Combining a single session of prolonged exposure with physical activity in patients with PTSD: The effect of sequence

Adding physical activity may be a promising new strategy to augment the effectiveness of prolonged exposure (PE) therapy in post-traumatic stress disorder (PTSD). However, it is unknown whether it is more effective to provide the physical activities before or after PE for PTSD. Therefore, the current study examined the influence of the sequence in which physical activity and PE are applied, on the primary outcome measures of trauma-related distress and vividness. In this quasi-experimental study, a total of 93 patients with PTSD were allocated to two conditions: (1) PE followed by physical activity (N = 50) and (2) physical activity followed by PE (N = 43). The physical activity intervention consisted of a low to moderate intensive outside walk. The reduction in trauma-related distress and vividness from pre- to post-intervention was significantly stronger in the group that performed physical activity after a single PE session compared to the group performing physical activity prior to the PE session. However, the explorative results with regard to freezing symptoms and emotion regulation problems indicated that both sequence groups showed an equal decrease in symptoms over time. The current findings suggest that the sequence in which physical activity and PE sessions are performed, could matter. A stronger effect on distress and vividness was found when physical activity was added after, instead of before, one PE session. These results could further guide interventions for patients with PTSD by taking sequence into account when combining single physical activity and PE sessions in clinical practice.