Sample Psychology Paper on Critical Review on the Impact of Engagement in Exercise on Sleep Quality among Veterans with Posttraumatic Stress Disorder Symptoms

Critical Review on the Impact of Engagement in Exercise on Sleep Quality among Veterans with Posttraumatic Stress Disorder Symptoms


Exercise improves physical health and has been found to lower the severe symptoms of psychological health. Various studies on the impact of regular exercise on sleep quality have produced positive results. This research intended to examine how exercise impacts sleep quality among veterans suffering from Posttraumatic Stress Disorder (PTSD). This is because most veterans with PTSD prominently report sleep disturbance and nightmares. The one year-long research involved 76 veterans who served in Operation New Dawn, Operation Enduring Freedom, and Operation Iraqi Freedom. The predictors measured were engagement in exercise, PTSD symptoms. Regression analysis of the data revealed that engagement in exercise was linked to better sleep quality while controlling for baseline PTSD symptoms, demographic factors, alcohol use, and baseline sleep quality. The results implicate that exercise can be administered as adjunctive therapy for patients with PTSD. These findings are in line with the current literature that posits that exercise has a beneficial outcome on sleep quality (Bosch et al., 2017). Since the research involved veterans outside the U.S., the results are generalizable. However, the research methodology suffers various limitations.

Exercise has been determined as a valuable factor in improving physical health. Similarly, exercise has been found to lower the severity of the symptoms of psychological health. The authors note that recent studies involving U.S. service members have indicated promising results regarding the impact of exercise on PTSD symptoms (Bosch et al, 2017). They cite a study that revealed that incorporating exercise in treatment improved PTSD symptoms. Sleep disturbance and nightmares are among the highly reported symptoms among veterans with PTSD. The authors note that these symptoms often persist even after the patient completes evidence-based psychotherapies. Sleep restriction, as indicated by several surveys, have negative outcomes on health including hypertension and increased inflammation (Bosch et al., 2017). It also increases an individual’s risk to chronic health conditions like diabetes and cardiovascular disease. Additionally, prolonged sleep restriction can result to poor mental health issues like cognitive impairment and depression. The literature behind these findings establishes that exercise induces physiological changes like the release of endorphins, which improves mood. Physiological changes can also break down tissues and deplete energy, improving sleep quality. However, the authors point out that PTSD patients skip exercise engagement to avoid arousal symptoms like increased heart beat that can cause habituation. This denies them the opportunity to enjoy mental and physical health benefits. While various studies have positively indicated the potential of exercise as an adjunctive treatment of PTSD, there is limited research on how exercise influences PTSD symptoms among veterans. The authors cite a research that indicated a positive impact of exercise on veterans with PTSD symptoms particularly hyper arousal at baseline. To extend this research, the authors sought to examine the impact of exercise on veterans with PTSD symptoms at baseline and at one-year follow-up (Bosch et al., 2017).

The research involved 184 OEF/OIF/OND veterans with PTSD symptoms. Data was gathered at baseline and after one year upon the completion of the baseline survey. Participants were initially screened via telephone to determine if they qualified for the study, consistent with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition – DSM-IV (Bosch et al., 2017). They were administered the Posttraumatic Stress Checklist – Military to determine whether they qualified for the DSM-IV criteria for PTSD. After the screening, only 94 individuals qualified for the study. The eligible individuals were sent questionnaires via mail. The researchers measured demographic factors including ethnicity, gender, education, age, and marital status at baseline. Alcohol use was also determined using the Michigan Alcohol Screening Test (MAST). PTSD symptoms, alcohol use, sleep quality, and engagement in exercise were correlated at baseline and at one-year follow-up (Bosch et al., 2017). One regression analysis was conducted to examine the effect of exercise on sleep quality at a year follow up and the other examined the effect at baseline and in a year follow-up.

The participants constituted 82% male, 58% Caucasian/White, 43% with a college degree, and 54% who served in the army (Bosch et al., 2017). The results indicated that participants who exercised reported lower PTSD symptoms at baseline. However, the regression analysis at one year follow-up did not yield any significant results. Participants who showed severe symptoms at baseline also reported low sleep quality at one-year follow-up (Bosch et al., 2017). The veterans who indicated poorer sleep quality also reported greater use of alcohol at baseline. Multiple regression analyses linked exercise engagement at baseline to improved sleep quality while multiple regression analyses of the association between exercise engagement at baseline and PTSD symptoms at one year follow-up yielded no significant results (Bosch et al., 2017).

The results were consistent with the existing literature that establishes that exercise can have positive outcomes on sleep quality. Sleep disturbance was identified among major symptoms of PTSD that influences severity of the disorder and thus, future PTSD treatment should focus on sleep disturbance. Another significant data indicates that symptoms of PTSD can persist even after the therapy. With the positive findings, exercise can be used as an adjunctive treatment for PTSD patients, particularly those with severe sleep disturbances. The researchers employed a superior assessment and identification of PTSD patients and symptoms through validated tools and criteria. The eligibility of participants was assessed according to the Diagnostic and Statistical Manual of Mental disorders, 4th Edition (DSM-IV) criteria. DSM-IV is a tool used in the diagnosis of psychiatric illnesses. It was extensively developed by highly experienced mental health professionals and organizations including the World Health Organization (WHO) and the American Psychiatric Association (APA) (Bell, 1994). Also, the telephone screening of participants included the administration of the Posttraumatic Stress Checklist- Military (PCL-M). PCL-M is a tool that assesses self-reports on the symptoms of PTSD among the military. PCL-M is used to monitor PTSD symptom change during treatment and after, screening individuals to check for PTSD symptoms, and providing PTSD diagnosis (U.S. Department of Veterans Affair, 2017).

Since the study involved non-U.S. veterans, it is pivotal in establishing the cross-culture generalization, putting into account that extensive research on PTSD has involved U.S. service men. The existing literature establishes that culture-specific perspectives influence the interpretation and response to PTSD symptoms and severity (Trepasso-Grullon, 2012). Cultural experiences, beliefs, and values impact an individual’s coping mechanism, likelihood of seeking and completing treatment for PTSD, and response manner on self-report tools. Trepasso-Grullon establishes that members from minority communities are less likely to seek and complete PTSD treatment compared to their Caucasian counterparts (2012). Similarly, Hispanic adults, compared to Caucasian and African-American adults, are more likely to delay to seek mental health services due to fear of stigmatization. Understanding the expression of and response to PTSD symptoms across ethnic groups has salient clinical implications. The knowledge will help providers to deliver culturally competent treatments for alleviating PTSD symptoms. A study by Marshall, et al. (2009) revealed that Hispanics report greater PTSD symptoms severity compared to non-Hispanic Caucasians. Additionally, the study found out that Hispanics experienced different symptoms from the ordinary posttraumatic distress. With this knowledge, the results produced by Bosch et al., (2017) are generalizable.

The study however had methodological limitations. Due to the small sample size and limited variability in symptoms, there was no notable association between engagement in exercise and PTSD symptoms at baseline and at one-year follow-up. Furthermore, the research only assessed symptoms a year later yet improvement in PTSD symptoms may take longer than one year to manifest. Consequently, the results concerning the impact of exercise on PTSD symptoms among veterans are unclear. The study also employed self-report methodology, which can be inaccurate.


The research aimed at examining the impact of exercise on PTSD symptoms among veterans. The researchers found out that engagement in exercise has positive outcomes on PTSD symptoms. This study used validated tools and criteria to assess and identify PTSD symptoms among participants. The tools included the DSM-IV and PCL-M, which make the study reliable. The study also involved veterans outside the U.S., therefore, enhancing cross-sectional generalizability of results since different ethnic groups experience and respond to PTSD distinctively. However, the study has methodological limitations including self-report technique, which can be inaccurate. Additionally, effects of exercise on sleep quality can take longer than a year to show, indicating that the results gathered were unclear. Nonetheless, the findings have significant clinical implications in the use of exercise as adjunctive treatment for PTSD symptoms.


Bosch, J., Weaver, T.L., Neylan, T.C., Herbst, E. & McCaslin, S.E. (2017, Sep 8). Impact of Exercise on Sleep Quality among Veterans with PTSD Symptoms. Military Medicine, 4. (Source provided by client).

NB: The additional assignment are for the evaluation section which required evidence.

Bell, C.C. (1994, Sep 14). DSM-IV: Diagnostic and Statistical Manual of Mental Disorders. JAMA, 272(10), 828-29. doi:10.1001/jama.1994.03520100096046

Marshall, G.N., Schell, T.L. & Miles, J.N.V. (2009, Dec). Ethnic Differences in Posttraumatic Distress: Hispanics’ Symptoms Differ in Kind and Degree. J Consult Clin Psychol, 77(6), 1169-78. doi:  10.1037/a0017721

Trepasso-Grullon, C. (2012). Differences among Ethnic Groups in Trauma Type and PTSD Symptom Severity. Graduate Student Journal of Psychology, 14. Retrieved from

U.S. Department of Veterans Affairs. (2017, May 11). PTSD Checklist for DSM-5 (PCL-5). PTSD: National Center for PTSD. Retrieved from