Developing and Testing a Trauma-Informed Exercise Intervention for Women Veterans With Histories of Sexual Violence

Women Veterans (WVs) disproportionately experience sexual violence (SV) throughout their lifetime. These experiences of SV are often repeated, resulting in a lifelong pattern of SV victimization which can have profound negative impacts on physical, mental, and psychosocial functioning and quality of life. Current VHA policies highlight the need for integrative interventions which effectively address the diverse negative health sequelae associated with lifetime SV. Yet, there is currently a gap in treatment offerings that address broad psychiatric, physical, and psychosocial health impacts of SV. Exercise has been shown to improve trauma-related mental health conditions among survivors of SV and improve trauma-related multimorbidity among Veterans with a PTSD diagnosis. Yet, many barriers exist to exercise among WVs which contribute to low exercise engagement from this group. This Career Development Award (CDA-2) thus aims to develop and test a trauma-informed telehealth exercise intervention tailored for WVs with histories of SV. Treatment development will be guided by 1) previous interventions completed among Veterans with PTSD, 2) documented preferences among women with histories of SV, and 3) trauma-informed approaches and integration of stakeholder feedback. During phase one of this project, the investigators will conduct pre-implementation stakeholder interviews with WVs with histories of SV and related healthcare providers to provide guidance on the structure and content of the proposed intervention. This information will be used to create the program manual for the proposed intervention. During phase two of this project, WVs aged 21-65 with lifetime history of SV will be recruited to participate in an open trial consisting of a 12-week, online physical activity program including aerobic and strength training. Qualitative data will be collected in parallel with quantitative outcomes to assesses the primary feasibility and acceptability outcomes. Exploratory outcomes will include functional status. Candidate outcomes to be assessed include physical, mental, and psychosocial health outcomes. This pilot trail will extend the understanding for trauma-informed exercise approaches for WVs with histories of SV and of the feasibility, acceptability, and potential benefits of exercise for this group. Results will be used to develop a fully powered randomized controlled trial for WVs with histories of SV.

• Functional Status - The World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2) [Time frame: baseline, post-intervention (12 weeks), follow up (24 weeks)]
• Physical Function - arm curls [Time frame: baseline, post-intervention (12 weeks), follow up (24 weeks)]
• Physical Activity Level - Godin Leisure-Time Exercise Questionnaire (GLTEQ) [Time frame: baseline, post-intervention (12 weeks), follow up (24 weeks)]
• PTSD - PTSD Checklist-5 (PCL-5) for DSM-V [Time frame: baseline, post-intervention (12 weeks), follow up (24 weeks)]
• Anxiety - Depression Anxiety and Stress Scale (DASS 21) [Time frame: baseline, post-intervention (12 weeks), follow up (24 weeks)]
• Depression - Patient Health Questionnaire (PHQ-9) [Time frame: baseline, post-intervention (12 weeks), follow up (24 weeks)]
• Psychosocial function- The Brief Inventory of Psychosocial Functioning (IPF-Brief) [Time frame: baseline, post-intervention (12 weeks), follow up (24 weeks)]
• Pain - Short-Form McGill Pain Questionnaire [Time frame: baseline, post-intervention (12 weeks), follow up (24 weeks)]
• Fatigue - Multidimensional Fatigue Inventory (MFI) [Time frame: baseline, post-intervention (12 weeks), follow up (24 weeks)]
• Health Status - 12-Item Short Form Health Survey (SF-12) [Time frame: baseline, post-intervention (12 weeks), follow up (24 weeks)]
• Quality of Life - The Quality of Life Scale (QOLS) [Time frame: baseline, post-intervention (12 weeks), follow up (24 weeks)]
• Exercise Motivation - Behavioral Regulation in Exercise Questionnaire (BREQ-3) [Time frame: baseline, post-intervention (12 weeks), follow up (24 weeks)]