What is a safe approach to a trauma workout for individuals with a history of trauma and potential post-traumatic stress disorder (PTSD)?

From the Guidelines

A safe approach to trauma workouts for individuals with trauma history or PTSD should begin with professional guidance from a mental health provider and trauma-informed fitness instructor. This approach is crucial as it ensures that the individual receives personalized guidance and support, taking into account their specific needs and boundaries. According to the guidelines developed through a Delphi process 1, it is essential to provide general support and access to social, physical, and psychological support, with specific mental health interventions only provided if indicated by a comprehensive assessment.

When designing a trauma workout, it is vital to start with gentle, grounding exercises like walking, swimming, or yoga, rather than high-intensity workouts that might trigger the sympathetic nervous system. Establishing clear boundaries by creating a predictable routine, offering choices throughout the session, and identifying safe spaces within the workout environment can help individuals feel more in control and comfortable. Incorporating mindfulness techniques such as deep breathing, body scanning, and present-moment awareness can help maintain connection with physical sensations and promote emotional regulation.

The approach should progress gradually, with slowly increasing workout intensity and duration, while consistently checking in about comfort levels. Including specific cool-down activities focused on regulation, like 5-10 minutes of gentle stretching and 2-3 minutes of diaphragmatic breathing, can help individuals transition out of the workout state and reduce the risk of triggering a traumatic response. This approach is supported by the principles of trauma-focused cognitive-behavioral therapy (CBT) 1 and eye movement desensitization and reprocessing (EMDR) 1, which aim to process disturbing memories and experiences in a safe and controlled environment.

Some key considerations when designing a trauma workout include:

• Starting with gentle, low-intensity exercises
• Establishing clear boundaries and a predictable routine
• Incorporating mindfulness techniques and emotional regulation strategies
• Progressing gradually and checking in about comfort levels
• Including specific cool-down activities focused on regulation

By prioritizing a safe and supportive approach, individuals with trauma history or PTSD can engage in physical activity that promotes both physical health and emotional healing, while minimizing the risk of triggering a traumatic response.

From the Research

Safe Approach to Trauma Workout

When considering a trauma workout for individuals with a history of trauma and potential post-traumatic stress disorder (PTSD), it is essential to prioritize a safe and gentle approach.

• The current evidence base does not provide specific guidance on trauma workouts for individuals with PTSD 2, 3, 4, 5.
• However, research suggests that physical activity can improve quality of life and well-being in the general population and in individuals with psychiatric conditions, including PTSD 6.
• A systematic review of physical activity and quality of life found strong evidence that physical activity improves quality of life and well-being in adults aged 18-65 years and older adults 6.
• Moderate evidence indicated that physical activity improves quality of life and well-being in individuals with schizophrenia and Parkinson's disease, and limited evidence suggested that physical activity improves quality of life and well-being for youth and for adults with major clinical depression or bipolar disorder 6.

Considerations for Trauma Workout

When designing a trauma workout, consider the following:

• Start with gentle and low-intensity exercises to avoid triggering or exacerbating PTSD symptoms.
• Incorporate mindfulness and relaxation techniques to promote relaxation and reduce stress.
• Provide a safe and supportive environment for individuals to engage in physical activity.
• Consult with a healthcare professional or a certified fitness professional with experience in working with individuals with PTSD to develop a personalized exercise plan.

Pharmacological Interventions

While the primary focus is on trauma workouts, it is essential to acknowledge the role of pharmacological interventions in managing PTSD symptoms.

• Selective serotonin reuptake inhibitors (SSRIs) are commonly used as a first-line treatment for PTSD, and research suggests that they can improve PTSD symptoms 2, 3, 4.
• Other medications, such as noradrenergic and specific serotonergic antidepressants (NaSSAs) and tricyclic antidepressants (TCAs), may also be effective in reducing PTSD symptoms 4.