Trauma-Informed Exercise as Adjunct Treatment for PTSD in Community Settings: A Systematic Review and Implementation Framework

Post-traumatic stress disorder is common, undertreated, and frequently accompanied by depression, poor sleep, and cardiometabolic risk, while first-line trauma-focused psychotherapies and medications leave many people untreated, non-adherent, or only partially recovered. Exercise is a biologically and behaviourally plausible adjunct because it can reduce PTSD symptom severity, improve comorbid mood and sleep, and target the physical-health burden that accompanies chronic hyperarousal, yet most trial evidence comes from clinics and hospitals rather than the gyms, recreation centres, and community classes where the public could actually train. This article synthesizes published systematic reviews, meta-analyses, and pivotal randomized trials of aerobic, resistance, yoga, multicomponent, and body- and movement-oriented interventions for adults with PTSD, and then specifies how that evidence should be translated into trauma-informed community delivery. Across reviews, exercise typically yields small-to-moderate reductions in PTSD symptoms, with additional benefits for depression and sleep; multicomponent programs often outperform single modalities, and a ۲۰۲۵ network meta-analysis of ۳۰ trials identified a non-linear dose–response peaking near ۷۳۰ MET-minutes per week, consistent with short, frequent, moderate-to-vigorous sessions. Key trials show that adding resistance training and walking to usual care can lower PTSD and depressive symptoms, and that ten minutes of aerobic exercise immediately after exposure therapy can improve long-term clinician-rated outcomes relative to stretching, although intensive trauma-focused packages are already highly effective and do not always gain further from added activity. Ordinary community fitness can re-trigger hyperarousal through noise, surprise touch, competition, and crowded space; trauma-informed physical activity therefore applies SAMHSA principles—safety, trustworthiness, peer support, collaboration, choice, and attention to cultural and gender issues—through invitational language, predictable structure, consent for contact, optional exits, and a strict scope of practice that keeps trauma processing off the gym floor. Community settings remain under-tested as causal sites of delivery, so efficacy should not be confused with implementation readiness. The CARE-TIE framework—Context, Autonomy and safety, Regulation of arousal, Evidence-based dose, Team and referral, Implementation and evaluation—is proposed as a public, auditable specification for adjunct programs that preserve clinical dose, name referral pathways, measure PCL-۵ and harm, and refuse to market unsupervised sport as stand-alone PTSD treatment.

کلیدواژه ها:

PTSD ، Trauma-Informed Care ، Exercise ، Community Settings ، Adjunct Treatment.