Abstract
Posttraumatic stress disorder (PTSD) is associated with heightened emotional responding, avoidance of trauma related stimuli, and physical health concerns (e.g., metabolic syndrome, type 2 diabetes, cardiovascular disease). Existing treatments such as exposure-based therapies (e.g., prolonged exposure) aim to reduce anxiety symptoms triggered by trauma reminders, and are hypothesized to work via mechanisms of extinction learning. However, these conventional gold standard psychotherapies do not address physical health concerns frequently presented in PTSD. In addition to widely documented physical and mental health benefits of exercise, emerging preclinical and clinical evidence supports the hypothesis that precisely timed administration of aerobic exercise can enhance the consolidation and subsequent recall of fear extinction learning. These findings suggest that aerobic exercise may be a promising adjunctive strategy for simultaneously improving physical health while enhancing the effects of exposure therapies, which is desirable given the suboptimal efficacy and remission rates. Accordingly, this review 1) encompasses an overview of preclinical and clinical exercise and fear conditioning studies which form the basis for this claim; 2) discusses several plausible mechanisms for enhanced consolidation of fear extinction memories following exercise, and 3) provides suggestions for future research that could advance the understanding of the potential importance of incorporating exercise into the treatment of PTSD.
Keywords: Behavioral tagging, Brain derived neurotrophic factor, Endocannabinoid system, Exposure therapy, Fear extinction, Pattern separation
Copyright © 2023 Elsevier Ltd. All rights reserved.
Conflict of interest statement
Conflict of interest Dr. Nemeroff has received research support from the National Institutes of Health (NIH); he has served as a consultant for AbbVie, ANeuroTech (division of Anima BV), Signant Health, Magstim, Navitor Pharmaceuticals, Intra-Cellular Therapies, EMA Wellness, Acadia Pharmaceuticals, Sage, BioXcel Therapeutics, Silo Pharma, XW Pharma, Neuritek, Engrail Therapeutics, Corcept Therapeutics Pharmaceuticals Company, SK Life Science, Alfasigma, Pasithea Therapeutic, EcoR1, GoodCap Pharmaceuticals, Senseye, Clexio, Ninnion Therapeutics; he has served on scientific advisory boards for ANeuroTech (division of Anima BV), the Brain and Behavior Research Foundation (BBRF), Anxiety and Depression Association of America (ADAA), Skyland Trail, Signant Health, Laureate Institute for Brain Research (LIBR), Magnolia CNS, Heading Health, TRUUST Neuroimaging, Pasithea Therapeutic, Sage; he is a stockholder in Xhale, Seattle Genetics, Antares, BI Gen Holdings, Corcept Therapeutics Pharmaceuticals Company, EMA Wellness, TRUUST Neuroimaging, Naki Health; he serves on the board of directors for Gratitude America, ADAA, Xhale Smart, Lucy Scientific Discovery; and he holds patents on a method and devices for transdermal delivery of lithium (patent 6,375,990B1) and a method of assessing antidepressant drug therapy via transport inhibition of monoamine neurotransmitters by ex vivo assay (patent 7,148,027B2). All other authors have received research support from NIH but have no other interests to disclose.
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