A fascinating recent study has looked at not only whether #weightlifting could be an effective treatment for #PTSD and #trauma more broadly, but also at whether lifting weights can be safe and enjoyable for people living with trauma, because of anxieties among some survivors and clinicians that the physical exertion of #exercise can trigger traumatic symptoms and make the condition worse.
The study (Whitworth J, et al. Acute changes in affective valence and perceived distress predict reductions in PTSD severity, appeared in the October 2023 edition of the journal "Mental Health & Physical Activity". ("Affective valence" here means the extent to which someone is or isn't enjoying something). The researchers looked at data from two Randomised Control Studies (RCTs), a pilot study and another where the initial experiment was repeated to see if the results were the same. Participants were between 18 and 45 years old, with histories of traumatic events, including military combat, physical assault, sexual assault, life-threatening illness or injury, who were screened for possible PTSD, where symptoms had been stable for 90 days or more.
Anyone who was already receiving treatment for PTSD (e.g. trauma-focused therapy or medication) was excluded from the study, together with anyone who was already engaged in 60 minutes or more of structured exercise each week. (People with contra-indications for exercise were also excluded.)
The people who did join the study went through an initial orientation stage to introduce them to the research and to administer a series of physical and mental health tests, presumably to gain a baseline picture of their fitness levels and psychological health. Participants were then randomized to either a Resistance Training Group or a Contact Group. Those in the Resistance Training Group went through a three week weight lifting programme of three sessions per week. Each session was 30 minutes long (5 minute warm up, 20 minutes high intensity resistance training, 5 minutes cool down / stretching). The exercises used for the resistance section were: Squats, Chest Press, Pull-Down, Shoulder Press and Bicep Curl. Participants were asked to work to momentary muscular failure, with a 60 to 90 second rest between sets. Sessions were supervised by a qualified Personal Trainer (PT).
The Control Group also came in for 9 sessions of 30 minutes each over 3 weeks, but received health education on issues such as sleep and nutrition, instead of doing exercise.
At the start of the first session, participants were asked to rate their PTSD symptoms over the previous week and also their current level of "affect" (which here means level of emotion or mood) and perceived level of arousal and distress. The information was gathered again half way through the session and at the end and the procedure repeated each session. This allowed the researchers to gain a detailed picture of the impact of the sessions on participants levels of distress (trauma symptoms) and of whether they were actually enjoying the sessions. The researchers also gathered fitness-related data such as participants' perceived level of exertion and muscular strength. At the end of the study, the data was analysed and results produced:
What they found was that in the Resistance Training Group, positive affect improved (participants mood improved) and levels of trauma-related distress went down. This is really significant because of the belief that exercise can be triggering or make trauma symptoms worse - the feeling in the body in resistance training when heart rate raises and muscles contract can feel to some people, like the physical impact on the body of a traumatic incident. This can lead people to avoid exercising.
The findings are consistent with another study cited in the paper, by Bichler at al in 2022, which used rock climbing (bouldering) and Nordic Walking with a cohort of trauma survivors and found that these activities "greatly increased" positive affect.
No adverse effects from exercise were found in either study: Resistance Group participants did report a higher level of physical arousal, than the control group, which is to be expected as they were engaged in high intensity exercise but crucially, there was no association between this increased arousal and severity of PTSD symptoms. The researchers think there could be two reasons why increased physical arousal from exercise doesn't trigger PTSD symptoms - either the increased physiological arousal from some stressors, such as exercise are interpreted differently and as being less threatening than trauma-related increases (e.g. from trauma reminders. The other potential explanation is that the short duration of the resistance sessions (20 minutes), keeps the arousal below the level where it could become triggering and that longer bouts of more intense and aerobic exercise would have produced higher levels of perceived arousal that would have led to an exacerbation of trauma symptoms and distress.
What all this means is that short bouts of resistance exercise can be safe and enjoyable for trauma survivors and can reduce trauma-related symptoms. The trauma survivors in the study weren't in therapy or on medication while they were on the programme. Its because of this research (and other recent work on the impact of resistance work on trauma symptoms which I'll be exploring in Part II of this blog) that I recommend weight lifting to clients who come to see for me, looking to recover from trauma. The really interesting question is how resistance training helps reduce trauma symptoms. I will be exploring this in depth in another future blog but in brief, I think it's because of interoception - the process of the nervous system telling the brain how the body is. Trauma symptoms occur because, if you've been through a traumatic event, the survival system in your brain is constantly looking for signs of another threat by analysing sensory information coming into the system from the external environment and the body. Lifting weights requires you to be aware of what is happening in your body, as you focus on posture, form and the muscles and joints you're using, which stimulates interoception and signals to the brain that the body is getting stronger. That information then becomes part of the data the brain uses when assessing threats in the environment. The brain notices the body feels stronger and more confident, making it less inclined to consider the environment is dangerous and so less trauma symptoms are triggered. Look out for upcoming blogs going into this in more depth!
