James Whitworth traces the path to his military service in simple terms: \u201cI heard the call, and I answered,\u201d says the Boston University Chobanian & Avedisian School of Medicine assistant professor of psychiatry. It was just after the attacks on September 11, 2001, Whitworth recalls, and he enlisted in the Army \u201cto serve in the global war on terror.\u201d<\/p>\n
Whitworth<\/a>\u00a0<\/span>deployed to Iraq, part of Operation Enduring Freedom and Operation Iraqi Freedom, along with\u00a0<\/span>nearly two million<\/a>\u00a0<\/span>of his compatriots, all told. Just 21 years old and thrust into an unknown landscape with daily threats to his life, Whitworth says he exercised at his base to cope with the stressful situation.<\/p>\n It was certainly a DIY gym setup: rusty weights and heavy tires in a military tent.<\/p>\n \u201cAnything and everything just to stay fit,\u201d Whitworth says. \u201cIt was a source of de-stressing; a coping strategy to deal with the rigors of combat. And it just kind of stuck with me, it was like a kernel on the back of my head\u2014I always knew that exercise was a helpful tool for dealing with stress.\u201d<\/p>\n After Whitworth was honorably discharged, this kernel grew into full-fledged research questions for his graduate and then doctoral research. But that research took on new urgency when Whitworth\u2019s close friend, a \u201cbattle buddy,\u201d died by suicide, he says.<\/p>\n \u201cIt surprised a lot of us. And it really shook things up for me. I wanted to do something, anything,\u201d he says. So, Whitworth refocused his exploration from the human-performance side of exercise, to its potential protective qualities against mental illness, stress, and trauma\u2014particularly post-traumatic stress disorder, or PTSD.<\/p>\n Mark Logue<\/a>\u00a0<\/span>was a sophomore at the University of Oregon, preparing for his final exams, when he received his call to service\u2014quite literally.<\/p>\n \u201cThe phone rang, and they told me to pack my bags,\u201d he recalls. \u201c\u2018Your unit has been activated and you\u2019re going to Operation Desert Storm,\u2019\u201d an official told him.<\/p>\n As a young person in the late 1980s, Logue registered for the US Army Reserve as a way to cover the cost of college and gain some worthwhile experience at basic training. It seemed like a fairly good deal: the reserves hadn\u2019t been activated in nearly 20 years, since the Vietnam War. That changed in 1990, however, when reservists were ordered to active duty to serve in the Gulf War.<\/p>\n Logue, who worked in the reserves as a medical supply specialist, was sent to Stuttgart, Germany, to help expand a medical facility for combat soldiers wounded in the Gulf. Luckily, he says, the large-scale casualties his unit prepared for never materialized and, soon enough, Logue returned home, where his studies resumed. He remained in the US Army Reserve until 1997, when he was honorably discharged.<\/p>\n Trained as a mathematician and statistician, Logue charted a course for a career in genetics during his doctoral program. He found he could apply his mathematical and programming skills to address real health problems, a deeply gratifying experience.<\/p>\n Logue, currently an associate professor of psychiatry and biomedical genetics at BU\u2019s medical school and of biostatistics at the University\u2019s School of Public Health, was working on genetic studies of anxiety disorders and dementia when he was approached by Mark W. Miller, a researcher in the US Department of Veterans Affairs\u2019 National Center for PTSD. Miller, a\u00a0<\/span>professor of psychiatry<\/a>\u00a0<\/span>at BU\u2019s medical school, had asked for Logue\u2019s help in analyzing a set of genetic data from veterans.<\/p>\n He agreed. \u201cI am a veteran and I\u2019m always up for finding out new and interesting things,\u201d Logue says.<\/p>\n Now, Logue and Whitworth both also work at the VA Medical Center in Boston\u2019s Jamaica Plain neighborhood. They\u2019re each seeking answers about PTSD by asking vastly different questions.<\/p>\n Stress responses to traumatic situations are completely normal\u2014a person\u2019s natural flight, fight, or freeze response helps them respond to danger appropriately. For some, however, particularly combat veterans or people who\u2019ve experienced physical or sexual assault, these natural physiological responses linger long after the danger is gone. This is PTSD.<\/p>\n Post-traumatic stress disorder is a condition that \u201cimpairs your functioning globally,\u201d Whitworth says. People with PTSD\u00a0<\/span>may experience<\/a>\u00a0<\/span>flashbacks or distressing thoughts, avoid people or places that remind them of the traumatic event, experience physical sensations like a higher heart rate or sweating, can have trouble sleeping, and more. It\u2019s an embodied experience.<\/p>\n \u201cThis is not just a disorder that makes you sad, depressed, anxious. It impacts your behaviors, your ability to participate in your role in society,\u201d Whitworth says. \u201cAnd this translates to avoidance and isolation. And so people wind up staying away from a lot of the activities they used to enjoy; maybe they don\u2019t feel safe going to a gym or a park.\u201d<\/p>\n People with PTSD may also avoid exercise because the physiological sensations\u2014elevated heart rate, breathing heavily, sweating\u2014feel similar to a stress response, and they fear it will trigger a panic attack, or worse, Whitworth says.<\/p>\n But his research indicates that this avoidance is often\u00a0<\/span>the exact opposite<\/a>\u00a0<\/span>of what will ultimately help.<\/p>\n In\u00a0<\/span>a widely cited 2019 trial<\/a>, Whitworth and his colleagues found evidence that resistance training (such as weight lifting) could have significant beneficial impacts on sleep quality and anxiety for people with PTSD. In subsequent studies, he\u2019s found that improved cardiorespiratory fitness in post-9\/11 veterans was\u00a0<\/span>associated with lower PTSD severity<\/a>, and that as little as three weeks of high-intensity resistance exercise is a\u00a0<\/span>feasible intervention for symptoms<\/a>\u00a0<\/span>in people with PTSD who aren\u2019t otherwise seeking treatment for it.<\/p>\n \u201cWhen we get people who have PTSD exercising, they feel better, there\u2019s an impact and it reduces symptoms,\u201d he says. \u201cIs it a cure? A panacea? Absolutely not. But it is a coping strategy. It\u2019s something that might be useful in augmenting other evidence-based practices, such as psychotherapy or medications.\u201d<\/p>\n Whitworth and other physiologists and psychologists are still working to understand why exercise seems to be an effective therapeutic tool, but he says one potential factor could be the same one that makes people avoid exercise: it simulates a stress response\u2014but in a safe and controlled environment. This kind of repeated exposure to those unpleasant sensations may work to normalize them, Whitworth reasons.<\/p>\n Another possible explanation is that exercise, and strength training in particular, builds senses of confidence, self-efficacy, and empowerment, Whitworth says. \u201cOnce you complete a challenging workout, or complete a heavy lift, you might think, \u2018Well, I mastered this\u2019 or \u2018This one wasn\u2019t so bad, maybe I can take on [a lift] that\u2019s a little bigger.\u2019 And that may augment your response to other similar or related stressors.\u201d<\/p>\n Finally, Whitworth is interested in exploring the physiological adaptation that accompanies exercise. Perhaps a more efficient endocrine system\u2014one of many side effects of going from \u201can untrained state to a trained state,\u201d Whitworth says\u2014helps people metabolize stress better.<\/p>\n While Whitworth is interested in gym reps and sets, Logue deals in datasets: huge swaths of genetic data that might hold clues to the deep-rooted foundations of PTSD. He runs computational tests on millions of genetic variants across hundreds or thousands of genomes to find the variants that are statistically associated with a specific disease.<\/p>\n Once Logue identifies those statistically likely variants, other clinical researchers can use that information to identify better, more targeted strategies for the care and treatment of a particular disease.<\/p>\n It\u2019s a technique that\u2019s resulted in a number of important discoveries. Researchers have discovered\u00a0<\/span>genetic variations that contribute<\/a>\u00a0<\/span>to the risk of developing type 2 diabetes, Alzheimer\u2019s disease, heart disorders, obesity, Crohn\u2019s disease, and prostate cancer.<\/p>\n Logue is part of a consortium of researchers pooling their datasets to search for clusters of genetic variants\u2014small abnormalities in the DNA sequences that make up a gene\u2014that are consistently present among people with PTSD.<\/p>\n Roughly a decade ago, Logue and his colleagues at the National Center for PTSD published the first ever genome-wide association study of PTSD; Logue was the lead author on its results,\u00a0<\/span>published in\u00a0<\/span>Molecular Psychiatry<\/em><\/a>, an offshoot of\u00a0<\/span>Nature<\/em>. They found a variant in a gene\u2014the retinoid-related orphan receptor alpha, or RORa\u2014that was associated with PTSD. Logue has copublished other papers since then, examining a possible connection between people with PTSD and the\u00a0<\/span>sizes of their hippocampus and amygdala<\/a>, for example.<\/p>\n The genetic differences Logue and other researchers identified may not immediately lead to a cure, but they are an important starting point for clinicians\u2014and could serve as markers on a genetic risk assessment for PTSD, Logue suggests.<\/p>\n For Logue and Whitworth, this work lives beyond the papers and the publications. It\u2019s more like a calling, and one that could have a real impact for their fellow veterans and service members.<\/p>\n \u201cIt\u2019s a personal connection,\u201d Whitworth says. His work, which, like any, can be tedious at times, is made more profound because of that connection. \u201cWhat gets me up in the morning for this sort of research, it\u2019s not looking at the statistics and seeing significant p-values. It\u2019s getting to talk to other veterans and knowing that the research that I\u2019m doing is for them.\u201d<\/p>\n That connection is true for many people who work at the VA, Whitworth says: \u201cThere\u2019s this intrinsic desire to serve those who have served. And that\u2019s powerful.\u201d<\/p>\n It\u2019s certainly true for Logue.<\/p>\n \u201cWorking at the VA spurs me on,\u201d Logue says. \u201cTo get to my office [at the VA], I walk through the lobby with patients and ride with them in the elevator\u2014these are veterans getting their care there. And then I go upstairs and analyze veteran data, and I\u2019m hoping that the things we do actually help veterans and can lead to treatments; maybe not today, maybe not next week, but eventually.\u201d<\/p>\n <\/p>\nWhat Is PTSD?<\/h3>\n
How Can Exercise Help with PTSD Symptoms?<\/h3>\n
Is There a Genetic Component to PTSD?<\/h3>\n
Honorably Discharged, but Still Serving<\/h3>\n