4 - (SYM 65) Improving Sleep in Older Veterans with PTSD: Preliminary Evidence for Exercise-based Interventions

Individuals with posttraumatic stress disorder (PTSD) experience sleep-related challenges (e.g., insomnia, nightmares) at high rates. These sleep difficulties, which often do not resolve with PTSD treatment alone, negatively affect the quality of life and functioning of this population. Older adults with PTSD may be especially at risk for sleep disturbances given the chronic experience of PTSD symptoms as well as age-related changes in sleep. Exercise is a promising intervention to improve sleep among older adults with PTSD, but there have been no published trials on the effect of exercise on sleep in this population.

This study evaluated the role of exercise on sleep in older adults with PTSD that participated in a 12-week pilot randomized trial. Fifty-four older U.S. military Veterans (mean age = 67 years old, 91% male, 85% Black or African American) were randomized 2:1 to supervised exercise (EX; n=36) or waitlist usual care (WL; n=18). Participants randomized to EX received an individualized exercise prescription and were supervised three times/week at a community fitness facility. Participants randomized to WL were able to enroll in the exercise program at the completion of 12 weeks. At baseline and 12 weeks, participants completed self-report measures of sleep quality, including the Pittsburgh Sleep Quality Index (PSQI) and the PSQI addendum for PTSD, which is focused on the impact of nightmares and intrusive memories. Given the pilot nature of study, data were analyzed descriptively focused on evaluating the strength of Cohen’s d effect sizes (ES; small = .20, medium = .50, large = .80) comparing pre-post changes in PSQI scores between the EX and WL groups.

At baseline, 91% (n=49) of the sample had poor sleep quality (PSQI global score >5). Pre-post analyses indicated small-to-medium ES differences favoring EX for the PSQI Addendum for PTSD (d=.42) and PSQI subscales of Daytime Dysfunction (d=.23), Use of Sleep Medications (d=.22), Sleep Latency (d=.45), Sleep Efficiency (.25), and Sleep Disturbance (d=.51). The PSQI global score was previously published with the main study outcomes and showed a medium-to-large ES difference favoring EX (d=.61). ES differences for the remaining PSQI subscales (Sleep Duration and Sleep Quality) were minimal (d< .20). Overall, these findings provide preliminary evidence for the potential benefits of exercise training on sleep-related difficulties in older Veterans with PTSD. Future research should replicate these findings in a fully powered trial to establish efficacy.