Exercise As PTSD Therapy: What The Latest VA Research Says In 2026

For decades, exercise was the thing clinicians mentioned after the real work was done. A growing body of VA-funded research including studies from the Rocky Mountain and Mid-Atlantic MIRECCs now suggests it may be part of the real work.

The conversation around PTSD Therapy treatment has always been dominated by two things: medication and talk therapy. Cognitive processing therapy, prolonged exposure, EMDR these are the evidence-based pillars the VA has built its clinical approach on, and for good reason. According to the National Center for PTSD, 53 out of every 100 veterans who complete one of these therapies will no longer meet the criteria for PTSD diagnosis afterward. That’s a meaningful number.

But that still leaves nearly half. And for a condition affecting up to 20% of veterans in the United States a figure the VA itself has documented “meaningful but incomplete” is a problem that demands additional answers. One of those answers, accumulating slowly and steadily across a growing body of peer-reviewed research, is exercise.

Not as a replacement. Not as a feel-good suggestion. But as a clinically studied, physiologically grounded intervention that, when done consistently, appears to change the way traumatized brains function.

The MIRECC Research: What It Found And Who Led It

Dr. Daniel J. Reis, a clinical psychologist at the VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) for Suicide Prevention, a federally funded research center at the nexus of PTSD and veteran suicide risk, led the most widely cited VA-affiliated review on exercise and PTSD in veteran populations.

Nine papers that met the inclusion criteria were found by Reis and his colleagues’ systematic review: three randomized controlled trials (RCTs) that compared exercise to a control condition, and six single-arm studies in which every participant underwent an exercise intervention. Veterans with PTSD diagnoses or those with clinically significant PTSD symptoms below the diagnostic criteria made up the participants.

Dr. Daniel J. Reis, VA Rocky Mountain MIRECC — Federal Practitioner, 2022

“We are seeing a lot of interest in complementary and alternative treatments, of which exercise is one. Integrated exercise regimens that blend aerobic and strength-based activities, some of which included yoga, are also intriguing therapeutic prospects. Exercise is proven to offer numerous advantages for physical well-being. Additionally, more and more studies are showing that mental health is a component of the same system.”

The Mid-Atlantic MIRECC: Physical Activity And Post-Deployment Outcomes

Under the direction of Victoria O’Connor and associates from the MIRECC Post-Deployment Mental Health (PDMH) cohort, which has been tracking post-9/11 veterans since 2005, the study examined the relationship between physical activity and the diagnosis of PTSD and the history of traumatic brain injury (TBI). These two disorders frequently co-occur and are clinically significant: TBI is common among war veterans and has been demonstrated to increase the intensity of PTSD symptoms. Instead than addressing PTSD as a stand-alone variable, the research specifically examined this relationship, adding significant depth to the literature on exercise and PTSD.

The Durham VA Study: Exercise In Older Veterans

It is important to take a quick look at how PTSD affects brain architecture in order to understand why exercise is beneficial. Amygdala hyperactivity (excessive threat signaling), hippocampal volume loss (impaired fear extinction and memory contextualization), and prefrontal cortex suppression (reduced capacity to override alarm responses) are among the well-documented structural and functional alterations linked to the condition. As a result, the brain becomes stuck in an unbreakable state of alertness.

Exercise uses a number of different but related techniques to overcome this. It has been demonstrated that aerobic exercise increases hippocampal volume and fosters neurogenesis, the development of new neurons in an area that PTSD actively reduces. Additionally, it controls the hypothalamic-pituitary-adrenal (HPA) axis, which in PTSD results in chronically dysregulated cortisol responses that, depending on the person and the trigger, are either dulled or exacerbated. The autonomic nervous system, the HPA axis, and the GABAergic system—the brain’s main inhibitory signaling network, which PTSD affects in ways that exacerbate anxiety and sleep—are the three stress-response pathways via which yoga particularly lowers allostatic load.

The Neuroscience: How Exercise Changes The PTSD Brain

It is important to take a quick look at how PTSD affects brain architecture in order to understand why exercise is beneficial. Amygdala hyperactivity (excessive threat signaling), hippocampal volume loss (impaired fear extinction and memory contextualization), and prefrontal cortex suppression (reduced capacity to override alarm responses) are among the well-documented structural and functional alterations linked to the condition. As a result, the brain becomes stuck in an unbreakable state of alertness.

Exercise uses a number of different but related techniques to overcome this. It has been demonstrated that aerobic exercise increases hippocampal volume and fosters neurogenesis, the development of new neurons in an area that PTSD actively reduces. Additionally, it controls the hypothalamic-pituitary-adrenal (HPA) axis, which in PTSD results in chronically dysregulated cortisol responses that, depending on the person and the trigger, are either dulled or exacerbated. The autonomic nervous system, the HPA axis, and the GABAergic system—the brain’s main inhibitory signaling network, which PTSD affects in ways that exacerbate anxiety and sleep—are the three stress-response pathways via which yoga particularly lowers allostatic load.

Key VA And MIRECC-Linked Studies At A Glance

The Research’s Findings And Conclusions

Recognizing the limitations of a literature that is promising but not yet conclusive is necessary for intellectual honesty. There is currently not much research linking exercise to PTSD, especially in populations that are unique to veterans. A large number of the papers that Reis et al. evaluated had small sample sizes. It is still really unclear what kind, frequency, intensity, and duration of exercise are best for reducing PTSD symptoms. Scholars have regularly observed that further long-term research is needed in this area.

Another important result is that exercise seems to be especially beneficial for soldiers who have not reacted well to first-line PTSD therapies. Exercise is not a comforting solution for the almost half of veterans who finish CPT, PE, or EMDR without achieving complete remission; rather, it may be addressing biological targets that psychotherapy alone does not.

Practical Implications: What This Means For Veterans Today

Exercise programming is growing within the institutional framework of the VA’s Whole Health concept, which specifically incorporates lifestyle and non-pharmacological techniques into veteran care. In addition to normal PTSD care, several VA medical facilities also provide trauma-informed yoga, supervised exercise programs, and outdoor recreation therapies.

Consistency over intensity, group formats over solitary exercise (the Durham study found that group-based programs were strongly preferred), trauma-informed environments that respect veterans’ relationship with their bodies, and realistic expectations improvements in symptom clusters like sleep and hyperarousal appear first, with broader gains accumulating over months, not weeks are some practical recommendations for veterans looking to incorporate exercise into PTSD recovery.