Exercise and Physical Activity in the Therapy of Substance Use Disorders

Exercise and physical activity are constantly gaining attention as adjuvant treatment for substance use disorders, supplementing classical pharmacological and psychotherapeutic approaches. The present work reviews studies addressing the therapeutic effects of exercise in alcohol abuse/dependence, nicotine abuse/dependence, and illicit drug abuse/dependence. In the field of smoking cessation, evidence is strong for exercise as an effective adjuvant treatment, whereas no generalizable and methodologically strong studies have been published for alcohol and drug treatment so far, allowing only preliminary conclusions about the effectiveness of exercise in these disorders. A couple of potential mechanisms are discussed, by which exercise may act as an effective treatment, as well as future directions for studies investigating exercise as a treatment strategy for substance use disorders

A systematic review of physical activity correlates in alcohol use disorders

Background: Physical activity might promote mental and physical health in persons with alcohol use disorder. Understanding the barriers and facilitators of participation in physical activity in persons with alcohol use disorder is an essential first step in order to devise effective physical activity interventions. Objective: The present review provides a systematic quantitative review of the correlates of physical activity in people with alcohol use disorder. Methods: Major electronic databases were searched by two independent authors from inception till June 2014. Keywords included ‘physical activity’ or ‘exercise’ and ‘alcohol dependence’ or ‘alcohol abuse’ or ‘alcohol use disorders’ or ‘alcoholism’. Results: Five papers evaluating 14 correlates were included. Three studies reported that alcohol dependence was unrelated to physical activity behavior, while alcohol abuse showed positive associations in 2 studies. No demographic variable was related with physical activity participation. Functional impairments and distress associated with alcohol use disorders including increased smoking rates, obesity, anxiety, depression and a lower self-efficacy may limit one’s ability to be physically active. Data on social, environmental and policy related factors are currently lacking. No included study assessed physical activity levels utilizing objective measurements (e.g. pedometers, accelerometers). Conclusion: Although the literature on physical activity correlates in persons with alcohol use disorder still is equivocal, our varied findings support the hypothesis that the participation in physical activity by people with alcohol use disorder is determined by a range of complex factors

Self-Concept and Physical Activity: Differences Between High School and University Students in Spain and Portugal

The period of adolescence stands out as a critical and decisive phase, first because it leaves its mark on personality development, which is affected by psychosocial factors, and second because the healthy lifestyle habits acquired during this stage form a foundation for adulthood. The objective of the present study was first to evaluate the levels of participation in physical activities (PA) and of self-concept in high school and university students, and second to find relationships between these psycho-physical variables. Four hundred and forty adolescents ranging in age from 16 to 20 years, from Spain and Portugal, participated in this study (cross-sectional design). The IPAQ and Self-Concept Form-5 questionnaires were used. The results demonstrated some differences; the Portuguese university students had lower scores in the academic, emotional and physical dimensions and vigorous PA but higher sitting time, walking and moderate PA compared to Portuguese high school students. In addition, Spanish university students had lower self-concept scores although higher practice of PA and lower sitting time than Spanish high school students (p < 0.05). On the other hand, a positive relationship was found between different dimensions of self-concept and levels of PA, while the relationship between these dimensions and the time the adolescent spent sitting was negative. In conclusion, the university students have lower scores of self-concept dimensions (in general), and the practice of PA is higher in Spanish university students, confirming the clear presence of differences between both educational stages. The relationship between the dimensions of self-concept in general and the level of PA was positive (following the contributions of Marsh)

Physical activity and the prevention, reduction, and treatment of alcohol and/or substance use across the lifespan (The PHASE review): protocol for a systematic review

Alcohol and substance use results in significant human and economic cost globally and is associated with economic costs of £21 billion and £15billion within the UK, respectively, and trends for use are not improving. Pharmacological interventions are well researched, but relapse rates across interventions for substance and alcohol use disorders are as high as 60–90%. Physical activity may offer an alternative or adjunct approach to reducing rates of alcohol and substance use that is associated with few adverse side effects, is easily accessible, and is potentially cost-effective. Through psychological, behavioural, and physiological mechanisms, physical activity may offer benefits in the prevention, reduction, and treatment of alcohol and substance use across the lifespan. Whilst physical activity is widely advocated as offering benefit, no systematic review exists of physical activity (in all forms) and its effects on all levels of alcohol and substance use across all ages to help inform policymakers, service providers, and commissioners.Alcohol and substance use results in significant human and economic cost globally and is associated with economic costs of £21 billion and £15billion within the UK, respectively, and trends for use are not improving. Pharmacological interventions are well researched, but relapse rates across interventions for substance and alcohol use disorders are as high as 60–90%. Physical activity may offer an alternative or adjunct approach to reducing rates of alcohol and substance use that is associated with few adverse side effects, is easily accessible, and is potentially cost-effective. Through psychological, behavioural, and physiological mechanisms, physical activity may offer benefits in the prevention, reduction, and treatment of alcohol and substance use across the lifespan. Whilst physical activity is widely advocated as offering benefit, no systematic review exists of physical activity (in all forms) and its effects on all levels of alcohol and substance use across all ages to help inform policymakers, service providers, and commissioners

Modulation der Belohnungsverarbeitung und Stressreaktivität als potentielle Wirkmechanismen

Based on a large number of cross-sectional and longitudinal epidemiological studies, the World Health Organization recommends regular physical activity for the maintenance of mental health. However, evidence is more heterogeneous regarding the therapeutic effects of exercise interventions in mental disorders. Beneficial effects of exercise in Major Depression (and some anxiety disorders) were subject to numerous reviews and meta-analyses, but there appears to be less evidence for other, similarly prevalent groups of mental disorders, e.g. substance use disorders. Several psychological and neurobiological mechanisms have been suggested to underlie the positive effects of exercise: enhanced neural plasticity, improved coping, mood enhancement, self-efficacy, reduced stress reactivity and altered reward processing. Hence, the aims of this dissertation are twofold: first, to systematically review clinical studies on the therapeutic effects of exercise in different mental disorders, especially substance use disorders. Second, to use functional magnetic resonance imaging (fMRI) to investigate exercise- induced alterations in reward processing and stress reactivity. For this thesis, two systematic literature reviews summarized and compared evidence from different groups of mental disorders. While meta-analyses revealed small, but clinically relevant positive effects of exercise in the treatment of depression and smoking, evidence from randomized-controlled trials was sparse for most other groups of disorders. Many studies also suffer from severe methodological limitations. Therefore, more systematic and methodologically sound research is necessary before exercise can be recommended as a general treatment for mental disorders. For the investigation of reward processing and stress reactivity, two fMRI paradigms were applied to highly trained and sedentary young men who had performed either 30 minutes of moderate intensity exercise or “placebo” exercise. The effects ofhabitual exercise training and acute bouts of aerobic exercise on reward processing and stress reactivity were analyzed, as well as their interactions. In both fMRI paradigms (a monetary incentive delay task and a psychosocial stress task), the acute effects of exercise were found to be stronger than chronic effects. More precisely, participants who had exercised prior to the fMRI experiments showed a decreased neural response of the ventral striatum during reward anticipation and feedback. During the psychosocial stress task, a diminished cortisol stress response and a higher tonic brain activation in the bilateral hippocampus and lower tonic brain activation in the anterior cingulate cortex were found. This supports the theoretical frameworks of the cross-stressor adaptation hypothesis and tonic-phasic dopamine hypothesis, suggesting that acute exercise activates the dopaminergic reward system and the hypothalamus- pituitary-adrenal axis in a sustained way (i.e. more than one hour after exercise cessation), which has an impact on the phasic activation of the respective system. In contrast, we found no or little differences between trained and untrained men. Transferred to the context of mental disorders, these results suggest that positive long-term outcomes of exercise interventions may in large part rely on accumulated acute effects. As a consequence, exercise could be used as an active coping strategy for substance craving or upcoming stressful situations. To summarize, the findings of this thesis provide an overview on exercise as an (adjunct) treatment for mental disorders and depict a number of gaps in the literature. Additionally, they add to the understanding of mechanisms by which acute exercise influences reward processong and stress reactivity.Auf der Grundlage zahlreicher epidemiologischer Quer- und Längsschnittstudien empfiehlt die Weltgesundheitsorganisation (WHO) regelmäßige körperliche Aktivität zur Prävention psychischer Störungen. Bezüglich der therapeutischen Effekte von Sport bei psychischen Störungen liegen bereits Übersichtsarbeiten und Metaanalysen für Depression und einige Angststörungen vor, weniger jedoch für andere psychische Störungen mit ebenfalls hoher Prävalenz (z.B. Suchterkrankungen). Als Wirkmechanismen von Sport werden unter anderem eine erhöhte neuronale Plastizität, Stimmungsverbesserung und Steigerung der Selbstwirksamkeit diskutiert. Auch die Belohnungsverarbeitung und Stressreaktivität, die bei psychischen Störungen Dysregulationen aufweisen, werden durch Sport moduliert. Ziel dieser Dissertation ist ein systematischer Überblick über Sportinterventionen bei psychischen Störungen, v.a. bei den bislang in der Literatur vernachlässigten substanzgebundenen Störungen. Zusätzlich sollen mit Hilfe funktioneller Bildgebung sportinduzierte neuronale, subjektive und psychoneuroendokrine Veränderungen der Belohnungs- und Stressverarbeitung untersucht werden. Zur Beantwortung des ersten Themenkomplexes wurden zwei systematische Literaturübersichten angefertigt, deren erste sich auf den Vergleich der vorliegenden Evidenzgrade für den Einsatz von Sport bei unterschiedlichen Störungsgruppen konzentriert, die zweite auf substanzgebundene Störungen. Während für Depression und Rauchen kleine, aber klinisch bedeutsame Therapieeffekte durch Sportinterventionen nachgewiesen werden konnten, mangelt es in den meisten anderen Störungsgebieten an randomisiert-kontrollierten Studien. Ein Großteil der bisher veröffentlichten Studien zeigt deutliche methodische Schwächen. Daher ist weitere Forschung unerlässlich, bevor Empfehlungen ausgesprochen werden können, bei welchen Störungsbildern welche Art von Sport eine wirksame Therapieoption darstellt. Für die Untersuchung zweier mutmaßlich zentraler Wirkmechanismen von Sport bei psychischen Störungen, nämlich die Veränderung der Belohnungsverarbeitung und der Stressreaktivität, wurde eine funktionelle Magnetresonanztomografie-Studie durchgeführt. Hochtrainierte und untrainierte Männer liefen für 30 Minuten bei moderater Intensität auf dem Laufband oder erhielten eine Placebo-Sportintervention. Anschließend wurden ein psychosozialer Stresstest sowie ein Belohnungsparadigma durchgeführt. Das Studiendesign ermöglichte die separate Betrachtung von habituellen und akuten Sporteffekten sowie deren Interaktionen. In beiden Experimenten zeigten sich akute Effekte von Sport, wohingegen sich trainierte und untrainierte Probanden nicht oder nur kaum voneinander unterschieden. Männer, die sich 30 Minuten auf dem Laufband bewegt hatten, hatten eine deutlich verminderte Aktivierung des ventralen Striatums während der Antizipation und des Feedbacks von Geldgewinnen. Ebenso fiel im Stresstest die Cortisol-Stressantwort bei Probanden der Laufbandgruppe geringer aus, verbunden mit einer stärkeren tonischen Hippocampus-Aktivität und einer verringerten Aktivität des anterioren Cingulums. Diese Ergebnisse lassen sich im Rahmen der „Tonisch- phasischen Dopamin-Hypothese“ und der „Cross-Stressor Adaptation Hypothese“ diskutieren und legen nahe, dass eine tonische (d.h. mehrere Stunden anhaltende) Aktivierung des Belohnungs- und Stresssystems die phasische Reagibilität verringert. Langfristig positive Effekte von Sportinterventionen bei psychischen Störungen könnten somit v.a. auf akkumulierte akute Effekte zurückgehen. Diese könnten somit gezielt als Strategien zur Stressreduktion oder Rückfallprophylaxe eingesetzt werden. Zusammenfassend gibt diese Dissertation einen Überblick über Sport als Behandlungsoption bei verschiedenen psychischen Störungen, zeigt Lücken in der bisherigen Forschung auf, und trägt zum Verständnis der Wirkmechanismen von Sport bei