PHASED: A systematic review of physical activity for alcohol and substance use disorders

Alcohol and substance use disorders have major health, social, and economic consequences for individuals, carers, family and friends, employers, and public services. Various legal, economic, social, and educational approaches aim to prevent alcohol and substance misuse but further ways are needed to help the most vulnerable. Usually they are treated with a variety of drug treatments and counselling based approaches, but these are often ineffective. Drug treatments present their own problems (e.g. addiction to the drug being used to treat the disorder and bad side effects) so there is a need for options which may not have these complications and improve treatment.

Physical activity (including lifestyle activity such as walking, structured exercise, and organised sport) could help in preventing and treating alcohol and substance use disorders, perhaps because it diverts attention away from the addiction, helps to build confidence or improves mood, and reduces withdrawal symptoms. Physical activity, unlike drug therapies, has little or no bad side effects and is potentially cheap and easily accessible.

This study aims to examine the research on physical activity in relation to alcohol and substance use disorders so that it can be better understood if and how physical activity can help prevent and treat those with these problems. The findings from the review will be summarised and used to get the views of services providers, funders, service users and other people, on what the best interventions are and for whom they should be offered. The possible costs of such services will be estimated.

All the information gathered and presented in a final report (and made available on a website) will provide people with important practical information on what has worked so far, and what may be most effective in the future for an alternative approach to preventing and treating alcohol and substance use disorders. 

The study is led by Dr Tom Thompson, Research Fellow at Plymouth University Peninsula Schools of Medicine and Dentistry, who commented: “We wanted to investigate the evidence about physical activity in relation to these disorders because it could help in prevention, reduction, and treatment. It may be that physical activity diverts attention away from the addiction, helps to build confidence or improves mood, reduces withdrawal symptoms, and supports a shift towards a healthy identity which is incompatible with excessive alcohol or substance use. It is also possible those who engage in physical activity in their younger years are less likely to develop problems with alcohol and substances later in life. Compared with drug treatments and other therapies, physical activity has little or no bad side effects and is potentially cheap and easily accessible. We are keen to make sure we are asking the right questions (and looking for the right answers) which will be useful for people in all areas of services. We are engaging with both users and providers of alcohol and substance use services throughout the project to keep us focused on working towards practical and meaningful findings.”

Background

Alcohol use disorders (AUDs) and substance use disorders (SUDs) have significant avoidable global human and economic cost. In the UK, AUDs and SUDs cost the economy £21bn (£3.5bn in healthcare) and £15bn (£488m in healthcare), respectively. Pharmacological interventions inherently have complications, and alternative therapies for treatment and prevention are needed. There is a growing interest in the possible role that physical activity (PA) may offer to reduce AUDs and SUDs with minimal or no adverse effects. Little is known about the best way PA can be promoted to both prevent and reduce AUDs and SUDs and NICE guidelines currently make minimal and vague reference to its role.

Aims

To systematically review the evidence to date in order to describe and quantify the effects of PA on AUDs and SUDs and understand how it is best delivered or promoted, in what setting, and among which populations, to encourage the prevention, reduction, and abstinence from AUDs and SUDs. In the final phase of the study our aim is to elicit the views of service leads and users on how the findings can be used to guide future funding and interventions for reducing progression, use and post-treatment relapse. 

Plan of investigation

A wide selection of electronic databases will be searched based on a list of key words to generate a list of published research (including grey literature and qualitative investigations) which will then be screened independently by two researchers according to a predefined checklist. Eligible studies will be rated for quality and risk of bias, and data on study details, participant characteristics, AUD/SUD related factors, intervention details and setting, control conditions, and outcomes will be extracted by one researcher and checked by another. Data across similar studies will be synthesised in a meta-analysis. Moreover, we will provide a detailed narrative synthesis using tables, diagrams and narrative texts across the studies, interventions, outcomes, populations and settings.

Potential benefits to people and NHS

The proposed review will present the evidence to date on the role of PA in the prevention, harm reduction and treatment of AUDs and SUDs. After summarising this literature service, leads and users will have the chance to reflect on and add further guidance on how PA interventions can be designed to have greatest reach and effectiveness. They will also add to recommendations on how support for PA can be offered within the NHS, and other public health services, and appropriate third sector and charity organisations, with implications for funding. The review will examine the many aspects of PA in how it is delivered, to whom, by whom, and in what setting to present the potentially most effective services. It will provide information for those involved in the treatment and prevention of AUDs and SUDs as to the most effective and cost-effective applications of PA. It will also highlight potential research gaps to allow for future research planning within the NHS. The review will also be presented to the appropriate NICE Guidelines review panel with ideas on how the findings could be incorporated into future revisions of guidance on effective interventions. Should there be a need for further research on the effectiveness and cost-effectiveness of PA interventions for specific groups then we will present the findings to the appropriate NIHR prioritisation panel, and other funders (e.g., National Lottery awards).

This study has been funded by the NIHR Research for Patient Benefit (RfPB) programme and is also supported by the NIHR Collaboration for Applied Health Research and Care South West Peninsula (NIHR PenCLAHRC). It is a collaborative project between Plymouth University, Plymouth Hospitals NHS Trust, Bristol University, Southampton University, King’s College London, and Plymouth City Council.

The team

  • Miss Lucinda Melichar, PUPSMD – Research Assistant, supporting all aspects of the review.
  • Dr Joanne Neale, King’s College London – Joanne will advise on the search strategy, qualitative analysis, identification of PPI groups for input and dissemination with a focus on substance use disorders, synthesis of findings and report production.
  • Dr Julia Sinclair, Southampton University – Julia will advise on the search strategy, the development of PPI input with a focus on alcohol use disorders, the synthesis of findings and report production.
  • Dr Rebecca Kandiyali, Bristol University – Rebecca will oversee and guide the economic review aspects of the research and support report production.
  • Mr Gary Wallace, Plymouth City Council – Gary will provide input to maximise stakeholder input, impact, and relevance as a local Public Health Service lead, and support report production.