPERO (ID:453615; 22.08.2023). |
| format | Article |
| id | doaj-art-897dfdc10fa348e491e66d521cde6f53 |
| institution | OA Journals |
| issn | 2398-502X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wellcome |
| record_format | Article |
| series | Wellcome Open Research |
| spelling | doaj-art-897dfdc10fa348e491e66d521cde6f532025-08-20T01:54:41ZengWellcomeWellcome Open Research2398-502X2025-04-01910.12688/wellcomeopenres.23033.326562The therapeutic potential of exercise in post-traumatic stress disorder and its underlying mechanisms: A living systematic review of human and non-human studies [version 3; peer review: 1 approved, 2 approved with reservations]David Gilbert0Thomy Tonia1Edoardo G. Ostinelli2https://orcid.org/0000-0002-8717-0832Toshi A. Furukawa3Hossein Dehdarirad4Emily Sena5https://orcid.org/0000-0002-3282-8502Fiona Ramage6https://orcid.org/0000-0002-4855-7911Spyridon Siafis7https://orcid.org/0000-0001-8264-2039Virginia Chiocchia8https://orcid.org/0000-0002-6196-3308Claire Stansfield9Simonne Wright10https://orcid.org/0000-0003-3295-256XFrancesca Tinsdeall11https://orcid.org/0009-0008-9248-2954Claire Friedrich12https://orcid.org/0000-0002-5841-4324James Thomas13https://orcid.org/0000-0003-4805-4190Charlotte Austin14Malcolm Macleod15https://orcid.org/0000-0001-9187-9839Georgia Salanti16Jaycee Kennett17https://orcid.org/0000-0002-7312-8676Soraya Seedat18Olufisayo Elugbadebo19https://orcid.org/0000-0003-3221-1323Andrea Cipriani20Ouma Simple21https://orcid.org/0000-0002-4510-6736Jennifer Potts22GALENOS Global Experiential Advisory Board, InHealth Associates, London, UKUniversity of Bern Institute of Social and Preventive Medicine, Bern, SwitzerlandDepartment of Psychiatry, University of Oxford, Oxford, England, UKKyoto University Office of Institutional Advancement and Communications, Kyoto, JapanEPPI Centre, UCL Social Research Institute, University College London, London, England, UKThe University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, Scotland, UKThe University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, Scotland, UKTechnical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, GermanyUniversity of Bern Institute of Social and Preventive Medicine, Bern, SwitzerlandEPPI Centre, UCL Social Research Institute, University College London, London, England, UKSouth African Medical Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, 7550, South AfricaThe University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, Scotland, UKDepartment of Psychiatry, University of Oxford, Oxford, England, UKEPPI Centre, UCL Social Research Institute, University College London, London, England, UKOxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, England, UKThe University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, Scotland, UKUniversity of Bern Institute of Social and Preventive Medicine, Bern, SwitzerlandOxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, England, UKSouth African Medical Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, 7550, South AfricaSouth African Medical Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, 7550, South AfricaDepartment of Psychiatry, University of Oxford, Oxford, England, UKSouth African Medical Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, 7550, South AfricaDepartment of Psychiatry, University of Oxford, Oxford, England, UKBackground Exercise for post-traumatic stress disorder (PTSD) is a potentially effective adjunct to psychotherapy. However, the biopsychosocial mechanisms of exercise are not well understood. This co-produced living systematic review synthesizes evidence from human and non-human studies. Methods We Included controlled human and non-human studies involving searches of multiple electronic databases (until 31.10.23). Records were screened, extracted, assessed for risk of bias, and reconciled by two independent reviewers. The primary outcome for human studies was PTSD symptom severity, while outcomes of interest for non-human studies included freezing behaviour, fear memory, fear generalization, startle response, and locomotion. Data were synthesised with random-effects meta-analysis. Results Eleven human studies met the eligibility criteria. Overall, exercise was not associated with symptom severity improvement compared to control (standardized mean difference [SMD] -0.08, 95% confidence interval [CI] -0.24 to 0.07; 8 studies, one at low risk of bias). High-intensity exercise reduced PTSD symptoms scores more than moderate-intensity exercise. There was insufficient data to examine the effects of exercise on functional impairment, PTSD symptom clusters, and PTSD remission. Only three studies, all at high risk of bias, examined mechanisms of exercise with inconclusive results. Exercise was associated with improvement in all behavioural outcomes, including locomotor activity (SMD 1.30, 95% CI 0.74 to 1.87, 14 studies), and changes in several neurobiological markers, including increase in brain-derived neurotrophic factor (SMD 1.79, 95% CI 0.56 to 3.01). Conclusions While non-human studies provide compelling evidence for the beneficial effects of exercise, human trials do not. Evidence from non-human studies suggest that exercise might increase the levels of brain-derived neurotrophic factor, enhance cognitive appraisal, and improve perceived exertion. Overall, the paucity of data on the effectiveness of exercise in PTSD and mechanisms of action underscore the need for rigorous trials. Registration The protocol was registered with PROSPERO (ID:453615; 22.08.2023).https://wellcomeopenresearch.org/articles/9-720/v3GALENOS PTSD exercise extinction learning memory regulation emotion regulationeng |
| spellingShingle | David Gilbert Thomy Tonia Edoardo G. Ostinelli Toshi A. Furukawa Hossein Dehdarirad Emily Sena Fiona Ramage Spyridon Siafis Virginia Chiocchia Claire Stansfield Simonne Wright Francesca Tinsdeall Claire Friedrich James Thomas Charlotte Austin Malcolm Macleod Georgia Salanti Jaycee Kennett Soraya Seedat Olufisayo Elugbadebo Andrea Cipriani Ouma Simple Jennifer Potts The therapeutic potential of exercise in post-traumatic stress disorder and its underlying mechanisms: A living systematic review of human and non-human studies [version 3; peer review: 1 approved, 2 approved with reservations] Wellcome Open Research GALENOS PTSD exercise extinction learning memory regulation emotion regulation eng |
| title | The therapeutic potential of exercise in post-traumatic stress disorder and its underlying mechanisms: A living systematic review of human and non-human studies [version 3; peer review: 1 approved, 2 approved with reservations] |
| title_full | The therapeutic potential of exercise in post-traumatic stress disorder and its underlying mechanisms: A living systematic review of human and non-human studies [version 3; peer review: 1 approved, 2 approved with reservations] |
| title_fullStr | The therapeutic potential of exercise in post-traumatic stress disorder and its underlying mechanisms: A living systematic review of human and non-human studies [version 3; peer review: 1 approved, 2 approved with reservations] |
| title_full_unstemmed | The therapeutic potential of exercise in post-traumatic stress disorder and its underlying mechanisms: A living systematic review of human and non-human studies [version 3; peer review: 1 approved, 2 approved with reservations] |
| title_short | The therapeutic potential of exercise in post-traumatic stress disorder and its underlying mechanisms: A living systematic review of human and non-human studies [version 3; peer review: 1 approved, 2 approved with reservations] |
| title_sort | therapeutic potential of exercise in post traumatic stress disorder and its underlying mechanisms a living systematic review of human and non human studies version 3 peer review 1 approved 2 approved with reservations |
| topic | GALENOS PTSD exercise extinction learning memory regulation emotion regulation eng |
| url | https://wellcomeopenresearch.org/articles/9-720/v3 |
| work_keys_str_mv | AT davidgilbert thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT thomytonia thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT edoardogostinelli thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT toshiafurukawa thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT hosseindehdarirad thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT emilysena thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT fionaramage thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT spyridonsiafis thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT virginiachiocchia thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT clairestansfield thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT simonnewright thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT francescatinsdeall thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT clairefriedrich thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT jamesthomas thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT charlotteaustin thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT malcolmmacleod thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT georgiasalanti thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT jayceekennett thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT sorayaseedat thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT olufisayoelugbadebo thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT andreacipriani thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT oumasimple thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT jenniferpotts thetherapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT davidgilbert therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT thomytonia therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT edoardogostinelli therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT toshiafurukawa therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT hosseindehdarirad therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT emilysena therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT fionaramage therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT spyridonsiafis therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT virginiachiocchia therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT clairestansfield therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT simonnewright therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT francescatinsdeall therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT clairefriedrich therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT jamesthomas therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT charlotteaustin therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT malcolmmacleod therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT georgiasalanti therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT jayceekennett therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT sorayaseedat therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT olufisayoelugbadebo therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT andreacipriani therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT oumasimple therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations AT jenniferpotts therapeuticpotentialofexerciseinposttraumaticstressdisorderanditsunderlyingmechanismsalivingsystematicreviewofhumanandnonhumanstudiesversion3peerreview1approved2approvedwithreservations |