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Regular physical activity may help treatments for substance use disorders more effective. EyeWolf/Getty Images
  • Common treatment approaches for substance use disorders include therapy and medication.
  • A new meta-analysis revealed that regular exercise could be another management technique to incorporate into treatment plans.
  • A large number of participants who engaged in exercise reduced or stopped their substance use.
  • More research is required into how — and to what extent — exercise may help those with substance use disorders.

In the past year, 46.3 million Americans over the age of 12 met the DSM-5 criteria for having a substance use disorder (SUD).

SUDs can involve both legal and illicit substances, ranging from alcohol and marijuana to opioids and cocaine.

Treatments for SUDs vary — with outpatient and inpatient programs offering approaches such as ‘detoxing’, cognitive behavioral therapy (CBT), and medications.

However, a new meta-analysis published in the journal PLOS One has revealed the benefits of another therapeutic measure: physical exercise.

Researchers at Université de Montréal in Canada wanted to explore the impacts of exercise on those with SUDs after recognizing the potential benefits of this intervention.

“I was working as a kinesiologist in a therapy house for people with SUD,” explained Florence Piché, a PhD candidate in physical activity at Université de Montréal and lead author of the study.

“I realized that physical health was not taken into account in [their] treatments, although the need was enormous,” she told Healthline.

For their investigation, Piché and her colleagues reviewed seven scientific research databases to find studies that had used physical activity as an SUD treatment intervention.

In total, 43 studies, comprising 3,135 participants, met their criteria. On average, study participants engaged in moderate intensity exercise for an hour, three times a week, for 13 weeks. The most common activity was jogging.

Of these studies, 21 explored the influence of exercise on stopping or reducing participants’ substance use. The results were significant: 75% of these studies saw a decrease or total cessation in substance use among those who engaged in physical activity.

Furthermore, 12 studies noted that participants experienced lower levels of depression after exercising. The researchers also saw that some participants in the analyzed studies reported improved sleep.

Would positive outcomes have been even greater if participants exercised more frequently or at a higher intensity?

“We don’t have the data to answer that,” said Piché. “However, if I extrapolate, we can assume that each person has a different therapeutic pathway and that their ‘optimal’ dose will therefore be different, too.”

Ultimately, she continued, “Physical activity [is] a simple way to empower [those with SUD] to take charge of their health and improve it.”

Piché stated the analysis results did not come as a surprise, as “the majority … are in line with what is observed in the general population.”

However, she said, the findings are still important — as they affirm “that physical activity is feasible during treatment and that the potential to help people with SUD is enormous.”

China Brezner, an LMFT and the detox/residential and dual diagnosis outpatient clinical director at Clear Recovery Center, agreed the findings highlight a potential role for exercise in SUD treatment.

“Studies like this are essential in order to properly assess the need for such interventions like physical activity, in hopes of providing individuals with a well-rounded, positive, and beneficial experience during treatment,” she told Healthline.

“Given the results of the study,” Brezner continued, “it would not be surprising if adding a regular fitness routine to treatments were to become a standard.”

The likelihood that exercise will be included in future treatment programs is high, agreed Aymet Demara, a licensed associate substance abuse therapist and associate clinical director at Scottsdale Recovery Center.

“[Through] my work, I am seeing that, in the future, one’s physical well-being and physical activities will be prioritized more often alongside therapy to continue growing a holistic approach to recovery,” she revealed to Healthline.

“Being able to balance a variety of approaches to sobriety can definitely help an individual’s journey,” Demara added.

However, Brezner noted, it should be recognized that “exercise is not by any means a substitute for conventional SUD treatment.”

Instead, we should view exercise as a “critical supplement that can lead to a successful recovery.”

Although the research established that regular physical activity might benefit those with SUD, some aspects relating to exercise as a potential treatment weren’t explored.

For instance, as previously mentioned, it’s unknown whether increasing or decreasing the amount or intensity of exercise would influence outcomes.

Additionally, the researchers could not determine whether participants continued exercising after the studies and, if not, how this affected their SUD.

The research also noted that “some groups, including individuals with a mental comorbidity [such as bipolar disorder or schizophrenia], were excluded,” said Brezner.

As such, it “makes it harder to conclude the overall significance of physical activity as a treatment for SUDs across all demographics.”

Furthermore, Piché and her team stated in the paper that cultural differences concerning SUD treatment approaches might also impact outcomes.

“More research is needed to identify the most effective intervention characteristics and to better understand the mechanisms underlying their effectiveness,” stated Dr. Sanam Hafeez, a neuropsychologist and director of Comprehend the Mind in NYC.

A potential reason that participants’ substance use decreased after exercise is that the intervention reduced their depression levels — and the association between SUD and depression is stronger than you might expect.

“There has always been a strong link between mental health and SUDs, especially when it comes to depression and anxiety,” explained Dr. Joshua Lichtman, medical director and psychiatrist at Neuro Wellness Spa.

“It is very hard to tell what comes first, but regardless of the timeline, these conditions exacerbate each other,” he told Healthline.

Lichtman said that those with mental health concerns, such as depression, often use substances as a form of ‘self-medication’ to try and alleviate their symptoms.

Demara added that, often, people with SUDs lack ‘healthy’ coping mechanisms and may use substances to numb overwhelming feelings of depression or anxiety.

However, Lichtman shared, “this inevitably backfires, and ultimately both mental health and substance use will worsen over time.”

Additionally, the use of substances, such as alcohol and drugs, can negatively impact chemicals in the brain that are associated with depression.

“Substance abuse may lead to long-term changes in brain chemistry that can alter levels of naturally occurring hormones like serotonin and dopamine,” revealed Lichtman.

Serotonin is known as the brain’s ‘happy chemical’, while dopamine is a chemical messenger linked to feelings of pleasure.

The researchers also noted that sleep improved among participants who engaged in physical activity — and “studies have shown that poor sleep leads to poor mental health,” said Lichtman.

For instance, a study of postpartum women found that poor sleep led to ‘significantly higher’ depression scores, while a study of farmers who experienced poor sleep obtained similar results.

Experts believe exercise aids in alleviating symptoms of depression through various mechanisms. Some of these include:

Endorphin release. “There is clear evidence that exercise is beneficial for mental health due to the strong biochemical effect produced by endorphins,” said Brezner. Endorphins are neurotransmitters that naturally boost our mood.

Lower inflammation. “Regular exercise can help reduce inflammation in the body,” Hafeez stated. ‘[Inflammation] has been linked to an increased risk of depression and anxiety.”

Increased self-confidence. Exercise can make us feel better about ourselves, in turn “helping increase self-confidence and self-esteem,” Hafeez said. Low-self esteem is linked to increased depression risk.

Social interaction. Partaking in group exercise allows for social interaction. And engaging with others, shared Hafeez, “can help combat feelings of loneliness and isolation often associated with depression.”

Demara revealed that regular exercise “helps individuals focus on a consistent regimen, making them feel accomplished. [It] also helps the client physically feel good in their body.”

The studies reviewed in this meta-analysis primarily focused on moderate-intensity cardio — the benefits of which are well documented.

“Aerobic exercises, such as cycling, swimming, or running, are particularly effective for improving mental health,” said Hafeez. “This is because they increase blood flow and oxygen to the brain, which can improve cognitive function and mood.”

However, don’t worry if lower-impact or slower exercise is more your thing. Hafeez revealed that strength training is associated with increased self-esteem and confidence.

And, she continued, “yoga or tai chi can also improve mental health. These practices can help to reduce stress and anxiety, improve mood, and promote relaxation.”

Whatever activity you go for, it’s important not to overdo it. Studies have found that exercising at a vigorous intensity or too often without adequate rest can lead to depression (as well as increased physical injury risk).

Essentially, Hafeez stated, “the best type of exercise for mental health is one you enjoy and can stick to over the long term.”