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 aimed to examine the research on physical activity in relation to alcohol and substance use disorders so that it could be better understood if and how physical activity could 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 were and for whom they should be offered. The possible costs of such services were estimated.

All the information was gathered and presented in a final report (and made available on a website) to 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 was 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

The aims were 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 was 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 were searched based on a list of key words to generate a list of published research (including grey literature and qualitative investigations) which was then screened independently by two researchers according to a predefined checklist. Eligible studies were 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 were extracted by one researcher and checked by another. Data across similar studies was synthesised in a meta-analysis. Moreover, we provided 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 review presented 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 had the chance to reflect on and add further guidance on how PA interventions could be designed to have greatest reach and effectiveness. They also added 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 examined 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 provided 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 also highlighted potential research gaps to allow for future research planning within the NHS. The review was also 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 was funded by the NIHR Research for Patient Benefit (RfPB) programme and was also supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC). It was a collaborative project between Plymouth University, Plymouth Hospitals NHS Trust, Bristol University, Southampton University, King’s College London, and Plymouth City Council.

Study findings

The study findings have been published in the following peer reviewed Open Access publications: Thompson, T.P., Horrell, J., Taylor, A.H., et al (2020). Physical activity and the prevention, reduction, and treatment of substance use across the lifespan (The PHASE review). Mental Health & Physical Activity, vol 19. doi.org/10.1016/j.mhpa.2020.100360

Horrell, J., Thompson, T.P., Taylor, A.H., et al (2020). Qualitative systematic review of the acceptability, feasibility, barriers, facilitators and perceived utility of using physical activity in the reduction of and abstinence from alcohol and other drug use, Mental Health & Physical Activity, vol 19. https://doi.org/10.1016/j.mhpa.2020.100355

An associated Editorial was also published: Taylor, A.H., Thompson, T.P. & Horrell, J. (2020). Editorial: ‘Do we really need another review on the effects of physical activity on alcohol and other drug use disorders?’ Mental Health & Physical Activity, vol 19. doi.org/10.1016/j.mhpa.2020.100362

Both original papers describing the findings are to feature in a Mental Health & Physical Activity, Virtual Special Issue on the effects of physical on alcohol and other substance use.

The team

Miss Lucinda Melichar, Faculty of Health – 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.