Exercise-based interventions for substance abuse populations are a topic of interest in research and clinical practice. However, a new scientific review argues that the wide number of methodological concerns and knowledge gaps in the literature prevents the development of clinical recommendations. The paper has been published in the journal Mental Health and Physical Activity.
The objective of the new scientific review was to summarize the evidence regarding the effectiveness of exercise-based interventions in altering psychological symptoms, substance use outcomes, and quality of life in adults with substance abuse or dependence. Substance abuse and dependence are significant public health concerns, with high prevalence rates and alarming suicide and mortality rates.
These conditions are characterized by compulsions, chronic relapse, and often co-occur with other disorders such as chronic pain or mental illnesses. Psychological symptoms and substance abuse outcomes are challenging to manage in these populations, leading to a negative impact on their quality of life, as well as economic, judicial, and health systems.
Exercise has been suggested as a potential intervention to help individuals with substance abuse or dependence. Regular physical activity may improve their self-discipline and help them cope with their symptoms.
“My main research lines are associated with the role that psychological (i.e., self-efficacy) and spiritual (i.e., meaning in life) factors play in the self-perception that individuals with chronic pain, cancer, or mental health issues have about their well-being, including factors such as self-perceived happiness and life satisfaction,” said study author Javier Martínez-Calderón, an assistant professor at the University of Seville and co-founder of the Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group.
“In this sense, I strongly believe that exercise-based interventions such as mind-body exercises or whatever type of exercise that we can practice may be very useful for people to know their physical bodies better, which I feel can help them to be more connected with themselves and improve their mental health. Concretely, I am very interested in the field of addictions because many people with any of these chronic disorders often succumb to the abuse of substances (i.e., opioids) to try to handle the course of their illness.”
Previous systematic reviews have examined the effectiveness of exercise-based interventions, with some showing promising results. However, it is still unclear which type of exercise is most beneficial for specific populations and which psychological symptoms or substance abuse outcomes can be effectively addressed through exercise.
The researchers conducted a comprehensive search of multiple databases. The eligibility criteria were based on the PICOs framework (Patient, Intervention, Comparison, Outcome, Study design). They included systematic reviews that evaluated exercise-based interventions in adults with substance abuse or dependence and co-occurring disorders, using any type of exercise.
The researchers screened 314 titles and abstracts and selected 18 systematic reviews that met the eligibility criteria. These systematic reviews included a total of 53 meta-analyses and 103 distinct clinical trials.
“A high number of clinical trials have evaluated the potential effectiveness of exercise-based interventions in this population. I felt very surprised and happy to observe how the potential benefits that physical activity may offer people with mental health issues are becoming to be demonstrated through clinical research,” Martínez-Calderón told PsyPost.
Exercise-based interventions were often represented using global terms such as “exercise” or “physical activity,” while populations and outcomes of interest were represented using terms like mental health, anxiety, depression, or smoking.
It remained unclear which type of exercise (e.g. aerobic exercises, yoga-based interventions, strength exercises, or resistance exercises) was most effective for each substance abuse population, and the specific exercise interventions that produced the highest benefits for different psychological symptoms or substance abuse outcomes. “In this context, it is practically impossible to recommend health professionals a specific type of exercise,” the researchers wrote.
The researchers also found several methodological concerns and gaps in knowledge. The methodological quality of the systematic reviews was generally judged to be critically low, with issues such as lack of transparency in study selection and the need for supplementary files listing excluded studies.
“Clinical trials covering this topic seem to show promising results to improve several outcomes (i.e., psychological symptoms) in individuals that present some abuse/dependence on substances,” Martínez-Calderón explained. “However, systematic reviews that summarized this primary evidence showed many methodological flaws, and thus, readers should be very cautious with the conclusions mentioned in these systematic reviews.”
The researchers emphasized the need for future research to focus on improving the quality of systematic reviews and increasing the number of high-quality clinical trials. They also called for the use of the GRADE approach in all meta-analyses to provide better understanding of the conditions under which clinical recommendations are made.
“Mostly, systematic reviews need to add the evaluation of the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach,” Martínez-Calderón told PsyPost. “This is probably the gold standard tool to judge the certainty of those outcomes that are evaluated in systematic reviews, which is essential to implement clinical research in the clinical setting.”
“The synthesis of the evidence in the field of mental health and physical activity needs to be improved,” the researcher added. “Concretely, the methodological quality of systematic reviews with meta-analysis. We have conducted two further overviews covering exercise for schizophrenia and exercise for posttraumatic stress disorders that we have tried to publish where we have found similar methodological issues that we observed in the present overview.”
The paper, “Evidence level of physical exercise in the treatment of substance abuse/dependence: An overview of systematic reviews including 53 meta-analyses that comprised 103 distinct clinical trials“, was authored by Javier Martinez-Calderon, Olga Villar-Alises, Cristina García-Muñoz, and Javier Matias-Soto.
