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.

增加体力活动可能是一种很有前景的新策略，可以提高长期暴露 (PE) 治疗在创伤后应激障碍 (PTSD) 中的有效性。然而，对于 PTSD，在 PE 之前或之后提供体育活动是否更有效尚不清楚。因此，目前的研究检查了身体活动和体育锻炼的顺序对创伤相关痛苦和生动性的主要结果测量的影响。在这项准实验性研究中，共有 93 名 PTSD 患者被分配到两种情况：(1) PE 后进行体力活动 ( N  = 50) 和 (2) 体力活动后进行 PE ( N = 43）。身体活动干预包括低到中等强度的户外步行。与体育锻炼前进行体育锻炼的组相比，在单次体育锻炼后进行体育锻炼的组中，从干预前到干预后，与创伤相关的痛苦和生动性的减少明显更强。然而，关于冻结症状和情绪调节问题的探索性结果表明，随着时间的推移，两个序列组的症状减少程度相同。目前的研究结果表明，进行体育活动和体育锻炼的顺序可能很重要。在一次体育锻炼之后而不是之前增加体育活动时，发现对痛苦和生动性的影响更大。