Exercise and PTSD Symptoms in Emergency Service and Frontline Medical Workers: A Systematic Review

Context: Emergency service and medical frontline workers are exposed to significant occupational stressors that may confer an increased risk of poor mental health, including posttraumatic stress disorder (PTSD). Emerging evidence suggests that physical activity and its structured subset, exercise, may be effective in improving symptoms of PTSD in veterans; however, the potential efficacy for other populations at high risk of occupational trauma exposure is currently unclear. Given the potential of physical activity interventions to improve both PTSD symptoms and physical comorbidities, there has been increasing interest in the potential role in the treatment of PTSD. Objective: The purpose of this review was to investigate the associations between physical activity levels and PTSD symptoms in emergency service and frontline medical workers. Design: A systematic review was conducted by searching major electronic databases for relevant studies published from database inception until February 2021. Eligibility Criteria: Studies among traditional emergency service occupations, e.g., police officers, firefighters, paramedics, and medical frontline workers, including doctors and nurses, were included. Study Selection: Experimental and observational studies with or without control groups were eligible for inclusion. Main Outcome Measure: The primary outcome measure was symptoms of PTSD. Results: The search identified eight eligible studies (four experimental and four observational). Three of the experimental studies showed that exercise significantly reduced symptoms of PTSD in emergency service personnel, including police and nurses. Based on the results of results of three studies, physical activity may be inversely associated with PTSD symptom severity among nurses and firefighters. Conclusions: Existing research suggests that physical activity may improve symptoms of PTSD in emergency service personnel and frontline workers. Considering physical activity promotion initiatives for occupations at high risk of trauma exposure may therefore be warranted to promote mental health. The existing research has several methodological limitations, and findings should therefore be interpreted with caution until further robust studies are available.