Physical activity (PA) is a promising intervention for substance use disorder (SUD), new research suggests.
Investigators reviewed 43 studies encompassing over 3000 patients with any SUD (excluding tobacco), and 75% reported a decrease in substance use following a PA intervention.
In addition, close to three quarters of studies also showed improvements in aerobic capacity, and a little over 25% reported a drop in participants’ depressive symptoms.
“The majority of studies show that physical activity during SUD treatment increases physical fitness, improves psychological health in terms of depression and anxiety, and decreases substance abuse, and no negative consequences were observed in any of the studies,” study investigator Florence Piché, MSc, a doctoral candidate at the University of Montreal, told Medscape Medical News.
“The take-home message for practicing clinicians and patients is that PA is feasible during treatment and beneficial to health, both globally and specifically for SUD symptoms,” she said.
The study was published online April 26 in PLoS One.
New Options Needed
SUD treatments tend to have poor adherence and high relapse rates, the investigators note, so “finding new ways to improve SUD treatment is a primary target for future research.”
PA has recently been investigated as a therapeutic tool for serious mental illness, so the investigators looked at whether it might also be an option for SUD.
Existing research includes that “prevent clear conclusions from being drawn.” For example, most research has focused on tobacco, so results may not be generalizable to other SUDs.
Some reviews focus on a single substance (eg, alcohol), excluding studies that look at the impact of PA in users of multiple substances, which constitute a large proportion of patients with SUDs in clinical settings.
To address these research gaps, investigators systematically reviewed PA interventions for adults undergoing SUD treatment, including all psychoactive substances except for studies focusing only on tobacco.
They searched seven databases for papers published from inception to May 2022. To qualify, a study had to include adults ≥ 18 years of age following a treatment for SUD (excluding tobacco) and receiving a PA intervention conducted in person over the course of more than one session.
The researchers looked at three outcomes: physical fitness and body composition, psychological outcomes, and behavioral factors and social environment.
The analysis included 43 studies with a total of 3135 participants. Most studies (81%) had a randomized controlled design, whereas others included pre-post designs or were cohort studies.
Although most studies included both male and female participants (58%), some included only men or only women and three studies did not specify participants’ sex.
Alcohol was the most commonly studied substance, followed by methamphetamine; all substances; and amphetamine, stimulants, cocaine, cannabis, heroin, and general “problem substances.”
Most studies (65%) had a “high presence of bias.”
The mean reported frequency of exercise was 3.4 ± 1.3 times per week, with a mean intervention duration of 12.9 ± 10.7 weeks and a mean duration of 51.7 ± 12.5 minutes per session (although 28% of studies did not provide session duration).
Jogging was the first choice of PA (35%), and in several studies, it was combined with cycling, resistance exercise, elliptical training, yoga, jump rope, ball games, and walking.
The second most common activity was resistance exercise (33%), also combined with aerobic, cycling, or occasional sporting events. Other forms of PA included tai chi, yoga, walking, and softball.
Of the physical fitness outcomes, the most studied was aerobic capacity (33%), followed by muscular capacity (23%) and heart rate and blood pressure (23%). Other outcomes included weight and body mass index. Craving was included as a “physical fitness outcome” in 19% of studies.
Aerobic capacity improved significantly in 71% of the studies that examined it, muscular capacity improved in 60%, and blood pressure and heart rate in 30% and 60%, respectively. Craving was improved in 60% of studies that included it as an outcome.
More than 63% of the studies included psychological outcomes. Half of those that examined depressive symptoms found improvement following the intervention, and 71% showed improvement in anxiety symptoms.
Body satisfaction and mood were significantly improved in all studies, whereas improvements were found in 33% of the studies on self-concept and in half the studies regarding executive function.
Of the 21 studies that looked at life domain outcomes, three quarters found significant decreases in substance use; all reported improvement in sleep quality, and 80% reported improvements in health-related quality of life.
Most studies didn’t mention adherence to PA, “making it difficult to measure its impact on the participant and to compare one participant to another.” Moreover, most studies excluded people with psychiatric comorbidities.
Nevertheless, the results “suggest that there is promising evidence indicating that PA can be beneficial for these patients,” the authors note.
The authors recommend that future studies should include participants with psychiatric comorbidities and that PA adherence be monitored and reported.
Purpose, Meaning, Discipline, Grit
Commenting for Medscape Medical News, Jeremiah Weinstock, PhD, professor in the clinical program and chair of the Department of Psychology at Saint Louis University, St. Louis, Missouri, acknowledged that exercise has potential as a component of addiction treatment.
For many, “exercise adds purpose and meaning to their life as it is a means of taking care of one’s body, working toward health and well-being, and is consistent with their goals and values,” said Weinstock, who was not involved in the study.
Some practitioners may be “uncomfortable” prescribing exercise “due to a lack of familiarity with what and how to prescribe exercise.” Or they may have questions regarding the safety of exercise, so Weinstock advises “starting small” (with walking) and then “working toward the public health guidelines for PA.”
Also commenting for Medscape Medical News, Jason Kirby, DO, MBA, chief medical officer at Landmark Recovery, said that the “clear correlation with healthy functioning should prompt most addiction specialists doing this work to incorporate a solid exercise regimen into their patients’ treatment plans.”
Kirby, an addiction specialist and CrossFit coach, said he always “incorporates healthy eating and moving bodies” when working with his patients.
“Fitness, much like a recovery community, teaches discipline, grit, consistency, and delayed gratification, all of which people in early recovery need to adopt into their ethos to get better at using substances compulsively,” he said.
“Since most patients in early recovery have problems with emotional regulation, healthy fitness regimens can be a positive outlet to focus negative emotions and harness positive ones,” added Kirby, who was not involved with the study.
Piché was supported by a Fonds de Recherche du Québec-Santé doctoral fellowship, and she received funding from CICC (Centre international de criminologie comparé) for the translation of the article. The authors, Weinstock, and Kirby declare no relevant financial relationships.
PLoS One. Published online April 26, 2023. Full text
Batya Swift Yasgur, MA, LSW, is a freelance writer with a counseling practice in Teaneck, New Jersey. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-oriented health books as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom (the memoir of two brave Afghan sisters who told her their story).
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