The Impact of Physical Activity on Severity of PSTD Symptoms

Introduction 

Post-Traumatic Stress Disorder (PTSD) can be described as a disorder, which is triggered by stress and trauma. This condition develops after an individual was exposed to an incident that resulted in severe physical harm or death. This condition is common among military troops, survivors of terror attacks, rescue workers, and victims of rape cases. Additionally, the condition can affect the family members of the victims of these incidents. Approximately, 6.8 million American adults have experienced PTSD at different stages in their lives. This condition can affect people of all age brackets from childhood to adulthood. Nonetheless, this condition is more prevalent among women than among men. In particular, 9.7% and 3.6% women and men respectively have experienced this condition in their lifetime (National Center for PSTD, 2016). In most cases, PTSD is accompanied by other mental conditions, including substance use disorder, depression, and anxiety disorders. In such cases, the success of the treatment plan depends on the diagnosis and the treatment of other conditions. This condition is sometimes referred to as acute stress disorder if the symptoms persist for one month. Individuals are diagnosed with PTSD if they experience symptoms a month after the incident. In some incidents, the symptoms might delay if they are experienced after six months following the traumatic incident. This condition is associated with three major types of symptoms: Intrusion symptoms, avoidance symptoms, as well as arousal and reactivity symptoms. Intrusion symptoms include nightmares, fearful thoughts as well as flashbacks and worrying that the incident might reoccur. Avoidance symptoms include the tendency to refuse to discuss the event and avoiding incidents that make the victim remember about the incident. Finally, arousal and reactivity symptoms include difficulty in sleeping, hypersensitivity to any possible dangers, irritability and angry outbursts as well as anxiety and tension (National Center for PSTD, 2016).

Although the primary cause of PTSD not known, the condition is associated with genetic, psychological, physical, and social variables. PTSD interferes with the way the body responds to stress. It has an impact on the hormones associated with stress and chemicals, which relay information between the nerves in the nervous system. Individuals who experienced other traumatic incidents previously or abuse in their childhood have high chances of developing this condition either months or years later after the event. Nonetheless, the risk of suffering from this condition might be increased by some temperamental variables like externalizing behaviours among other issues that relate to anxiety. Besides, this condition is triggered by some environmental risk variables such as family dysfunction, cultural variables, childhood adversity, and a history of psychiatric illness in the family. The level of the risk depends on the magnitude of the trauma. People are more likely to develop PTSD if the magnitude of the trauma was high and vice-versa. The outcomes of the condition worsen further due to the lack of social support from the family members, inappropriate coping mechanisms, financial stress, or family instability. Although PTSD symptoms are usually treated using both pharmacological and non-pharmacological therapies, physical activity plays a significant role in reducing the severity of its symptoms.

Review of the Literature 

This section of the paper focuses on previous studies done on the impact of physical activity on the severity of symptoms of PTSD. In particular, the paper will cover both theoretical and empirical theories that are related to the topic.

Theoretical Framework 

This section of the paper focuses on various models of behaviour change. Researchers have focused on various models of behaviour change, which relate to health behaviours. Health Belief Model (Rosenstock, 1990) is one of the well-researched and the most popular model of behaviour change. The second popular model in this field is the Theory of Planned Behavior (Ajzen, 1986). The transtheoretical model (Prochaska, Norcross, & DiClemente, 2005) is the third theory that relates to health behaviours. Although the three models are different, all of them emphasize the power of a person in choosing the best behaviours in life and clinging on them. Social-Ecological Model also addresses other variables that have an impact on health behaviours. These factors include physical environments, community, society as well as both the local and state government (Green, Richard, & Potvin, 1996). The Social-Ecological Model for physical activity was developed from the work of Brofenbrenner (1977).

The Theory of Planned Behavior : This theory states that the behaviours of individuals in activities that are related to health are determined by their willingness to participate in the activity. In particular, the results of the activity and its results will be determined by the attitude of an individual towards that activity. Additionally, the results depend on the level of motivation, beliefs, and the social norms of the person engaging in the activity (Ajzen, 1986). Physical activity cannot be increased by the intentions of an individual alone since most individuals who are active are past planning for physical activities and they have managed to overcome their past habits of remaining to inactivate (Dishman, 2004). Physical activity is not likely to happen if a person does not have the intention to perform. Despite the Theory of Planned Behavior informing individuals about the decision that they need to make to become active, knowledge of multifaceted theory is required (Conn, Tripp-Reimer, & Maas, 2003).

Transtheoretical Model (TM): This is the second model of behaviour change, which may play a significant role in determining the level of physical activity to engage in. It was developed to give support to the intentional behaviour change of individuals. This model claims that individuals encounter different stages to be able to make any change in their behaviour. This model was developed at the University of Rhode Island Cancer Prevention Research Center. The researchers used findings of how individuals quit smoking to develop this model (Prochaska & Velicer, 1997). Just like in Theory of Planned behaviour and Health belief model, the intentions to engage in the physical activity are emphasized in this model. Also, this model of behaviour change focuses on self-efficacy. People have used TM in many years to acquire knowledge in exercise behaviours. Multiple theoretical constructs, which is a major concept in the field of counselling is used to develop TM.

Additionally, this model focuses on various phases of change readiness, including pre-contemplation, preparation for change, contemplation, action, and maintenance (Prochaska, Norcross, & DiClemente, 2005). According to Prochaska et al. (2005), TM stages vary from each other greatly. The first phase is the pre-contemplative stage of the TM, in which people do not consider a change. Sometimes people might not be aware that they need to make some changes in their lives. A good example of persons in the pre-contemplative stage is individual who attend counselling sessions because their family members or friends want them to change. Validating the feelings of a person should be the primary goal and intervention measures that are put in place in this stage. Besides, the feelings should be validated to fit the level of motivation of the client. The second phase in the TM is the contemplative stage. In this stage, the clients are resistant to embrace the process of change. However, they acknowledge the benefits that are associated with change. In this stage, the treatment plans adopted should not concentrate on the goals a lot but rather focus on matching them with the motivation level of the client. In particular, a person should focus on the benefits that are associated with change. Besides, one should focus on creating awareness for the client regarding the impact of their behaviour on themselves and other people. The next phase in TM is the preparation for change stage. In this stage, individuals commit themselves to change. They start by putting measures for the change/s to occur in place. Clients should get the required resources for implementing their plans using the treatment plans. It is very important to establish self-efficacy at this phase of TM. The next phase is the action stage in which individuals are involved in the change of the behaviour. Individuals should be accorded ongoing support in this phase. The last phase is the maintenance stage, in which a person is involved in activities of behaviour change. It is assumed that an individual intends to continue with these behaviours in the long-run. This stage aims at giving continuous support to an individual. Additionally, any incidents of potential relapse are addressed in this phase.

A part of the TM was developed from the work of the social cognitive theory, which was developed by Albert Bandura’s (1986). This theory claimed that individuals should believe in their ability to perform a particular task and get the desired outcomes before they embark on it. The primary goal of any exercise program is to establish self-efficacy. The recommended level of activity is promoted through self-efficacy. Besides, the concepts from the Theory of Planned Behavior portrays that adult behaviour depends on perceived control, behavioural beliefs, and normative beliefs (Conn, TrippReimer, & Maas, 2003). Previous researchers have used The TM widely to evaluate exercise behaviour. TM is among the most popular cognitive-behavioural intervention measures. This approach has given positive outcomes in the short-run among individuals with an anxiety disorder. Nonetheless, participant adherence has challenged long-term interventions, which lasts over one year. In the present study, the cognitive-behavioural theoretical approach is considered as the most effective construct. This approach works within the set timeframe and gives the expected results. Additionally, strong empirical evidence has been provided by approaches that have utilized the cognitive framework.

The Health Belief Model : This theoretical model guide disease prevention programs and health promotion. Medical practitioners use this model to predict the changes that are likely to occur in the health behaviours of an individual. It is the most popular model, which is used to enhance the understanding of health behaviours. The major features of the Health Belief Model concentrate on the beliefs concerning the health conditions of an individual (Tarkang & Zotor, 2015). These beliefs play a significant role in predicting health-related behaviours of an individual. The major factors, which determine the health behaviours of a person are predicted by this model. The Health Belief Model is implemented in developing both short- and long-term interventions measures. Five components are related to an action, which determines the capacity of the Health Belief Model to establish the major decision-making points (Tarkang & Zotor, 2015). The first one involves collecting information through the assessment of individuals' health needs. Also, it involves other efforts for establishing an individual who is at risk and the most target population. The second one involves communicating the effects of the health issues that relate to risk behaviours of individuals to the target population. This move will enable the target population to take caution thus avoiding the health risk. Another aspect involves establishing and minimizing barriers to the action. The last element involves portraying actions through developing skill and providing the required support.

Empirical Framework 

This section of the paper focuses on previous literature concerning the relationship between physical activity and PSTD.

Physical Activity : Physical activity can be described as the movement of the body, which requires the expenditure of energy. Example of physical exercises includes walking to class, swimming, taking the stairs as well as doing household chores. Exercise is considered as a type of physical activity. However, not every physical activity is exercise. Healthcare practitioners recommended physical activities to the general population as a way of preventing and treating various conditions (Demers, n.d). In particular, the American College of Sports Medicine (ACSM) and the Centers for Disease Control (CDC) advocate for physical activity since it plays a significant role in improving public health. Health issues that are prevented by engaging in physical activity are heart disease, hypertension, obesity, non-insulin-dependent diabetes mellitus, various mental conditions such as PSTD, and osteoporosis. Therefore, physical activities are effective in the prevention and the treatment of non-psychiatric conditions. Nonetheless, medical entities recommend physical activity to people with or without health issues to improve the quality of their lives (Demers, n.d). On the contrary, the mental health of individuals is compromised by physical activity particularly when it is performed more intensely. Therefore, several aspects of psychologist or psychiatrist in clinical practice are influenced by the knowledge of the physical activity. Physical activity reduces the severity of the symptoms of PSTD in a various way.

The effectiveness of physical activity in reducing the symptoms of PTSD : Recently, the researchers have focused on the impact of physical activity and exercise in treating and reducing the severity of symptoms of PTSD. In most cases, researchers use physical activity and exercise interchangeably. However, the two terms are different from one another. Physical activity refers to any movement of the body, which is produced by skeletal muscles and energy is utilized. There are different forms of physical activities such as walking and cycling. Regular physical activity plays a significant role in improving the quality of life of an individual. In particular, it improves body balance, musculoskeletal strength, coordination, and aerobic fitness (Penedo & Dahn, 2005). On the other hand, the term exercise refers to a subtype of physical activity, which is well structured, planned, and repetitive. The primary exercise of exercise is to maintain or improve the physical fitness of an individual (Carek, Laibstain & Carek, 2011). Cardiorespiratory fitness can be described as physical fitness, which refers to the ability of an individual to perform dynamic, large-muscle, and high-intensity physical activity for a long duration. This type of physical activity depends on the cardiovascular, skeletal muscle, and respiratory systems. Regular exercise and physical activity, which are designed to improve cardiorespiratory fitness accrue a wide range of health benefits to individuals (Herring et al, 2012). For instance, these exercises and physical activities lower the risk of diabetes, cardiovascular disease, and obesity. Additionally, regular exercise and physical activity benefit mental health. According to Hegberg, Hayes, and Hayes (2019), aerobic exercise that enhances cardiorespiratory fitness are effective in the treatment of some conditions such as depression, schizophrenia, and anxiety. The treatment occurs through both psychological and physiological mechanisms. The use of exercise in treating this condition has been more effective compared to other treatment options such as psychotherapy and pharmacology (Carek, Laibstain & Carek, 2011).

Although some symptoms of PTSD overlap with those of other mental disorders such as anxiety and depression, PTSD is different from these disorders. The difference occurs in terms of the symptomatology, aetiology, and neurobiological. Additionally, the cause of PSTD differs from other mental condition. PSTD specifically occurs following a traumatic incident. Therefore, the treatment that is effective for depression and anxiety might be less effective in treating PTSD. However, physical activity and exercise have proved to be effective in the treatment of PSTD just like in other conditions (Hegberg, Hayes, & Hayes, 2019). The mechanisms of physical activity are effective in reducing the severity of PTSD symptoms.

Additionally, research shows some correlation between exercise and PTSD symptoms. According to Hegberg, Hayes, and Hayes (2019), physical activity reduces the severity of PSTD symptoms, which are indicated in the DSM-IV manual. In particular, exercises lower the rate of re-experiencing, hyperarousal, and avoidance after a traumatic incident. Reed and Buck (2009) argue that approximately 96% of soldiers who engaged in vigorous exercise did not experience PSTD. They exercised for around 20 min for either two or more times every week. Additionally, the participants who were experiencing PSTD and were exercising regularly portrayed mild symptoms as opposed to those who were not involved in the exercise. Also, individuals who combined both intense and moderate exercise reduced the chances of developing new PTSD symptoms or their symptoms being persistent. Furthermore, Harte, Vujanovic and Potter (2015), conducted a cross-sectional study in which they involved trauma-exposed adults. The total number of participants was 108 whose average age was 23.9. About 58% of the total participants were males while 81.7% were white. The participants engaged in vigorous-intensity exercise rather than on moderate-intensity exercise. Consequently, the participants were inversely associated with severe PTSD symptoms.

Relationship between physical activity and individuals’ wellbeing : Physical activity has an impact on the general wellbeing of individuals. The mental alertness of a person is enhanced by a short physical activity such as taking a 10 minutes’ walk (Mental Health Foundation, 2019). A person feels fresh and more energized to carry on with other activities after the exercise. Consequently, the general wellbeing of a person with PSTD is improved by physical activity thus enabling the person performs his or her daily duties easily.

The impact of physical activity on the self-esteem of a person with PSTD : Physical activity boosts the self-esteem of an individual. Self-esteem can be described as how individuals feel about themselves and how they perceive their self-worth. Self-esteem is a major indicator of the mental wellbeing of individuals and their ability to deal with various stressors in life. Physical activity tends to influence the self-esteem and self-worth of individuals positively. This effect of physical exercise is evident in all groups of people, including children, adolescents, adults and the older population. Additionally, it is evident in both males and females. Increase in self-esteem, in turn, lowers the level of stress and anxiety (Peluso & Andrade, 2005). Therefore, physical activity reduces the severity of PSTD symptoms. Additionally, exercises improving the quality of life of individuals suffering from PSTD.

The impact of physical activity on the mood of individuals : Studies show that physical activity has a positive effect on the mood of individuals. Upon evaluating the mood of individuals after a physical exercise, the researcher established that the participants were happy and more contented compared to when they are physically inactive. The impact of physical activity was greatest when the mood of individuals was initially low (Peluso & Andrade, 2005). Positive mood was achieved following a low-intensity aerobic exercise that lasted from 30 to 35 minutes and was done for 3 to 5 days in a week.

The impact of physical activity on stress: Physical activity harms the stress, which is one of the PSTD symptoms. Stress is a response of the body towards some life-threatening incidents. When persons are stressed they develop some physical symptoms that are uncomfortable thus making them behave differently. Additionally, individuals experience intense emotions during that time. In most case, stress is characterized by changes in the sleeping patterns, loss of appetite, sweating, and lack of pleasure in activities that a person used to enjoy. These symptoms are usually caused by stress hormones that are running in the body. This response is popularly known as ‘fight or flight’ response (Mental Health Foundation, 2019). During such incidents, the level of adrenaline and noradrenaline hormones in the body increase, which, in turn, raises the level of blood pressure. Additionally, the rate of heartbeats increases as well as the rate at which an individual perspire. These mechanisms prepare the body to respond to the emergency. Also, the rate of blood flow towards the skin can be reduced. Physical activities reduces the level of stress by allowing blood to flow faster in the body. Very active individuals have low rates of stress. This process, in turn, lowers the severity of symptoms of PSTD.

The connection between physical activity and mental health: Physical activity accrues benefits individuals’ overall mental health particularly those suffering from anxiety and depressive symptoms. According to Morgan (2009), engaging in physical activity enhances the quality of life of individuals suffering from non-psychiatric conditions such as fibromyalgia and peripheral arterial occlusive disorder. Additionally, physical activity plays a significant role in addressing diverse issues such as menopause and nicotine abstinence . Also, research shows that exercises help to improve the mood of individuals. According to Dua and Hargreaves (2012), a better mood is reported among individuals who do not have psychiatric symptoms and exercise regularly. Nonetheless, the impact of both medium and long physical activity has been inconsistent among normal individuals. On the contrary, the study shows that physical activity improves other aspects like vitality, self-esteem, the level of satisfaction with one’s physical appearance as well as the general well-being.  According to Kritz-Silverstein, Barrett-Connor and Corbeau (2011), engaging in physical activity regularly prevents individuals from being depressed. Being physically inactive increases the chances of being depressed. Aerobic exercises have been used to study the impact of regular physical activity on the mood of individuals. However, some anaerobic physical activity like flexibility training and bodybuilding lowers depressive symptoms. The study does not address the impact of aerobic and anaerobic exercise on anxiety symptoms. According to Rehor et al (2011), a single episode of aerobic physical activity tends to improve anxiety and depressive symptoms among individuals.

Recommendations for Physical Activity 

Researches indicate an inverse relationship between mental conditions, including PSTD and physical activity (Chambliss & Dishman, 2004). Also, physical activities minimize behavioural disturbances in individuals, which is a major symptom among people suffering from PSTD (Lyketsos, Lopez, & Jones, 2002). According to Taylor, Cable, and Faulkner (2004), physical exercises minimize depressive symptoms. Also, individuals should engage in aerobic exercise since they reduce the level of depression and mental stress. Additionally, physical activities enhance the transportation of blood in the body. It also lowers the level of cholesterol in the blood by raising blood lipoproteins with high density and reducing the level of low-density blood lipoproteins. Additionally, physical exercise triggers resistance training in the body thus accruing other health benefits. Physical exercise and psychotherapy give the same positive effect among individuals with depressive symptoms. Psychological change is also associated with physical activities. However, the researchers have not defined the level of physical activity required by an individual to make changes in mental health symptoms. On the contrary, the American Heart Association (AHA) and the American College of Sports Medicine (ACSM) have defined the recommended level of physical activity for individuals aged from 18 to 24 years. According to these organizations, a person in this age bracket is supposed to engage in moderate-intensity physical activity for 30 minutes in five days every week (ACSM, 2008). The American College of Sports Medicine (2008) states that people should engage in moderate physical activity for at least 150 minutes a week. A person can meet this requirement by engaging in moderate physical exercise for a minimum of 30 minutes in five days every week. However, people aged between 18 and 24 years are not meeting the set recommendations. According to the American

College Health Association (ACHA) (2005) only 44.2% of the total number of people in this bracket who meet the set guidelines.

Research Gap 

Although research has been done on the impact of physical activity on the severity of PTD symptoms, the study needs to be conducted on mental health issue associated with these activities. First, the future researcher needs to focus on health issues, which are associated with excessive exercise. Some individuals end up becoming obsessed with physical activities thus becoming preoccupied with exercise. Consequently, they end up training excessively even when medical instructions direct them otherwise. This excessive training ends up interfering with both occupational and personal relationships of individuals. Additionally, some individuals who engage in excessive exercises tend to portray the symptoms of an eating disorder. Besides, the researchers need to focus on muscle dysmorphia, which is a condition associated with excess physical activity. This condition leads to the alterations of the body structure, especially among the bodybuilders and weightlifters. Individuals tend to believe that they are skin and weak even if they have large and muscular bodies. Another issue that researchers need to focus on is how physical exercise triggers individuals to use anabolic-androgenic steroids. People engaging in physical activities tend to use anabolic-androgenic steroids exclusively. Consequently, physical activities impair mental health of individuals. Also, people using these substances portray a high level of irritability and aggressiveness. Finally, researchers should focus on how intense physical activity leads to mood disturbances. Despite improving mood, physical activities are also associated with mood disturbances. A person’s mood is not improved after engaging in intense physical exercise in a single session but rather after doing the exercises repeatedly. Therefore, the mood of a person is likely to worsen than before exercise following a single incident of physical exercise. Also, the mood of a person is likely to worsen following moderate-intensity physical activity.

Conclusion 

In summary, physical activity plays a significant role in reducing the severity of PSTD symptoms. People who engage in moderate to intense physical exercises regularly are less likely to suffer from PSTD. Additionally, those who are suffering from PSTD and exercise regularly tend to experience mild symptoms. In particular, physical activity reduces the three major types of symptoms that are experienced by people with PSTD. These symptoms include intrusion symptoms, avoidance symptoms, as well as arousal and reactivity symptoms. Previous studies done on the topic indicate that physical activities improve the mental health conditions that are non-psychiatric, including PSTD. Theories on the impact of exercise on mental health indicate the effect of physical activity in preventing and treating mental conditions. First, the Theory of Planned Behavior states that the behaviours of a person in activities that are related to health depend on the willingness to participate in the activity. Secondly, the theory of the Transtheoretical Model (TM) discusses how behaviour change is determined by the level of physical activity that a person engages in. Thirdly, the Health Belief Model acts as a guide for disease prevention programs and health promotion. It indicates the changes that are likely to occur in the health behaviors of an individual. On the empirical study, research indicates that physical activity influences the health of individuals in various aspects. First, physical activities reduce the severity of PSTD symptoms. Individuals engaging in intense physical activities are not likely to experience PSTD even after being exposed to traumatic incidents. Additionally, those that experience PSTD and engage in intense physical activity only have mild symptoms. Additionally, physical activities improve the overall mental health of individuals. First, it improves the wellbeing of a person. Also, physical exercises are known to improve the level of the mood of a person. However, the mood is boosted following various sessions of exercise rather than after a single incident. Nonetheless, a gap exists in this field of study even if scholars have studied the impact of physical activity on mental disorders in particular PSTD. In particular, researchers need to focus on the negative effect of physical activities on the health of individuals. Excessive exercise tends to interfere with both the personal and professional lives of a person. Additionally, most people who engage in intense physical exercises tend to misuse drugs especially steroids.

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