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Research

  • “I Know I Can Do Anything I Set my Mind to Now.” From the Invictus Pathways Program to Representing Australia Competitively: A Qualitative Analysis of the Perceptions and Experiences of Veterans and Their Family Support Networks About the Impact of Participation, opens in a new tab, Dannielle Post, Amy Baker, Steve Milanese, et al., Journal of Military Social Work and Behavioral Health Services, (17 June 2025). Participating in competitive events such as Invictus Games and Warrior Games has been identified to have benefits for the physical and psychological wellbeing of veterans. There is, however, potential for negative impacts for veterans who either do not achieve selection in representative teams or who experience the ‘post-games blues’ following participation in competitive events. The potential double-edged-sword of competition for this population needs to be understood. UniSA’s Invictus Pathways Program (IPP) has supported veterans to train for and participate in competitive events, applying a holistic approach that promotes recovery and wellbeing for all veterans through physical activity. Applying thematic analysis to semi-structured interviews undertaken with participating veterans and their family members, this paper describes the lived-experience perspectives of the journey through training, team selection processes, veterans representing themselves and their country on the international stage, and veterans’ plans post- competition. The findings suggest perceptions that participation in competitive games was followed by “post games blues” for most of the participants in this study, and that the factors that contributed were varied. Participation in competitive events was valued and seen as a high point for veterans and members of their family support network. Despite the evidence for physical and psychological benefits for veterans who participate in competitive events, similar to elite athletes, there is an identified need to provide appropriate support throughout training, participation, and post-competition, to mitigate potentially detrimental impacts on mental health and wellbeing wherever possible.
  • Effectiveness of surfing on psychological health in military members: a systematic review, opens in a new tab, González-Devesa D, Vilanova-Pereira M, Araújo-Solou B, et al., BMJ Military Health, (October 2024). This study aims to systematically review the available evidence on the effects of surfing on mental health in active military personnel and veterans. Studies were searched across four electronic databases (MEDLINE/PubMed, Web of Science, SportDiscus and Scopus) until May 2024. A total of seven studies met the inclusion criteria and were included. Depression and anxiety symptoms (n=7), positive affect (n=5) and pain (n=3) were the main outcomes analysed. Overall, the studies reviewed generally reported beneficial effects of surfing on depression, anxiety and positive affect. However, none of the four studies that examined pain as an outcome observed any positive effects of surfing. There is evidence indicating that surfing may positively influence the management of anxiety, depression and overall positive affect among military personnel. Nonetheless, it cannot be definitively concluded that surfing provides superior benefits compared with other forms of exercise.
  • Fallout: the psychosocial harms of negative military discharge experiences, opens in a new tab, Cameron Grant, Lydia Woodyatt, Henry Bowen, et al., Frontiers in Psychology, Volume 16, (May 2025). Military discharge marks a pivotal life transition, often resulting in loss of identity, purpose, and belonging. Negative discharge experiences are further associated with feelings of institutional betrayal. This study explored which aspects of discharge negatively impact veterans during and after their transition. Findings revealed that veterans experience harm when they perceive their discharge as an institutional or personal transgression—ranging from bureaucratic disregard to service-related injuries leading to rejection and overt betrayal by bad actors. These events, regardless of severity, undermine veterans’ shared military identity and values, posing a psychological threat to their sense of belonging, severing familial-like bonds, and fostering feelings of rejection, diminished self-worth, isolation, and betrayal—hindering transition and identity reconstruction. We argue that the harm stems not from discharge itself but from veterans experiencing these negative experiences as a violation of shared values—values they were required to embody for group membership. In identity-centric workplaces like the military, where enculturation fosters deep, family-like bonds, discharge represents a unique psychosocial hazard. Proactive management is essential to mitigate lasting psychological harm.
  • A narrative review of exercise intervention mechanisms for post-traumatic stress disorder in veterans, opens in a new tab, Fang Zhao, Chuchen Liu, Zhiyi Lin, Frontiers in Public Health, Volume 12, (2025). Post-traumatic stress disorder (PTSD) severely disrupts the daily lives of veterans and active duty personnel and may influence their suicidal behaviour. This study provides insight into existing research on PTSD in veterans through a narrative review. Exercise was found to reduce PTSD symptoms in veterans at both psychological and physiological levels, which in turn inhibits their suicidal tendencies. At the psychological level, exercise improved veterans’ Subjective Well-Being and Psychological Well-Being, and at the physiological level, it improved veterans’ brain structure, neuroendocrine system, and immune system. By combing these mechanisms in detail, we hope to provide theoretical support for the implementation of exercise interventions in the treatment of veterans with PTSD. However, it is important to note that the specifics of the exercise program, such as the optimal type, dosage, and duration to alleviate PTSD symptoms, remain unclear and require further research and exploration.
  • Military Sports Recovery Athletes’ Perspectives on Role of the Coach in Athletes’ Well-Being: The Importance of Supporting Basic Psychological Needs, opens in a new tab, Nicola Jordan, Stephen Macdonald, Justine Allen, Adapted Physical Activity Quarterly, Volume 42(1), pp.114-132, (2025). The purpose of this study was to investigate the experiences of athletes in a competitive military sports recovery program with a specific focus on the extent to which coaches supported, or frustrated, athletes’ basic psychological needs. Eight military veteran athletes competing in parasport took part in semistructured interviews. The accounts of their experiences of working with coaches in this context and their influence on their psychological needs and well-being were thematically analyzed. Results demonstrated that coaches’ behaviors that support basic psychological needs can have positive effects on athletes’ well-being and support their wider rehabilitation. Furthermore, frustration of these needs through controlling behaviors contributed to psychological ill-being. Findings suggest practical implications to help inform coaching practice to support optimal recovery and an environment that promotes well-being.
  • Brothers and sisters in arms: A mixed-methods investigation of the roles played by military support and social identity processes in the mental health of veterans during the transition to veterancy, opens in a new tab, Juliet R. H. Wakefield, Mhairi Bowe, Blerina Këllezi, et al., Journal of Community & Applied Social Psychology, Volume 34(1), e2756, (January/February 2024). The transition to veterancy can be psychologically challenging, and although the military provides support, the importance of social connectedness for well-being is largely unrecognised. The significance of this oversight is highlighted by the Social Identity Model of Identity Change (SIMIC), which conceptualises life change as social identity change. SIMIC has been applied to numerous life transitions, but not to veterancy, although there is evidence that the social and psychological challenges of this transition may be especially profound (e.g., due to the chronically salient, highly structured and largely unique nature of military life and identity). To remedy this, in Study 1 (N = 210), UK-based veterans completed an online survey. Consistent with SIMIC, social group maintenance and gain predicted mental health via the psychological resources they provided (meaning, self-esteem, sense of personal control), and group gain was predicted by perceived military support during the transition. Study 2 (N = 14) extended these findings qualitatively through exploration of veterans' transition experiences. These studies are the first to apply aspects of the SIMIC to the veterancy transition, and they show the applicability of SIMIC in this context. They also highlight the need for transition-related education that includes guidance on group joining and reconnecting.
  • The Contribution of Sport in the Rehabilitation Process of Disabled Military Veterans: A Case Study of the 2016 Invictus Games, opens in a new tab, Ian Brittain, Kyle Bunds, Jason Bocarro, Journal of Global Sport Management, Volume 9(1), pp.62-85, (2024). A growing body of research highlights the positive impacts of sport and physical activity upon the physical and mental well-being of traumatically injured military personnel. This study, conducted at the 2016 Invictus Games in Orlando, Florida, sought to understand the role of sport in the rehabilitation process of military personnel who have undergone traumatic injury or have experienced chronic illness. Data were derived from in-depth focus groups, semi-structured interviews, and open-ended questions with competitors, team managers, and family members. Findings indicated that the use of sport and physical activity has been an effective rehabilitation tool for those who competed. Tactics such as goal setting and team mentality, often critical components of both sport and military training, are helpful in allowing these competitors to reconnect with their military identity, without the negative implications of self-comparison. However, following conventional rehabilitation to optimise all available function, participants in this study found that sport or competitive rehabilitation, as some called it, brought with it several potential benefits that assisted them in moving towards some semblance of post traumatic growth. Overall, it would appear that the participants taking part in the Invictus Games had, through participation in sport/ competitive rehabilitation, achieved a level of post traumatic growth that helped them undergo a significant improvement upon their outlook on life. This helped them adjust to their new situation to such an extent that they no longer concentrate on their physical loss and their change in physical ability, but instead have developed an appreciation of their existing ability i.e., they have achieved, or are at least moving steadily towards, a new ‘normal’.
    • Benefits identified included connection to others and sense of belonging stemming from their military identities and a renewed sense of (military) camaraderie and social relatedness, improved strength and function. Sport offered an opportunity to improve the athletes’ physical competence through improving physical ability post-injury.
    • Two subthemes became clear from the research participants regarding exactly how rehabilitation through sport might assist in positive psychological changes amongst the competitors - sport providing a purpose and sport as a release for aggression.
  • Physical Activity Participation, Quality of Life, and Behavioral Health Disorders for Veterans with PTSD, opens in a new tab, McDonagh, Krista; Bennett, Jessie; Geden, Sarah, Therapeutic Recreation Journal, Volume 58(1), pp.96-114, (2024). The growing prevalence of behavioral health disorders in veterans has triggered a wide-spread effort to identify and provide complementary interventions. This study investigated physical activity as a complementary treatment option for veterans with posttraumatic stress disorder (PTSD) for recreational therapy (RT) programs. A correlational survey research design was used to examine relationships between participation in three types of physical activity (traditional indoor fitness, outdoor adventure activity, and mind-body practices) and four psychosocial measures for veterans with PTSD (depression, anxiety, health-related quality of life [HRQoL], and substance use). A total of 102 participants completed the online survey. Results indicated that the frequency and duration of traditional indoor fitness activities and outdoor adventure activities were significantly associated with higher HRQoL, lower reoccurrence of substance use risk, substance use, and depression. Implications for the use of physical activity in recreational therapy for veterans with behavioral health disorders and future research studies were presented.
  • Safe at home: A phenomenological exploration into team sports’ perceived influence on PTSD symptoms in military veterans, opens in a new tab [Ph.D. thesis], Ward, Jeffrey M., Electronic Theses and Dissertations, Paper 4426, University of Louisville, (2024). The primary aim of this investigation was to explore how participation in team sports can alter veterans’ perceptions of their PTSD symptoms and overall well-being. Using phenomenological qualitative semi-structured interviews with eight veterans engaged in team sports, the research highlights the transformative power and holistic health benefits of such involvement. This dissertation used a two-paper format: The first paper identified direct perceived influences of team sports, revealing promising enhancements in veterans’ mental health and a potential reduction in suicidal ideation. The subsequent paper builds on these findings, detailing the role of team sports in offering a supportive community that helps veterans’ ongoing transition from military to civilian life. The results show that regular participation in team sports can serve as a powerful intervention for improving and sustaining veterans’ mental health, support structures, and life purpose. This research highlights the necessity of including structured team sports in veteran care and the profound impact in enhancing veterans’ psychosocial health and quality of life. Moreover, this study shows the strategic potential of team sports as a dynamic tool for sports practitioners, emphasizing their role in pioneering preventative care for veterans. Lastly, this research invites sports practitioners to consider team sports as a proactive measure in all programs, enhancing traditional care models with robust, community-driven activities that actively and meaningfully engage veterans.
  • Supporting a lifetime of fitness for the military veteran athlete: a narrative review,, opens in a new tab Melissa J. Tinney, Chantal Nguyen, Frontiers in Sports and Active Living, Volume 6, (December 2024). The military veteran starts their career at peak physical fitness. Once injured or retired, physical activity for the veteran is integral to rehabilitation, recovery, and ongoing wellness. This may require adaptation for continued participation in physical activity. The military veteran, in the United States, has access to resources which can facilitate ongoing physical activity, engagement in competitive and recreational sports, no matter what age or ability. Reviewing the current literature will help understand the scope of programs available, their outcomes, and strategies employed to support a lifetime of fitness that may be applied to other populations and health care systems.
  • Unveiling the Influence of Competitive Sports on the Sense of Self and Identity of Disabled Veterans: A Systematic Review and Mixed-Methods Synthesis, opens in a new tab, Anna Hendrick, Eve Binks, Neil Ferguson, et al, Identity: An International Journal of Theory and Research, Volume 24(3), pp.194-212, (2024). Veterans can encounter identity struggles upon departure from the military which are intensified if veterans have sustained a disability or life altering injury. Physical activity has been shown to empower disabled veterans to cultivate a positive post injury identity. The purpose of this systematic review was to synthesize the evidence available on disabled veterans’ experience participating in competitive sport and explore the impact competing has on their self-identity. Studies were eligible if they were: 1) Published in English between 2012–2023 in a peer reviewed journal; 2) included veterans with a disability who participated in competitive sports; 3) explored veterans’ self-identity. Searches were conducted in four databases: SportDiscus; PsycInfo; Psycharticles; EBSCO. Nine articles met the eligibility criteria. Studies were assessed and a convergent integrated mixed methods synthesis was carried out. Findings were aggregated into three themes: 1) The importance of social connections for self-identity; 2) Self-views and quality of life; 3) Sport and the establishment of a new self. Competitive sport enables disabled veterans to cultivate a positive post-injury identity, whilst also restoring an affiliation with their previous military identity. Findings suggest that competing in sports positively impacts disabled veterans’ identity recovery.
  • Process evaluation of the Invictus Pathways Program, opens in a new tab, Dannielle Post, Amy Baker, Steven Milanese, PLOS One, (November 2023). UniSA’s Invictus Pathways Program (IPP), a service program, was originally developed to assist veterans to train for and participate in the Invictus Games. More recently, the scope of the IPP has widened to support and improve wellbeing and facilitate post traumatic growth and recovery among participants who are living with physical and mental health injuries and conditions. This paper describes the components of the IPP and reports its process evaluation. This process evaluation has demonstrated that the physical activity training components of the IPP were delivered with high levels of fidelity, and that satisfaction with the IPP is mostly high, although there are areas that could be improved. There is a need for a more structured approach to the ongoing evaluation of the IPP. This includes ensuring that program staff have a shared understanding of the purpose of evaluation activities and that these activities occur as intended. Beyond this is the need to secure funding to support the sustainability of the IPP, so that it can continue to contribute to the wellbeing of veterans living with physical and mental health conditions, and their families.
  • The physical, psychological, and social impacts of participation in the Invictus Pathways Program: A qualitative analysis of veterans’ perceptions and experiences, opens in a new tab, Dannielle Post, Amy Baker, Steven Milanese, et al., PLOS One, (October 2023). UniSA’s Invictus Pathways Program (IPP) is motivated by the spirit of the Invictus Games to mobilise the benefits of sport to aid physical, psychological, and social wellbeing. Originally developed to assist veterans to train for and participate in the Invictus Games, the program has extended its scope to promote recovery and wellbeing for all veterans through physical activity. This paper describes the expectations and experiences of the IPP from the perspective of program participants. The qualitative analysis identified five higher order themes: Life experiences prior to participation in the IPP, Making a choice to participate in the IPP, Expectations of participation in the IPP, Impact of participation in the IPP, and Future Plans. There were perceptions that the IPP was beneficial for the participating veterans, irrespective of their physical and psychological health status. Participants described the positive impact of the IPP on their physical fitness, their social engagement, and their sense of belonging within the IPP and the university. Participants perceived the IPP to be an opportunity for them to ‘give back’ by contributing to the education of the students delivering the IPP. Participants reported the intention to continue being physically active. For some, this meant selection in an Invictus Games team, for others, this meant getting involved in community sporting organisations.
  • I AM FAMILY: Understanding the adapted sport experiences of family members of military personnel with physical and psychological illnesses and injuries through the lens of the Invictus Games, opens in a new tab, Amber Duong, Lauren Roberts, Heidi Cramm, et al., Psychology of Sort and Exercise, Volume 68, 102457, (September 2023). The current study sought to explore the experiences of families in adapted sport through the context of the Invictus Games, an international adapted sport competition for military personnel with physical and psychological illnesses and injuries that is unique in its inclusion of family programming. Family members (n = 21; partners, parents, siblings, and children) of Invictus Games Toronto 2017 competitors participated in semi-structured interviews. Data were analyzed using reflexive thematic analysis. Three themes were identified: recognition of family experiences during service and after onset of disability; creating a sense of belonging; and improving family knowledge and perceptions. This study provides insight regarding how adapted sport events can support the well-being of both individuals with illnesses and injuries and their families.
  • The effectiveness of the National Veterans Summer Sports Clinic for veterans with probable posttraumatic stress disorder, opens in a new tab, Kristen Walter, Nicholas Otis, Michal Kalli Hose, et al., Frontiers in Psychology, Volume 14, (July 2023). The sample included 74 U.S. veterans who participated in the National Veterans Summer Sports Clinic (NVSSC), an annual, week-long adaptive sports program in San Diego, California. Participants were categorized into two subgroups: those who met criteria for probable PTSD using the PTSD Checklist for DSM-5 (n = 20) and those who did not (n = 54). Participants completed self-report assessments before and after each daily activity, before and after the program, and 3 months following program completion. Over the course of NVSSC program participation, the diagnostic subgroups (probable PTSD vs. no PTSD) did not significantly differ on changes in depression, positive affect, negative affect, or insomnia. Compared to those without PTSD, veterans with PTSD experienced greater reduction in generalized anxiety during the program). Veterans with PTSD also experienced significant improvements in PTSD symptoms at postprogram. For both groups, significant benefits were shown during the program but rebounded by the 3-month follow-up. Over the course of each daily activity, positive affect and depression/anxiety scores significantly decreased, with no differences between PTSD diagnostic groups across time.
  • Sustained positive behaviour change of wounded, injured and sick UK military following an adaptive adventure sports and health coaching recovery course, opens in a new tab, Sutton RJ, Kay CWP, McKenna J, et al., BMJ Military Health, Volume 169(6), pp.499-504, (2023). A rising trend has occurred in the physical and mental health challenges faced by recovering UK service personnel. To support these individuals, bespoke inclusive multiactivity and adventurous training courses (MAC) have been developed. Unlike many outdoor adventure therapy programmes, the MAC is delivered to recovering UK military personnel who are still serving in the armed forces, although they may have discharged from the service prior to the 1 year follow-up. This study investigated the MAC’s influence on participants’ ability to sustain day-to-day changes that facilitate positive mental health and psychological need satisfaction. The 146 UK service personnel who participated in this study attended a five-day MAC 12 months ago. Positive behaviour changes were reported by 74% of the respondents. These changes align with positive psychological well-being (98%). Impactful elements of the course experienced by participants mostly aligned with the three basic psychological needs of autonomy (34%), competence (36%) and relatedness (61%). Recovery support programmes that encompass health coaching adventurous activities, such as the MAC, can initiate long-term positive behaviour change for recovering military personnel. In this specific context, the concurrence of the self-determination theory concepts that underpin the course delivery and participant outcomes is a powerful endorsement of implementation fidelity.
  • Military Veterans and Adaptive Sports, opens in a new tab, Melissa J. Tinney, Deanna Brinks, Sara Dykowski, et al., in 'Adaptive Sports Medicine: A clinical guide', Arthur Jason De Luigi (ed), Springer, pp.425-433, (2023). Adaptive sports have been an integral part of rehabilitation for military veterans. In this chapter, we discuss the military veteran and sequelae from combat injury that are unique to this population and what those medical considerations mean when planning and providing adaptive sports programs for veterans. We review current programs, evaluate the existing research on this topic, identify key considerations and medical outcomes for veterans, and recognize areas for future research on this topic.
  • Wounded warriors: Multiple identities, physical activity and life satisfaction, opens in a new tab, Martin, Jeffrey; Martin, Adam; Snapp, Erin; et al., Acta Universitatis Carolinae: Kinanthropologica, Volume 59(1), pp.5-17, (2023). The purpose of the current study was to examine a model specifying that military, athlete, exercise, and disability identities would predict life satisfaction as mediated by physical activity (PA). Methods: Seventy-one military veterans (N = 71) with impairments participated and completed Exercise, Athlete, Disability, Military, identity scales and Life Satisfaction and PA questionnaires. Results: A mediation model indicated the indirect effect of the four identities on life satisfaction through PA was not significant However, PA was predicted by the 4 identities, [F (4, 66) = 2.49, p = 0.05] and accounted for 13% of the variance, with disability identity having the only significant beta weight. Life satisfaction was also predicted by the 4 identities and PA ([F (5, 65) = 4.88, p = 0.001] and accounted for 27% of the variance. However, only the military and athletic identities had significant beta weights. Conclusions: Our findings provide preliminary support for the value of military veterans maintaining a military identity and holding an athletic identity. The current findings suggest that sport psychologists and rehabilitation professionals take a more nuanced and open-minded perspective about veterans who desire to maintain a military identity when becoming civilians
  • The Impact of Adaptive Sports and Physical Activity for Veterans with Disabilities: A Synthesis Project , opens in a new tab[masters thesis], Rachel Mezzoni, The College at Brockport, (December 2022). Over the years, adaptive sports and physical activity has become more prominent to support individuals with disabilities. Veterans with a disability tend to have a more unique situation while living with a disability because of the demands from being in service. While reviewing existing research, it has shown that adaptive sports and physical activity impact veterans who have a disability in multiple different facets. Three key themes were found in the research: the physical, psychological, and social benefits, the impact of community engagement, and the access veterans have to programs and the conditions within the program. The purpose of this synthesis project was to review the literature on the impact adaptive sports and physical activity has on veterans with physical disabilities.
  • Acute influence of an adaptive sporting event on quality of life in veterans with disabilities, opens in a new tab, Alexis Sidiropoulos, Jonathan Glasberg, Timothy Moore, et al., PLOS One, (November 2022). Veterans with disabilities can experience poor quality of life following military service due to the associated negative physical and psychological ramifications. However, participation in physical activities has shown to induce both physical and mental benefits and improve the quality of life of this population. Adaptive sports, an innovative approach to address the unique physical and psychosocial needs of veterans with disabilities, are becoming more widely used as a rehabilitation tool to improve the quality of life for these veterans. This study aimed to determine the acute influence of participation in a single-day, veteran-based, adaptive kayaking and sailing event on the perceived overall health, quality of life, and quality of social life of veterans with varying disabilities. It was hypothesized that all three categories and the sum score of quality of life would reflect a positive acute response after participation in the community-based physical activity event. Veterans responded to three quality of life-related questions using a 5-point Likert scale before and directly after participating in the event. Findings indicated that an adaptive sporting event can have an acute positive influence on the quality of life of veteran participants, with improvements observed in all three categories of perceived quality of life. Therefore, it is advantageous for the whole-health rehabilitation of veterans with disabilities for the Department of Veterans Affairs to continue to provide opportunities for veterans to participate in non-traditional, community-based activities.
  • Is exercise/physical activity effective at reducing symptoms of post-traumatic stress disorder in adults — A systematic review, opens in a new tab, Ferozkhan Jadhakhan, Nichola Lambert, Nicola Middlebrook, et al., Frontiers in Psychology, Volume 13, (August 2022). Thirteen studies, including several that included military veteran participants, from four countries involving a total of 531 patients were selected for inclusion. Individual forms of exercise/physical activity examined showed some effect on reducing PTSD symptoms but combined exercises (resistance training, aerobic, strength and yoga) administered over a 12 week period, three times a week for 30–60 min showed greater effects on PTSD symptoms. The authors conclude that the limited evidence suggests that a combined exercise intervention has the best evidence for a having a beneficial effect on PTSD symptoms.
  • ‘More Important Than Winning’: a Retrospective Online Research Survey Evaluating the Effects of Participating in an Adaptive Sports Program for Wounded, Injured and Ill Australian Defence Force Veterans,, opens in a new tab. Lewis, A. Journal of Military and Veterans’ Health, Volume 30(3). (July 2022). The Australian Defence Force (ADF) Adaptive Sports Program offers participation in recreational and competitive sports to wounded, injured or ill veterans to support rehabilitation, recovery and social reintegration. There has been limited research on the impact of sport participation on the physical and mental health and wellbeing of current and former serving ADF veterans. A survey was sent to 210 ADF Adaptive Sports Program participants in training camps for preselection for the Invictus Games and Warrior Games 2018–2020. Survey questions invited participants to reflect on their involvement in the program over the previous 2 years. Responses were received from 29% of program participants.
    • Among the 60 respondents, 78% reported greater engagement in physical activity after participation, and 89% reported that they had experienced a positive effect on their rehabilitation pathway.
    • These preliminary findings demonstrate that the Adaptive Sports Program increases physical activity and supports rehabilitation, recovery and reintegration for engaged participants competing in local and international events.
    • Further research is needed to identify outcomes in the wider group of program participants and confirm that the program is an effective strategy for supporting wounded, injured and ill veterans.
    • Targeted program promotion to veterans discharging from ADF, particularly the 18% discharging for medical reasons, with timely follow-up at designated intervals (e.g. at 3, 6 and 12 months), has the potential to engage veterans early in their transition and rehabilitation pathway. The ASP requires appropriate resources, financial and personnel, to support this. Providing veterans with funding through subsidies and grants could also facilitate engagement in community sport. Ongoing participation in community sport should precede enrolment in key events such as Invictus Games or Warrior Games.
  • Extreme sport as an intervention for physically injured military veterans: the example of competitive motorsport, opens in a new tab, Danai Serfioti, Nigel Hunt, Disability and Rehabilitation, Volume 44(24), pp.7566-7574, (2022). Physically or psychologically injured military veterans are motivated and benefited by physical activity or sport that may involve high levels of achievement. The aim of this study was to provide an in-depth insight into the impact of Competitive Motorsport (CM) on physically injured/disabled veterans’ subjective well-being and in turn determine if it improves the quality of their lives. Two sets of semi-structured interviews were conducted with 14 male British military veterans including a 6-month follow-up. All participants were subjected to a permanent, moderate or severe, physical injury/disability. Five key elements (familiar environment, team spirit, adrenaline rush, competition and equality) made CM a unique experience for physically injured/disabled veterans. Various psychological and physical benefits were found, including an increased sense of accomplishment, opportunity to socialise in a non-clinical environment, embracement of body image and adoption of a healthier lifestyle. Since physical activity and sport are among growing research on alternative interventions for military veterans, they deserve serious consideration as part of the treatment regimens and rehabilitation programmes to improve physically inured/disabled veterans’ physical and mental health.
  • Perceived barriers to, and benefits of physical activity among British military veterans that are wounded, injured, and/or sick: a Behaviour Change Wheel perspective, opens in a new tab, Robert Walker, Martin Colclough, Caroline Limbert, et al., Disability and Rehabilitation, Volume 44(6), pp.900-908, (2022). Many British military veterans that are wounded, injured, and/or sick (WIS) face significant physical, psychological and social challenges following discharge from the military. There is increasing evidence to support the application and benefit of physical activity for veterans that are WIS. The aim of this study is to identify the perceived barriers to, and benefits of physical activity among veterans that are WIS. Nine semi-structured interviews were conducted to explore perceived barriers to, and benefits of physical activity amongst veterans that are WIS. A thematic analysis was conducted, and themes mapped to the Behaviour Change Wheel’s capability, opportunity, motivation–behaviour (COM-B) model. Perceptions related to physical capability, psychological capability, physical opportunity and reflective motivation were predominant barriers to engagement in physical activity. As well providing opportunities to socialise, the perceived benefits of engagement in physical activity seemed to mirror the perceived barriers, suggesting a reciprocal relationship. Using the Behaviour Change Wheel, incentivisation, education, persuasion, enablement and environmental restructuring were identified as potentially beneficial intervention functions when seeking to increase levels of physical activity among veterans that are WIS living within the United Kingdom.
  • Quality Participation in Military Veterans with an Acquired Physical Disability, opens in a new tab, Hannah Strasdin, Stephanie M. Flood, Celina Shirazipour, Canadian Disability Participation Project, (November 2021). This knowledge translation bulletin summarizes published research that examines the experiential elements of quality participation and pathways through which military veterans with an acquired physical disability initiate and maintain physical activity long-term. Four experiential elements and three pathways were identified and can be integrated into programming to promote long-term physical activity participation for adults with acquired disabilities.
  • Self-Representations of Military Veterans Suffering From Chronic Post-traumatic Stress Disorder: The Role of Sport, opens in a new tab, Celia Belrose, Anais Duffaud, Dominique Levy, et al., Frontiers in Psychiatry, Volume 12, (November 2021). This exploratory qualitative study examined the self-representation of veterans with chronic PTSD before a sport rehabilitation program. Veterans were given the prompts “body” and “person” and asked to free associate. PTSD severity and the mind–body connection were assessed using the Posttraumatic Stress Disorder Checklist for DSM-5, and the Freiburg Mindfulness Inventory, respectively. Parasympathetic activity was recorded at rest. A subgroup of the population volunteered to participate in a post-program session to record the same semantic, psychological, and physiological variables. Although before the program, veterans gave more negatively than positively valenced words, no relation was observed between the overall number of negative words and PTSD severity. Post-program, changes were observed in terms of valence. Specifically, some negatively-valenced categories of words disappeared, and some positive categories appeared. At the same time, there was a fall in PTSD severity, an increase in the mind–body connection, and a decrease in parasympathetic activation. This study highlighted that veterans with chronic PTSD have a negative representation of the self. A dedicated, 9-day program that included regular sport improved self-representations related to both the person and their body, and reduced PTSD symptoms. The findings underline the importance of ensuring that programs for patients suffering from chronic PTSD should include sporting activity, and highlight the benefits. Sport appears to be a path to the reappropriation of a positive image of the self, by improving the representation of the body. This relationship could be consistent with improved interoception, but our results need further investigation.
  • Demographic and Functional Characteristics of National Veterans Wheelchair Games Participants: A Cross-sectional Study, opens in a new tab, Cecelia Rose Lee-Hauser, Richard Schein, Vince Schiappa, et al., Military Medicine, Volume 186(7-8), pp.e749-755, (July-August 2021). The purpose of this study was to establish a baseline of common characteristics of the Veteran population that participated in the National Veterans Wheelchair Games (NVWG) in 2017 and 2018, including their perception on how their participation is associated with function and social factors. A sample of 426 Veterans, 87% who were male and an average population age of 56 years old, reported high FMA scores on each of 10 items (daily routine, comfort, health, operate, reach, transfer, personal care, indoor mobility, outdoor mobility, and transportation) along with SPORTACUS scores scoring above 5, based on a 1-6 scoring scale (1 being “completely disagree” and 6 being “completely agree”), on each domain indicating sports participation is associated with their ability to function and participate in the community. Based on these results, it can be concluded for this military Veteran population that participation in a large, organized adaptive sports programs such as the NVWG has a positive association with daily function, quality of life, community participation, and use of higher quality assistive technology.
  • The National Veterans Summer Sports Clinic: Change and duration of psychological outcomes, opens in a new tab, Kristen Walter, Nicholas Otis, A.C. Del Re, et al., Psychology of Sport and Exercise, Volume 55, 101939, (July 2021). The current study evaluated the psychological outcomes of attendees of the 2017 and 2018 National Veterans Summer Sports Clinic (NVSSC) in San Diego, California. Seventy-four veteran participants completed self-report assessments before and after the week-long program, as well as 3 months following program completion. In addition, participants completed brief assessments before and after each of the daily recreational activities (cycling, surfing, sailing, kayaking, and archery/pickleball). Findings showed that depression, anxiety, social functioning, and positive and negative affect significantly improved from pre-to postprogram, but returned to baseline levels at 3-month follow-up. Within sessions, depression/anxiety and positive affect significantly improved each day, with no differences in the amount of change across days. Depression/anxiety and positive affect also significantly improved within each activity, regardless of order, with no differences in the magnitude of change across activities. The NVSSC produced significant changes in psychological outcomes among veteran participants within immediate and short-term time periods; however, gains were not maintained longer-term. Follow-on engagement in exercise activities is likely necessary for continued benefit; future research, including studies with control groups, would provide greater clarity.
  • Qualitative Analysis of a Supervised Exercise Program for Older Veterans With PTSD, opens in a new tab, Julia Browne, Alyssa Medenblik, Michelle Pebole, et al., The American Journal of Geriatric Psychiatry, Volume 29(6), pp.565-572, (June 2021). Older veterans with post-traumatic stress disorder (PTSD) experience substantial physical and mental health challenges. Given the well-known and wide-reaching benefits of exercise, exploring the impact of interventions designed specifically for this population would be valuable. As such, the present study explored perspectives from older veterans with PTSD who participated in Warrior Wellness, a 12-week supervised exercise intervention designed for older veterans with PTSD. This study was aimed at evaluating 1) facilitators of engagement, 2) perceived benefits from the intervention, and 3) recommendations about possible modifications to the intervention.
    • Shared experience, program features, camaraderie during workouts, and accountability emerged as facilitators of engagement. Perceived benefits spanned physical health, mental health, and behavioral domains.
  • Gender Differences in Psychological Outcomes Following Surf Therapy Sessions among U.S. Service Members, opens in a new tab, Lisa Glassman, Nicholas Otis, Betty Michalewicz-Kragh, et al., International Journal of Environmental Research and Public Health, Volume 18(9), 4634, (April 2021). This study compared changes in depression/anxiety (Patient Health Questionnaire-4), positive affect (Positive and Negative Affect Schedule), and pain (Numerical Pain Rating Scale) between U.S. service men and women (N = 74) during six weekly surf therapy sessions. Overall, participants reported decreased depression/anxiety and increased positive affect, but no change in pain rating following each session. Significant gender differences were found in the magnitude of changes in depression/anxiety and positive affect during surf sessions, despite no differences in pre-session scores on either outcome. Women showed greater improvements in depression/anxiety and positive affect compared with men—an important finding, given that surfing and military environments are often socially dominated by men. Future research is needed to replicate these findings in other samples, extend this research to other underrepresented populations, and identify barriers and facilitators of the sustainable implementation of surf therapy across populations.
  • Experiences of Military Veterans in a Therapeutic Horseback Riding Program, opens in a new tab, Johnson RA, Albright DL, Marzolf JR, et al., Clinical Nursing Research, Volume 30(7), pp.923-933, (2021). Posttraumatic stress disorder commonly occurs among U.S. military veterans. Therapeutic horseback riding (THR) has emerged as an adjunct therapy. We explored 20 veterans’ perceived benefits, drawbacks and views of a 6-week THR program. Participants had confirmed diagnoses of posttraumatic stress disorder, traumatic brain injury, or both. Veterans rode the same horse weekly, the same day, at the same time. Data were collected as part of a randomized clinical trial testing the effects of THR on Post-Traumatic Stress Disorder. Veterans responded to an open-ended questionnaire. Content analysis was used for data analysis. Benefits were “Connection to the Horse,” “Relaxing,” “180 Degree Change,” and “Meeting New People.” Drawbacks were “None,” “Struggle to Get There,” “Pain,” “Too Short,” and “It is Structured.” Overall perceptions were “I Absolutely Loved It,” “Feel Again,” “The Horse,” “The People,” and “No Worries.” Participants viewed THR as positive. Findings may elucidate why THR may be clinically beneficial.
  • Military veteran athletes’ experiences of competing at the 2016 Invictus Games: a qualitative study, opens in a new tab, Gareth Roberts, Rachel Arnold, Fiona Gillison, et al., Disability and Rehabilitation, Volume 43(24), pp.3552-3561, (2021). The aim of this study was to explore military veterans’ experiences of participation at the 2016 Invictus Games. Fifteen UK military veterans (10 male, 5 female) who participated in the 2016 Invictus Games were recruited. Semi-structured interviews were conducted to explore experiences pre, during, and post-competition, and analyzed using applied thematic analysis. Some key findings and recommendations include:
    • Findings highlight that military veterans have unique motives to compete at the Invictus Games, including “reconnection with previously military life” and “being a role model”.
    • Whilst veterans encounter team and culture organizational stressors while competing, they share similar post-Games experiences to full-time athletes, including the concept of “post-games blues”.
    • Experiences shared by military veterans at the Invictus Games can aid in the promotion of sport as a viable form of recovery.
    • Primary and secondary stress management strategies should be implemented with military veterans to reduce organizational stressors and their responses to them.
    • Psychoeducation programmes should be introduced pre-Games to better prepare military veterans for their post-Games experience.
  • University-Based Adaptive Sport Camps as a Model for Engaging Injured Military Veterans in Community Development, opens in a new tab, Arthur-Banning, Skye; Garst, Barry; Young Suk Oh; et al., Journal of Park & Recreation Administration, Volume 39(3), pp.105-119, (2021). As more veterans return home from active duty with injuries or retire with disabilities and seek to reintegrate into the community, adaptive sport programming is an important recreational opportunity. Specifically, improved quality of life, more fluid community reintegration, positive psychosocial outcomes, and overall improved health are all stated benefits of participation in adaptive sport programs for individuals with disabilities. This program engaged veterans or members of the armed forces with disabilities in a unique university-based adaptive soccer camp experience with three main goals in mind: (1) to expose the veterans to the adaptive soccer sports of CP/TBI soccer and blind soccer, (2) to provide U.S. Soccer grassroots coach certification, (3) and to identify talent for the U.S. Soccer Paralympic National Team. In addition to facilitating this experience for veterans, we evaluated the camp program based on three main research questions: (1) How do injured military veterans and professionals serving veterans with disabilities evaluate satisfaction in an importance by performance analysis? (2) To what extent is a university-based VA Adaptive Sport Camp a promising setting for learning soccer related skills? and (3) What do injured military veterans and professionals serving veterans with disabilities identify as barriers to participation? Evaluation findings indicated that veterans wanted more information about coaching, the students, and additional community opportunities and were not concerned about the accommodations or food choices at camp, further highlighting the importance of the adaptive sport nature of the program itself. Veterans identified several camp elements that worked well in a university-based setting such as student interaction, scheduling, and balance between being a participant and learning coaching skills and would encourage other colleagues to attend in the future. Finally, participants identified perceived barriers to future participation were based largely on travel distance and costs. Subsequently, the programmers have sought to provide more programs around the country with partner agencies and in so doing, reduce travel time and costs. Overall, this programming model has significant promise for growth and has already provided results consistent with positive community reintegration and increased veteran participation in soccer-related activities, which can pave the pathway for more in-depth program analysis.
  • Pathways for Long-Term Physical Activity Participation for Military Veterans With a Physical Disability, opens in a new tab, Shirazipour CH; Latimer-Cheung AE, Adapted Physical Activity Quarterly, Volume 38(1), pp.1-24, (2021). A gap in knowledge exists regarding how to maintain physical activity (PA) for individuals with acquired disabilities following initial introductory experiences. The current study aimed to contribute to filling this gap by exploring the PA pathways of military veterans with a physical disability, particularly those who maintain long-term PA, from impairment to the present. Veterans with a physical disability (N = 18) participated in interviews exploring their PA history and experiences. A reflexive thematic analysis was conducted to generate common pathways in PA participation, as well as to examine which elements of participation supported PA maintenance. Three long-term pathways were identified—two parasport pathways and one recreational PA pathway. Four elements of participation (i.e., mastery, challenge, belongingness, meaning) supported to maintain PA at key junctures. This knowledge provides further understanding of how to promote long-term PA for individuals with acquired disabilities and can support advancements in theory, as well as program development.
  • Outdoor recreational activity experiences improve psychological wellbeing of military veterans with post-traumatic stress disorder: Positive findings from a pilot study and a randomised controlled trial, opens in a new tab, Mark Wheeler, Nicholas Cooper, Leanne Andrews, et al., PLOS One, (November 2020). Exposure to the natural environment is increasingly considered to benefit psychological health. Recent reports in the literature also suggest that outdoor exposure that includes recreational pursuits such as surfing or fishing coupled with opportunities for social interaction with peers may be beneficial to Armed Forces Veterans experiencing Post-Traumatic Stress Disorder (PTSD). Two studies were conducted to evaluate this possibility. In particular, these studies aimed to test the hypothesis that a brief group outdoor activity would decrease participants’ symptoms as assessed by established measures of PTSD, depression, anxiety and perceived stress, and increase participants’ sense of general social functioning and psychological growth. Experiment one employed a repeated measures design in which UK men and women military veterans with PTSD (N = 30) participated in a group outdoor activity (angling, equine care, or archery and falconry combined). Psychological measures were taken at 2 weeks prior, 2 weeks post, and at 4 month follow up. We obtained a significant within participant main effect indicating significant reduction in PTSD symptoms. Experiment two was a waitlist controlled randomised experiment employing an angling experience (N = 18) and 2 week follow up. In experiment 2 the predicted interaction of Group (Experimental vs. Waitlist Control) X Time (2 weeks pre vs. 2 weeks post) was obtained indicating that the experience resulted in significant reduction in PTSD symptoms relative to waitlist controls. The effect size was large. Additional analyses confirmed that the observed effects might also be considered clinically significant and reliable. In sum, peer outdoor experiences are beneficial and offer potential to complement existing provision for military veterans with Post Traumatic Stress Disorder.
  • Pilot randomized controlled trial of exercise training for older veterans with PTSD, opens in a new tab, Katherine Hall, Miriam Morey, Hayden Bosworth, et al., Journal of Behavioral Medicine, Volume 43, pp.648–659, (2020). Exercise training positively impacts mental health, yet remains untested in older adults with posttraumatic stress disorder (PTSD). We conducted a randomized controlled pilot trial to test the feasibility and acceptability of exercise training in older veterans with PTSD. Fifty-four veterans ≥ 60 years, with a DSM-V diagnosis of PTSD, were randomized to supervised exercise (n = 36) or wait-list (WL; n = 18). Primary outcomes included recruitment rates, attendance, satisfaction, and retention. Secondary outcomes included changes in PTSD symptoms, depression, health-related quality of life, and sleep quality; assessed at baseline and 12 weeks. There were no adverse events. Attrition was minimal (14%), and adherence to the exercise intervention was high (82%). Clinically significant improvements in PTSD and related conditions were observed following exercise. Exercise training is safe and acceptable in older adults with PTSD, may improve PTSD symptoms, and broadly impacts PTSD-related conditions. Future definitive trials are warranted.
  • ‘Sport was the centre of my memories’: the performance of sport in Australia’s Asian garrisons, opens in a new tab, Sean Brawley, Mathew Radcliffe, Sport in History, Volume 40(1), pp.28-55, (2020). For better or worse, sport mirrors and mediates much of everyday life. Within both the military and colonial spheres, the physical attributes of sport are especially prized as tangible representations of social and cultural hierarchies. In turn, this further enhances the prestige and influence of sport within these two particular environments. Sport becomes particularly potent in instances where military forces undertake garrison duties in overseas colonial and post-colonial environs. This paper highlights the centrality of sport to the lives of the Australian service personnel and their families who were posted to Australia’s garrisons in the decades after World War II. The myriad roles of sport within these overseas garrison environments – as comforter, connector, healer and reinforcer on the one hand, and as isolator, oppressor and subverter on the other – are explored. This paper suggests that, for a variety of reasons, participation in sports served as the central organising force for most Australian service personnel and their families in these Australian military communities.
  • A Longitudinal Examination of Military Veterans’ Invictus Games Stress Experiences, opens in a new tab, Gareth Roberts, Rachel Arnold, James Turner, Frontiers in Psychology, Volume 10, (August 2019). This study explored patterns of change in stress variables (i.e., stressors, appraisals, emotions) encountered by wounded, injured, and sick military veterans in the build up to, during, and following an international sporting competition. 40 Invictus Games (IG) athletes and a control group of 20 military veteran athletes completed questionnaires at seven time points over a 12-week period. Furthermore, participants provided morning and evening saliva samples at four time points to measure cortisol and secretory immunoglobulin A. Team and culture stressors and anger and dejection emotions significantly increased in the build up to competition, whilst challenge appraisals and excitement and happiness emotions significantly decreased over the same time-frame. A number of the stress related variables also predicted performance, well-being, and mental health. Specifically, organizational stressors and threat appraisals were found to negatively relate to performance, well-being, and mental health. Furthermore, whilst challenge appraisals and problem focused coping positively related to veterans’ well-being, adopting emotion-focused and avoidance coping strategies negatively predicted well-being and mental health. Turning to emotions, experiencing anger, anxiety, and dejection negatively related to mental health, well-being and performance; whereas happiness and excitement displayed a positive relationship with these outcomes. By understanding this study’s findings, practitioners and organizations can help to proactively prevent organizational demands and aid individuals in optimally responding and adapting to encounters, which can ultimately, help to mitigate negative outcomes and proliferate the positive outcomes for military veterans participating in competitive sport.
  • Insights Following Implementation of an Exercise Intervention in Older Veterans with PTSD, opens in a new tab, Michelle Pebole, Katherine Hall, International Journal of Environmental Research and Public Health, Volume 16(14), (July 2019). Individuals with post-traumatic stress disorder (PTSD) face numerous barriers to exercise. Little is known about behavioral strategies to promote participation in this population. This is a secondary analysis of individual barriers and goals, exercise prescription characteristics, and patient perceptions of the Warrior Wellness program, a pilot randomized controlled trial of a 12-week, community-based, randomized controlled exercise trial targeting older adults with PTSD, (N = 45; mean age = 68; male = 91%). The exercise sessions were held from 9:00–10:30 a.m. at a community-based fitness center located in close proximity to the Durham Veterans Affairs Medical Center (VAMC). Veterans exercised in a group, but each received their own prescription and completed it separately. The most common cited goals for participating included weight loss (65%) and increasing strength (65%). Exercise mode varied among those who completed the program (n = 37), with 14 (38%) using exclusively treadmill; eight (22%) using only bike, and 15 (41%) utilizing a combination. Patient-reported exercise duration and intensity progressively increased over the 12 weeks, and duration differed by mode of exercise. We observed high rates of attendance (84%) and completion (88%) to the program. Patient-reported barriers to attendance most often included health problems (62%) and medical appointments (55%). Participant responses to a program evaluation revealed high levels of satisfaction, preferences for group-based programs, and insights about the acceptability of the exercise environment (physical and social).
  • Can scuba diving offer therapeutic benefit to military veterans experiencing physical and psychological injuries as a result of combat? A service evaluation of Deptherapy UK, opens in a new tab, Alice Morgan, Harriet Sinclair, Alexander Tan, et al, Disability and Rehabilitation, Volume 41(23), pp.2832-2840, (2019). This study took the form of a service evaluation of Deptherapy, a UK-based niche charity offering support to military veterans who have experienced life-changing injuries. Deptherapy provides scuba diving qualifications, consisting of theory and practical diving experience, to participants alongside a Peer Support Buddy scheme that provides continuing support to servicemen involved with the charity. A total of 15 male veterans were invited to take part in the study. The methodology comprised retrospective and current quantitative measures of mental well-being and functional ability, utilising the General Health Questionnaire-28, and subsequent semi-structured interviews with participants, their families and health professionals. Participants reported an improvement in levels of anxiety, depression and social functioning, and a reduction in insomnia, following their involvement in organised scuba diving activities. There was a mean average difference of 14.3 points improvement on the General Health Questionnaire-28 scale variants between prior interaction with Deptherapy and current perceptions following engagement with the programme. The positive perceptions, as indicated from the semi-structured interviews, were more pronounced in those whose injuries were predominantly psychological, rather than physical. Scuba diving can offer significant therapeutic benefits, particularly for ex-military amputees experiencing co-morbid anxiety and/or chronic psychological adjustment disorders, notably in terms of improvements in social dysfunction and symptomology of depression.
  • Military-Tailored Yoga for Veterans with Post-traumatic Stress Disorder, opens in a new tab, Robin E Cushing, Kathryn L Braun, Susan W Alden, et al., Military Medicine, Volume 183(5-6), pp.e223-e231, (May-June 2018). Eighteen Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans completed the pre- and post-intervention self-report questionnaires. Age ranged from 26 to 62 yr (median = 43 yr), length of service ranged from 2 to 34 yr (median = 18.8 yr), and 13 (72.2%) had completed college. This study demonstrates that a trauma-sensitive yoga intervention may be effective for veterans with PTSD symptoms, whether as stand-alone or adjunctive therapy. The impressive decrease in PTSD symptomatology may be due to the tailored military-specific nature of this intervention and the fact that it was led by a veteran of post-9/11 conflicts. More research is needed with a larger sample and a more diverse veteran population.
  • Perception of Employment by the Veterans Participating in the National Veterans Wheelchair Games: A Survey Study, opens in a new tab, William Kim, Leah Lee, Daniel Lans, et al., PM&R, Volume 10(3), pp.263-268, (March 2018). A total of 50% of the participants stated that the NVWG made a difference in attaining employment. Those currently working were 1.5 times more likely to say that the NVWG had a positive effect on employment than those not currently working. Those who felt that the NVWG had a positive effect on employment attended 3-4 more wheelchair games on average than those reporting that the NVWG did not have an impact on employment. Positive responses were obtained from the Likert scale distribution. Our study suggests that participating in the NVWG provides psychosocial support to the veterans and may have a positive influence in employment outcomes.
  • Veterans Group Exercise: A randomized pilot trial of an Integrative Exercise program for veterans with posttraumatic stress, opens in a new tab, Lizabeth A. Goldstein, Wolf E. Mehling, Thomas J. Metzler, et al., Journal of Affective Disorders, Volume 227, pp.345-352, (February 2018). We developed a group-based Integrative Exercise (IE) program combining aerobic and resistance exercise, which is familiar to veterans, with mindfulness-based practices suited to veterans with PTSD. This study aimed to evaluate the effects of IE on PTSD symptom severity and quality of life, as well as assess the feasibility and acceptability of IE. Veterans (N = 47) were randomized to either IE or waitlist control (WL). Veterans in IE were asked to attend three 1-h group exercise sessions for 12 weeks. This initial study suggests that IE is an innovative approach to treating veterans with symptoms of PTSD that reduces symptoms of posttraumatic stress and improves psychological quality of life. This approach to recovery may expand the reach of PTSD treatment into non-traditional settings and to veterans who may prefer a familiar activity, such as exercise, over medication or psychotherapy.
  • Effects of therapeutic horseback riding on post-traumatic stress disorder in military veterans, opens in a new tab, Rebecca A. Johnson, David L. Albright, James R. Marzolf, et al., Military Medical Research, Volume 5, Article 3, (January 2018). Fifty-seven participants were recruited and 29 enrolled in the randomized trial. They were randomly assigned to either the horse riding group (n = 15) or a wait-list control group (n = 14). The wait-list control group experienced a 6-week waiting period, while the horse riding group began THR. The wait-list control group began riding after 6 weeks of participating in the control group. Participants had a statistically significant decrease in PTSD scores after 3 weeks of THR as well as a statistically and clinically significant decrease after 6 weeks of THR. Logistic regression showed that participants had a 66.7% likelihood of having lower PTSD scores at 3 weeks and 87.5% likelihood at 6 weeks. Under the generalized linear model, our ANOVA findings for the coping self-efficacy, emotion regulation, and social and emotional loneliness did not reach statistical significance. The results for coping self-efficacy and emotion regulation trended in the predicted direction. Results for emotional loneliness were opposite the predicted direction. Logistic regression provided validation that outcome effects were caused by riding longer.
  • Kripalu Yoga for Military Veterans With PTSD: A Randomized Trial, opens in a new tab, Kristen M. Reinhardt, Jessica J. Noggle Taylor, Jennifer Johnston, et al., Journal of Clinical Psychology, Volume 74(1), pp.93-108, (January 2018). Fifty-one participants were randomized into yoga or no-treatment assessment-only control groups. Primary outcome measures included questionnaires and the Clinician Administered PTSD Scale. Both yoga (n = 9) and control (n = 6) participants showed significant decreases in reexperiencing symptoms, with no significant between-group differences. Secondary within-group analyses of a self-selected wait-list yoga group (n = 7) showed significant reductions in PTSD symptoms after yoga participation, in contrast to their control group participation. Consistent with current literature regarding high rates of PTSD treatment dropout for veterans, this study faced challenges retaining participants across conditions. These results are consistent with recent literature indicating that yoga may have potential as a PTSD therapy in a veteran or military population. However, additional larger sample size trials are necessary to confirm this conclusion.
  • Association Between Adaptive Sports Programs and Quality of Life Among Amputee Veterans, opens in a new tab [Ph.D. thesis], Seay, Sean V., Walden Dissertations and Doctoral Studies, 4755, (2018). Adaptive sports programs (ASPs) are important for enhancing the physical, psychological, and social aspects of life for amputee combat veterans while reducing the risk of depression and anger. Although the role of ASPs in improving quality of life (QoL) has been researched in relation to amputee combat veterans of World War II, the Korean War, and the Vietnam War, there has been limited examination of the role of ASPs in improving QoL among veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation Noble Eagle (OND). Therefore, the purpose of this study was to assess the effects of ASPs on the QoL of amputee veterans of OEF, OIF, and OND using logistic regression as well as 3 surveys assessing QoL and life satisfaction in combat veterans who suffered traumatic amputations between 2003 and 2013. The dependent and independent variables included psychosocial and behavioral factors for those amputees who participated in an ASP versus those amputees who did not. There was a statistically significant association between gender and perception of overall health. Likewise, there was a statistically significant association between enjoying life and having a meaningful life and participation in an ASP. The findings indicate that participation in ASPs may help improve QoL and overall health for amputee veterans. Public health programs and policies aimed at improving the overall health and wellbeing of amputee veterans should consider ASPs as essential therapeutic interventions for promoting health in amputee veteran populations.
  • Exploring strategies used to deliver physical activity experiences to Veterans with a physical disability, opens in a new tab, Celina Shirazipour, Alice Aiken, Amy Latimer-Cheung, Disability and Rehabilitation, Volume 40(26), pp.3198-3205, (2018). Physical activity is an important method of rehabilitation used to promote positive physical and psychosocial outcomes among military personnel, including Veterans, with a physical disability. However, minimal research has explored physical activity program implementation strategies, particularly how these strategies may foster positive rehabilitation outcomes, and quality participation experiences among Veterans post-injury. The purpose of the current study is to document strategies used to deliver physical activity programs to Veterans with a physical disability. Semi-structured interviews were conducted with program staff from three Veteran physical activity programs, and program documentation was collected. Data were analyzed using a thematic analysis. Four themes were identified representing strategies used for delivering physical activity programming: (1) foster social connections; (2) challenge participants; (3) tailor programs and outcomes to match participant needs; and (4) include knowledgeable coaches/instructors.
  • The Effects of the Warrior Transition Unit’s Physical Activity Program on Affect of Wounded Military Personnel, opens in a new tab, Gwan Yon Hwang; Davis, Ron; Driver, Simon, Palaestra, Volume 32(1), pp.9-14, (2018). Warrior Transition Units (WTU) were created to successfully transition soldiers who are considered wounded, ill, or injured through comprehensive medical and adaptive reconditioning care, including sport and recreational activities. Entry-level sports engagement in WTU may transition from noncompetitive to competitive which may impact the soldier’s physical and emotional well-being status. The purpose of this study was to compare the differences in physical activity affect between two groups of wounded military personnel (N = 22) with WTU experience. Group 1 (NonCompWTU, n=11) engaged in on and off campus noncompetitive activities (e.g., rock wall climbing, community golf driving range) and Group 2 (CompWTU, n=11) competed in a wheelchair basketball tournament. Physical activity affect was measured using the physical activity affect scale ([PAAS], Lox et al., 2000) pre and post activities. The PAAS is a 12-item tool that measures 4 subscales (Positive Affect [PA], Negative Affect [NA], Tranquility [TR], and Fatigue [FA]). Independent and paired t-tests were used to determine differences across groups and pre-post activities (p <.05). Cohen’s D effect size (ES) was also reported. Results reported no statistical differences in PA, NA, TR, and FA across groups at the beginning of the activities; however, PA was significantly different across groups following the activities. The noncompetitive activities significantly increased PA and TR, while reducing NA from pre to post within Group 1. However, a significant increase between pre and post activities existed for FA within each group. While further study is needed to investigate the impact of the noncompetitive and competitive physical activity participation on affect of wounded military personnel, APA professionals should consider this challenge to improve the well-being of this population.
  • The Impact of Ocean Therapy on Veterans with Posttraumatic Stress Disorder: Final Technical Report and Summary, opens in a new tab, Russell Crawford, forOperation Surf, (2018). The purpose of this quantitative study was to determine the effect of nature-based therapy, an alternative form of treatment that focuses on the interaction of the individual and the environment, on combat veterans with PTSD. The focus was to determine if the therapy reduced PTSD symptoms, decreased depression and increased self-efficacy among veterans. Participants in Amazing Surf Adventure’s Operation Surf program were eligible to participate. Both men and women between the ages of 20 and 55 participated in this study. All participants were military combat veterans. A total of 113 subjects were contacted for participation, and 95 subjects responded to the survey. Their PTSD, depression and self-efficacy were measured using online surveys prior to the commencement of the therapy. The same veterans were surveyed using the same surveys at the end of the program and also 30 days after the program. This chapter firsts presents summary statistics of the collected data at each time point and then repeated-measures ANOVAs to answer the research questions and hypotheses. The chapter is concluded with a summary. Participants experienced an average 36% decrease in PTSD symptoms, a 47% decrease in depression, a 68% increase in self-efficacy.
  • The health and wellbeing needs of veterans: a rapid review, opens in a new tab, Candice Oster, Andrea Morello, Anthony Venning, et al., BMC Psychiatry, Volume 17, article 414, (December 2017). The current paper reports on the findings of a rapid review of the literature on the health and wellbeing needs of veterans, commissioned by the Australian Department of Veterans’ Affairs to inform future programs and services. A total of 21 systematic reviews were included. The reviews reported on a range of mental, physical and social health problems affecting veterans. While there was limited information on prevalence rates of physical, mental and social health problems in veterans compared to civilian populations, the reviews demonstrated the interconnection between these domains and the effect of demographic and military service factors. A key finding of the review is the interconnection of the mental, physical, and social health of veterans, highlighting the importance that an integrated approach to veterans’ wellbeing is adopted. It is suggested that understanding key factors, such as demographic factors and factors relating to military service, can support improved service provision for veterans.
  • This is your new normal: A qualitative study of barriers and facilitators to physical activity in Veterans with lower extremity loss, opens in a new tab, Alyson Littman, Erin Bouldin, Jodie Haselkorn, Disability and Health Journal, Volume 10(4), pp.600-606, (October 2017). Semi-structured interviews were conducted with male Veterans with a lower extremity amputation (LEA). Two raters analyzed interview transcripts using a qualitative descriptive approach, involving both a priori and emergent themes. Among the 27 male Veterans (mean age = 54 years) interviewed, facilitators to PA included acceptance of their limb loss, confidence (to try new activities or adapt activities), creating a daily routine involving PA, resources, supportive others, perceived benefit, and having a history of being physically active. Barriers to PA were illnesses/injuries, poorly-fitting prostheses, low self-efficacy, insufficient resources, unsupportive others, and hassle.
  • Investigation of the Impact of Sports, Exercise and Recreation (ser) Participation on Psychosocial Outcomes in a Population of Veterans with Disabilities Using the Sports Outcome Research Tool and Comprehensive Uniform Survey (Sportacus). A Longitudinal Study, opens in a new tab, Justin Laferrier, Emily Teodorski, Nathan Sprunger, et al., Journal of Novel Physiotherapies, Volume 7, (September 2017). A convenience sample of 163 individuals (91 sports-participants and 72 non-participants) matched on disability type with a variety of disabilities took part in this longitudinal study. Variables of interest were: SER participation vs. non-participation, years of SER participation since onset of disability (less than one year, one to five years, five to ten years, and more than ten years), the type of activity they engaged in (individual activities or a combination of team and individual activities) and time (pre-event, immediately post-event, one month post-event, and three months post-event). Main outcome measures were self-esteem, depression, posttraumatic growth and QOL. SER participants had significantly higher self-esteem, posttraumatic growth and QOL, and significantly lower depression scores than non-participants. There were also significant differences found between the independent variables of: time, number of years participating in SER since onset of disability and type of activity engaged in and various outcome measures studied.
  • Quality participation experiences in the physical activity domain: Perspectives of veterans with a physical disability, opens in a new tab, Celina Shirazipour, M. Blair Evans, Nick Caddick, et al., Psychology of Sport and Exercise, Volume 29, pp.40-50, (March 2017). Eighteen veterans (15 men, 3 women) with a physical disability were recruited using maximum variation sampling to take part in interviews. The interviews explored their PA experiences, with a focus on exploring participants' perspective of a quality PA experience. Data were analyzed using thematic analysis. Two overarching themes, elements of a quality experience and conditions enabling access to a quality experience, were identified. Within the overarching theme of elements of a quality experience, four key themes were identified: group cohesion, challenge, having a role, and independence and choice. A further three key themes (the physical and social environments, and program structure) were identified within the overarching theme of conditions for accessing the quality experience.
  • An Analysis of BBC Television Coverage of the 2014 Invictus Games, opens in a new tab, Shirazipour, Celina; Meehan, Madelaine; Latimer-Cheung, Amy, Adapted Physical Activity Quarterly, Volume 34(1), pp.33-54, (2017). The Invictus Games are a parasport competition for service members and veterans with illnesses and injuries. The 2014 Games were aired by the BBC, for a total of 12 hr of coverage. This study aimed to investigate what messages were conveyed regarding parasport for veterans during the BBC's Invictus Games broadcast. A content analysis was conducted. Five qualitative themes were identified: sport as rehabilitation, the promotion of ability over disability, the social environment, key outcomes of participation, and the importance of competition. Quantitative results indicated that 2 segment types accounted for the majority of the broadcast: sport coverage (50.57%) and athlete experiences (12.56%). Around half of the coverage focused on participants with a physical disability (51.62%). The findings demonstrate key similarities to and differences from previous explorations of parasport media coverage, with the needs of the event and athlete population potentially influencing the broadcast.
  • Exercise and Post-Traumatic Stress Disorder in Military Veterans: A Systematic Review, opens in a new tab, James W. Whitworth, Joseph T. Ciccolo, Military Medicine, Volume 181(9), pp.953-960, (September 2016). The purpose of this review was to (1) provide the rationale for the use of exercise in the treatment of veterans with PTSD and (2) systematically review studies examining the relationship between exercise and PTSD in military veterans. A search of electronic databases (PubMed, PsycINFO, and Web of Science) for relevant studies published in print or online from January 1980 to September 2015 produced 204 unique articles and 13 relevant studies (9 observational studies, 2 experimental, and 2 qualitative). Results of these initial studies are promising and suggest that regular exercise is inversely correlated with PTSD and its symptoms in military veterans. However, the longitudinal effect of exercise on PTSD in military veterans remains unclear because the current research lacks a common focus and suffers from several methodological limitations.
  • Female Veterans' Involvement in Outdoor Sports and Recreation: A Theoretical Sample of Recreation Opportunity Structures, opens in a new tab, Neil Lundberg, Stacy Taniguchi, Rachel McGovern, et al., Journal of Leisure Research, Volume 48(5), pp.413-430, (2016). Previous research has recognized the need to better understand the experience of female veterans and their adjustment upon returning home, especially considering that a growing number of veterans are women. Their stories, particularly as they relate to combat and the associated wounds of war, largely remain untold. Therefore, the purpose of this project was to employ a theoretical sample from Grounded Theory methodology to determine if similar recreation opportunity structure patterns existed in the use of outdoor sports and recreation for a sample of female veterans, as had been found in previous research with individuals with physical disabilities. The investigation revealed findings that substantiated the way in which recreation opportunity structures provide novel environments where physical skills and emotional capacities could be developed through (a) establishing social networks and bonding, (b) facilitating a sense of freedom from constraints, and (c) by providing opportunities to redefine or recapture their identity.
  • Physical and social factors determining quality of life for veterans with lower-limb amputation(s): a systematic review, opens in a new tab, Jan Christensen, Thomas Ipsen, Patrick Doherty, et al., Disability and Rehabilitation, Volume 38(24), pp.2345-2353, (2016). The literature search identified 2073 citations, leading to the inclusion of 10 studies in the systematic review. Physical activity level, sport participation, level of amputation, back pain, years of education, as well as duration and severity of phantom pain were found to be determining factors for HRQoL among veterans with lower-limb amputation. Conclusions: The identified physical and social determinants were similar to those found in civilian traumatic amputees. More high quality research designs, interventions and complex statistical analyses are warranted to identify the physical and social factors that influence the HRQoL of veteran amputees.
  • Values-Based Sport Programs and Their Impact on Team Success: The Competitive Sport Model at the United States Military Academy, opens in a new tab, Ralph Pim, International Sport Coaching Journal, Volume 3(3), pp.307-315, (2016). The purpose of this paper is to examine the values-based competitive sport program at the United States Military Academy (West Point), and to determine if the components of character and leadership development were associated with team success. Strategies employed at West Point to develop cultures that produced leaders of character and teams of significance were reviewed. Major points of emphasis in the competitive sport program included (i) teaching values through sport, (ii) identifying and defining core values, (iii) developing warrior athletes of character, (iv) building teams and cultures of significance, (v) reinforcing values through recognition, and (vi) assessing character and leader development of athletes and teams. Characteristics and specific behaviors of great leaders and teams were identified. A rubric for assessing character and leader development in sport and a survey evaluating the competitive sport experience on the desired learning outcomes of the West Point Cadet Leader Development System were presented. Results indicated that competitive sports programs built on values encouraged and developed behaviors that produced success both on and off the field. Subsequent investigations are recommended to identify how character and leadership development can be integrated into the coaching process and applied in civilian secondary schools and institutions of higher learning.
  • Changes in Meeting Physical Activity Guidelines After Discharge From the Military, opens in a new tab, Alyson Littman, Isabel Jacobson, Edward Boyko, et al., Journal of Physical Activity and Health, Volume 12(5), pp.666-674, (2015). Using data from 28,866 Millennium Cohort Study participants (n = 3782 of whom were discharged during the years between assessments), we 1) investigated changes in meeting federal PA guidelines for moderate-to-vigorous activity (MVPA) following military discharge and 2) determined predictors of meeting these guidelines after discharge. MVPA declined more in those who were discharged than in those who were not (−17.8 percentage points vs. −2.7 percentage points), with greater declines in former active-duty personnel, those who had deployed with combat exposures, had 14 to 25 years of service, and had been discharged more recently (>2 years prior). In those who were discharged, being normal or overweight (vs. obese), and a nonsmoker or former smoker (vs. current smoker) were positively associated with meeting MVPA Guidelines at follow-up, while meeting MVPA Guidelines at baseline and depression were inversely associated. Reductions in MVPA were substantial and unexpected. Increased understanding of transitional periods that may benefit from interventions to mitigate declines in PA will help prevent excess weight gain and physical inactivity-associated health consequences.
  • Investigation of the Impact of Sports, Exercise, and Recreation Participation on Psychosocial Outcomes in a Population of Veterans with Disabilities: A Cross-sectional Study, opens in a new tab, Laferrier, Justin; Teodorski, Emily; Cooper, Rory A., American Journal of Physical Medicine and Rehabilitation, Volume 94(12), pp.1026-1034, (December 2015). Two hundred twenty service members/veterans with disabilities who were participants in one of three annual adaptive sporting events took part in this cross-sectional study. Variables of interest were years of sport, exercise, and recreation participation since the onset of disability as well as the type of activity they engaged in. Main outcome measures were self-esteem and quality-of-life. A positive relationship was found between participant quality-of-life and the number of years spent participating in sports, exercise, and recreation since the onset of their disability. A significant difference was found between pre-event and postevent self-esteem scores. A significant difference was also found in self-esteem scores between the levels of years of participation in sports, exercise, and recreation when averaged across activity type. Finally, there were significant differences found on self-esteem scores between the levels of type of activity averaged across years of participation. Our results indicate that participation in sports, exercise, and recreation has a positive influence on self-esteem and quality-of-life in individuals with disabilities.
  • The Effects of Surfing and the Natural Environment on the Well-Being of Combat Veterans, opens in a new tab, Nick Caddick, Brett Smith, Cassandra Phoenix, Qualitative Health Research, Volume 25(1), pp.76-86, (2015). Although researchers have identified the benefits of physical activity on well-being, there is little evidence concerning the effects of nature-based physical activity. We investigated the effect of one nature-based activity—surfing—on the well-being of combat veterans experiencing posttraumatic stress disorder (PTSD). We conducted interviews and participant observations with a group of combat veterans belonging to a United Kingdom-based veterans’ surfing charity. Our primary analytical approach was dialogical narrative analysis. Based on our rigorous analysis and findings, we suggest that surfing facilitated a sense of respite from PTSD. Respite was a fully embodied feeling of release from suffering that was cultivated through surfing and shaped by the stories veterans told of their experiences. We significantly extend previous knowledge on physical activity, combat veterans, and PTSD by highlighting how nature-based physical activity, encapsulated in the conceptual notion of the “blue gym,” can promote well-being among combat veterans.
  • Identifying contextual influences of community reintegration among injured servicemembers, opens in a new tab, Brent Hawkins, Francis McGuire, Sandra Linder, et al., Journal of Rehabilitation Research and Development, Volume 52(5), pp.527-542, (2015). This study presents the second phase of a larger explanatory sequential mixed-methods study that sought to understand the influence of contextual factors on community reintegration (CR) among injured, community-dwelling servicemembers. Factors that had an indirect but important influence on CR, including adapted sports, recreation, and other social programs; rehabilitation programs and therapists; school, work, and volunteering; and organizations and policies in developing social supports and personal factors. Comparisons between servicemembers indicated that participants with low CR described many more contextual barriers and far fewer contextual facilitators to reintegration than those with high CR. Those with moderate CR were unique in that they described many facilitators and barriers to reintegration. Adapted sports, recreation, and other social programs were discussed very frequently and with high regard as facilitators of CR. These programs were examples of participation in community activities, yet these events and programs served a larger purpose than mere participation. Programs were the vehicle for CR through which development of social supports, self-efficacy, and other personal factors were gained. They helped establish connections with other people (e.g., other servicemembers, injured civilians) and provided participants with opportunities to push personal boundaries and realize their own potential. Participants who discussed frequent participation in these events discussed these psychosocial benefits. Specific to adapted sports, some participants described participation as highly influential to CR.
  • Addressing Posttraumatic Stress Among Iraq and Afghanistan Veterans and Significant Others: An Intervention Utilizing Sport and Recreation, opens in a new tab, Bennett, Jessie L; Lundberg, Neil R; Zabriskie, Ramon, et al., Therapeutic Recreation Journal, Volume 48(1), pp.74-93, (2014). The purpose of the study was to evaluate the effectiveness of an existing "couples" adaptive sport and recreation program called Higher Ground developed by Sun Valley Adaptive Sports to reduce symptoms of PTSD, facilitate posttraumatic growth, and enhance marital satisfaction for veterans with PTSD and their significant others. The sample consisted of two experimental groups (Group A five couples, Group B six couples) and a control group (six couples). This study identified important findings suggesting that couples' sports and recreation programs can be used to reduce PTSD symptoms and increase marital adjustment and satisfaction. More specifically, the findings suggest that the combination of processing themes through discussion and journaling, learning a recreational activity that requires focus, and having a trained staff that can provide a positive recreational experience may help to address the PTSD symptoms of re-experiencing, hyperarousal, and avoidance/ emotional numbing. A recreation experience's ability to distract, aid in the development of meaningful relationships, produce positive emotions, and enhance perceptions of competence (Kleiber, et al., 2002), appears to be relevant to the sport and recreation participation of veterans and their significant others.
  • Enhancing the well-being of veterans using extended group-based nature recreation experiences, opens in a new tab, Jason Duvall, Rachel Kaplan, Journal of Rehabilitation Research and Development, Volume 51(5), pp.685-696, (2014). Physical and mental health issues associated with military service persist as challenges for many veterans. This study draws on existing research showing the value of engaging in nature-based recreation to examine the effects of such experiences on veterans specifically. Four organizations, offering 12 different programs each lasting 4–7 d, were included in the study. Examples of included activities were fishing, kayaking, whitewater rafting, backpacking, hiking, mountain biking, paddle boarding, canoeing. Ninety-eight veterans were recruited and surveyed 1 wk before, 1 wk after, and approximately 1 mo after participating in these extended group-based outdoor experiences. In addition to background information, the survey instrument assessed changes in psychological well-being, social functioning, and life outlook. The results showed significant improvements in each of these domains 1 wk after the outdoor experience. Some improvements persisted over the next month, but to a lesser degree. The positive changes were particularly strong for veterans who initially reported more severe ongoing health issues. Overall, the findings suggest that extended group-based nature recreation experiences that bring veterans together can have significant positive effects on veterans struggling with serious health problems.
  • The impact of sport and physical activity on the well-being of combat veterans: A systematic review, opens in a new tab, Nick Caddick, Brett Smith, Psychology of Sport and Exercise, Volume 15(1), pp.9-18, (January 2014). A systematic review was conducted. The question guiding this review was ‘what is the impact of sport and physical activity on the well-being of combat veterans?’ 11 studies were identified as relevant for inclusion. Data from these studies were extracted by means of a directed content analysis, the results of which were reported in a narrative synthesis. Sport and physical activity enhances subjective well-being in veterans through active coping and doing things again, PTSD symptom reduction, positive affective experience, activity in nature/ecotherapy, and quality of life. Impact on psychological well-being includes determination and inner strength, focus on ability and broadening of horizons, identity and self-concept, activity in nature/ecotherapy, sense of achievement/accomplishment, and social well-being. Participating in sport and/or physical activity can also enhance motivation for living.

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