Determining the Benefits of Exercise on Cardiovascular Risk in PTSD

Inclusion Criteria:

* Age 18-65 years
* Trauma exposure
* PTSD symptoms
* Subclinical atherosclerotic CVD (e.g., coronary, cerebrovascular, or peripheral arterial plaque or calcifications on imaging), clinical atherosclerotic CVD (e.g., myocardial infarction or revascularization), or increased risk for atherosclerotic CVD (i.e., \>2 of hypertension, diabetes mellitus, hyperlipidemia, and active smoking)
* Ability to understand and sign informed consent

Exclusion Criteria:

* History of stroke, brain surgery, or seizure
* Use of certain CVD medications (e.g., beta-blockers, high-intensity statins \[e.g., rosuvastatin 20/40 mg and atorvastatin 40/80 mg\], PCSK-9 inhibitors)
* Psychiatric or cardiovascular medication change within 4 weeks (i.e., stable regimen is allowed)
* Unstable blood pressure or cardiac arrhythmia
* Currently in a supervised or graduated exercise program
* Neurological or systemic inflammatory disease/current systemic anti-inflammatory therapy
* Moderate/severe alcohol/substance use disorder
* Current mania/psychosis
* Weight \>300 lbs.
* Claustrophobia
* Pregnancy
* Metal implants
* Uncontrolled hyperglycemia (HgbA1c\>7.5%)
* Subjects who have had significant radiation exposure as part of research (\>2 nuclear tests, computed tomography images, or fluoroscopic procedures) during the preceding 12-months