A few years ago, while training a client at the gym, there was a loud crash in the weight room, followed by one of the gym members angrily yelling and swearing at the member who dropped the barbell full of weight plates. Turns out, she was a combat veteran with post-traumatic stress disorder (PTSD) and the loud crash was a trauma trigger for her.
What Is PTSD?
According to the American Psychological Association (APA), PTSD can develop after someone experiences a traumatic event, including combat, an accident, a terrorist attack, a natural disaster or a crime (including sexual crimes). People with PTSD may experience flashbacks or nightmares, which may be recurrent, and might also avoid activities or places that remind them of the event; they also tend to experience emotional “numbing.” PTSD may put one’s nervous system on high alert (hyperarousal), always ready to fight or flee, making them more easily startled and creating difficulty with sleep and concentration. Someone with PTSD may also experience guilt for surviving the trauma when others did not.
While PTSD has been around for ages, it’s only been recognized as an official diagnosis since 1980. According to a 2018 review in Military Medical Research, in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, Edition 5 (DSM-5), PTSD is classified into 20 symptoms with four clusters: intrusion, active avoidance, negative alterations in cognitions and mood, and marked alterations in arousal and reactivity.
People with PTSD tend to avoid traditional therapy, not wanting to have to relive the experience with a therapist, according to Robert Motta in the book Psychology of Health. Motta also describes how PTSD tends to change the person on every level, involving an alteration of one’s sense of self, as well as one’s view of their environment.
Exercise and PTSD
Because those with PTSD tend to avoid traditional treatment, it’s important to find evidence-based alternative treatments that are safe and effective that can help move them toward healing. There have been hundreds of studies done that show the benefits of exercise on anxiety and depression. Because anxiety and depression are both a part of PTSD, it would seem logical that exercise may also help ease the symptoms of PTSD.
Turns out, there does seem to be a connection.
Motta cites several studies in support of exercise for PTSD, particularly aerobic exercise, in a chapter in Psychology of Health entitled, “The Role of Exercise in Reducing PTSD and Negative Emotional States.” One such study was a 2017 longitudinal study published in General Hospital Psychiatry that suggests strenuous exercise has a beneficial effect on PTSD symptoms, including avoidance/numbing and hyperarousal, and that total exercise had positive benefits on avoidance/numbing.
In a 2019 review in Frontiers in Psychiatry, researchers reviewed 19 studies examining aerobic exercise and PTSD symptomatology and found that the evidence so far supports aerobic exercise as a stand-alone intervention or an adjunct to standard treatment for PTSD.
But what about other forms of exercise?
One 2022 review in Military Medicine found that out of the studies they reviewed, there was no significant differences seen among various types of exercise in terms of their effects on PTSD symptoms. In other words, whether it was yoga, high-intensity or low-intensity activity, or group or individual activity, they all seemed to have a beneficial influence on PTSD symptoms.
As a health and exercise professional, you may be able to play a special role in the healing process of clients with PTSD. Post-traumatic growth (PTG) refers to the positive psychological change that can occur following a traumatic event(s), per a 2016 review in the Journal of Traumatic Stress.
An example of PTG would be parents who lose a child and instead of allowing the grief to swallow them up for the rest of their lives, they start an organization to help other families going through similar situations. It’s taking your pain and using it for good–including your own personal growth.
PTG also includes mindful resilience, which, according to Jason Linder, PsyD, in a Psychology Today article, includes present-focus, flexibility, tolerating uncertainty and self-knowledge/self-control.
Guidelines for Helping Clients with PTSD
As a health and fitness professional, there are some guidelines that will help you help them get the most from your sessions together if a client is experiencing PTSD; however, it’s important to always stay inside your scope of practice.
Christian Koshaba–a US Air Force veteran, ACE Certified Personal Trainer and owner of veteran-focused gym Three60fit–says its best to avoid classifying a person with PTSD as a victim. “Do not bring the attitude of ‘feeling sorry’ for the individual,” says Koshaba. “They want to be treated with respect, not as a charity case.”
In addition, Koshaba recommends the following:
Create an environment conducive to the veteran’s emotional and mental state. “Some veterans crave the camaraderie and group atmosphere, whereas some veterans who may be potentially triggered by loud noises and groups need a more intimate quiet experience,” says Koshaba.
Research more about PTSD and learn about potential triggers. “Build a rapport with the individual and try not to be too invasive with their military experience. Some veterans desire to open up and speak about their trauma, whereas others may not be inclined to speak about it,” says Koshaba.
Find common ground. “What stories and experiences can you share to make them feel welcome and allow them to trust you and see that you can empathize with them?” asks Koshaba. The Wounded Warrior Project adds a word of caution regarding how you empathize with your client: Avoid saying things like “I know how that feels…” or “That’s just like when I…” Everyone’s feelings and experiences are unique, so avoid comparing your own experiences to theirs.
Initially avoid vigorous activity. “Learn the veteran’s physical limits. Inducing too much of an increased heart rate can mimic the fight or flight response and send the individual into a trauma-related experience or memory,” advises Koshaba.
Another tip that some have found helpful when teaching classes to those with PTSD is to lock the door to the studio before class starts. Depending on the cause of the PTSD, this can create an environment that feels safe. It’s important to let clients know that this is a practice of yours in an effort to encourage them to be there on time.
Working with veterans and others with PTSD can be a fulfilling and rewarding experience. Research more about the condition and learn as much as you can before announcing that you work with those with PTSD. Volunteering at local veteran-related organizations can be a great way to gain more knowledge, meet veterans in your community and build rapport before offering your services to them.
US Department of Veterans Affairs