Direct and indirect effects of exercise on posttraumatic stress disorder symptoms: A longitudinal study

Gen Hosp Psychiatry. 2017 Nov;49:56-62. doi: 10.1016/j.genhosppsych.2017.06.012. Epub 2017 Jun 27.


Objective: Emerging evidence suggests that exercise may have beneficial effects on posttraumatic stress disorder (PTSD), and that this relationship may be indirectly affected by sleep, pain, and alcohol/substance use. The present study examined the longitudinal direct and indirect effects of exercise on PTSD symptoms.

Method: A national sample of 182 individuals, screening positive for PTSD, completed online assessments of PTSD symptoms, exercise behavior, psychological distress, sleep quality, and alcohol/substance use at baseline and three-month follow-up.

Results: There were direct effects of strenuous intensity exercise on avoidance/numbing (b=-2.18, SE=1.12, p=0.05) and hyperarousal symptoms (b=-1.87, SE=0.82, p=0.03); and direct effects of total exercise on avoidance/numbing symptoms (b=-1.76, SE=0.94, p=0.05). Strenuous intensity exercise was indirectly associated with total PTSD symptoms (ab=-2.53, 95% CI: -5.72 to -0.38), avoidance/numbing (ab=-0.99, 95% CI: -2.43 to -0.05), and hyperarousal symptoms (ab=-0.78, 95% CI: -1.88 to -0.07) through sleep, while total exercise was indirectly associated with total PTSD symptoms through alcohol use (ab=0.32, 95% CI: 0.18-1.42).

Conclusion: Findings suggest that exercise has a complex, longitudinal, and beneficial association with PTSD symptoms. Future studies should continue to examine this relationship and any direct and indirect effects exercise may have on PTSD and its related conditions.

Keywords: Alcohol use; PTSD; Physical activity; Sleep.

MeSH terms

  • Adult
  • Alcohol Drinking / physiopathology*
  • Exercise / physiology*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Sleep Wake Disorders / physiopathology*
  • Stress Disorders, Post-Traumatic / physiopathology*
  • Young Adult