Posttraumatic stress disorder (PTSD) is prevalent among military Veterans and is more than just a psychological condition; PTSD has profound negative impacts on health, function, and quality of life. Older Veterans are the largest patient population served by the Veterans Health Administration (VHA), and many have lived with PTSD for 40+ years. Veterans with PTSD engage in low levels of physical activity and spend much of their time in sedentary activities, adding to their risk of physical disability. The benefits of exercise on mental health and physical well-being in older adults are well-substantiated, but the effects of exercise training on late-life PTSD symptoms is a new area of study. This study is designed to examine the effects of 6 months of supervised exercise training on PTSD symptoms and PTSD-related conditions (e.g., functional impairment, sleep) in 188 older Veterans with PTSD.

Inclusion Criteria:

• Veteran status
• registered for care at Durham VA Health Care System (VAHCS)
• live within 50 miles of fitness facility
• meet diagnostic criteria for PTSD as assessed by the CAPS-5

Exclusion Criteria:

• history of any psychiatric disorder with severe psychotic features in the past 5 years (e.g., bipolar disorder, mania), as indicated by ICD-10 codes F20-F29 (ICD-9 category 298.9)

• prominent suicidal ideation or hospitalization for suicidality in the previous 6 months

• clinically significant: neurological disorder, systemic illness affecting central nervous system (CNS) function, or history of seizure disorder in the past 5 years

• uncontrolled diabetes defined as:

  • Abnormal fasting plasma glucose 126 mg/dL, random plasma glucose 200 mg/dL
  • no active medications for diabetes management (Metformin, insulin, etc.)
  • no clinical notes in the patient's electronic health record (EHR) indicating monitoring by primary care physician (PCP) or Endo for diabetes management)
  • end stage liver disease or currently receiving dialysis
  • physical disabilities precluding use of exercise equipment (assistive mobility devices acceptable)
  • significant cognitive impairment or diagnosis of Alzheimer's Disease or Dementia
  • hospitalization or ER visit in the past 6 months for conditions contraindicated for exercise (cardiac event; physical trauma)

All of the individual participant data collected during the trial, after de-identification, will be made available.

A limited dataset (LDS) will be created and shared pursuant to a Data Use Agreement (DUA) appropriately limiting use of the dataset and prohibiting the recipient from identifying or re-identifying (or taking steps to identify or re-identify) any individual whose data are included in the dataset. Only de-identified (stripped of 18 HIPAA) and anonymized datasets (void of any identifying code, study or otherwise) will be shared.

Data will be made available immediately following publication. No end date.

Requests for de-identified meta-data will be considered by the PI, under a data-sharing agreement that includes: 1) a commitment to using the data only for research purposes; 2) a commitment to securing data using appropriate digital technology; and 3) a commitment to destroying or returning the data after analyses are complete. Data access will be provided only to qualified researchers, with a methodologically sound proposal, fully consistent with the VA/NIH data sharing policies and applicable laws and regulations.

Enrollment until end of follow-up (6 months)

When participants disclosed suicidal ideation on the PHQ-9 survey, the research team conducted our risk-assessment protocol to determine appropriate steps for responding and supporting participants. Some participants reported physical health symptoms during research exercise session prompting in-depth assessment by research team and follow-up with care team as indicated.