The role of exercise in post-traumatic stress disorder: clinical evidence, sleep, cognition, and psychotherapy...

Post-traumatic stress disorder (PTSD) constitutes a profoundly incapacitating psychiatric disorder distinguished by the presence of intrusive recollections, heightened arousal, disruptions in sleep patterns, cognitive impairments, and diminished quality of life (QoL). Notwithstanding the advancements achieved in pharmacological treatments and trauma-oriented psychotherapeutic interventions, a considerable number of patients encounter persistent residual symptoms, underscoring the necessity for supplementary therapeutic modalities. This review scrutinizes the nascent role of physical exercise as an adjunctive treatment for PTSD, concentrating on clinical evidence pertinent to the alleviation of symptoms, regulation of sleep, enhancement of cognitive function, and augmentation of the efficacy of trauma-focused psychotherapeutic interventions, particularly exposure-based therapies. Empirical data derived from randomized controlled trials and preliminary studies suggest that modalities such as aerobic exercise, high-intensity interval training, resistance training, and comprehensive exercise regimens may contribute to reductions in the severity of PTSD symptoms, as well as associated anxiety, depression, hyperarousal, and insomnia. Furthermore, exercise interventions have been associated with improvements in cardiorespiratory fitness, mindfulness, interoceptive awareness, and overall psychological QoL across a variety of populations, including veterans, refugees, law enforcement personnel, military service members, and adolescents. Mechanistically, physical exercise appears to augment neuroplasticity through transient elevations in brain-derived neurotrophic factor, modulation of autonomic regulatory functions, and facilitation of fear extinction learning processes. Significantly, aerobic exercise in conjunction with exposure-based psychotherapy has shown promising potential for enhancing long-term clinical outcomes. Collectively, the existing body of evidence suggests that exercise may represent a feasible, safe, and biologically plausible adjunctive intervention for PTSD; however, larger multicenter trials are necessary to establish optimal exercise prescriptions and elucidate the underlying neurobiological mechanisms.