Aerobic Exercise Interventions for Patients in Opioid Maintenance Treatment: A Systematic Review

Abstract

Background: Opioid maintenance treatment (OMT) is the standard for treatment of opioid use disorder, but some individuals on OMT experience disrupted sleep, heightened sensitivity to pain, and continued relapse to non-medical opioid use. An adjunctive treatment that has potential to address these shortcomings of OMT is aerobic exercise. Objective: The aim of the present review was to identify and evaluate components of aerobic exercise interventions targeting OMT patients. Methods: For this PROSPERO-registered review (ID CRD42020139626), studies were identified via electronic bibliographic databases, funded research ( NIH RePORTER) and clinical trials databases ( ClinicalTrials.gov), and reference sections of relevant manuscripts. Studies that evaluated the effects of an aerobic exercise intervention using a comparison condition or pretest-posttest design in adult OMT patients were included. Results: Of 2971 unique records, three primary studies and one supplemental manuscript comprised the final sample. All studies were randomized trials involving supervised exercise interventions enrolling small samples of middle-aged OMT patients. Exercise interventions included a variety of aerobic and non-aerobic activities (e.g. flexibility exercises), and none controlled the dose of aerobic exercise. Few studies used objective measures of physical activity or cardiorespiratory fitness and there were no significant effects of adjunctive exercise on substance use outcomes, but tests of the latter were likely underpowered. Conclusions: Though early in the accumulation of evidence, interventions targeting aerobic exercise for OMT patients appear feasible, acceptable to patients, and beneficial. Longer-term studies that employ larger samples, include assessments of behavioral and biological mechanisms of change, more rigorous measurement of physical activity, and controlled doses of aerobic activity are warranted.

The Role of Physical Activity in Opioid Substitution Therapy: A Systematic Review of Interventional and Observational Studies

“…We find a wide range of different outcomes in the included studies, which was also noted in another systematic review on the OST population. 33 As such, there is a need to coordinate a standard in physical function testing, which can increase the use of exercise tests in both research and clinical practice.…”

“…In the present review, we explicitly focus on studies on PA in the treatment of OUD, that is, treatment for people with opioid dependence, such as heroin or prescription opioids. Although some previous systematic reviews 26 , 33 , 34 that cover OST have been published, these have included interventional studies exclusively, resulting in few studies. They showed that exercise interventions have the potential to improve health and wellness features for people in OST.…”

“…To date, one systematic review deals specifically with individuals in OST. 33 That review includes 3 interventional studies. Two other systematic reviews on populations with SUD address OST.…”

Pain among patients with substance use disorders and non-pharmacological options: An integrative review

“…Due to the challenges that SUD patients face, when pain is involved opioids are used as the first line of treatment without consideration of the after-effects. [12] An increase in evidenced based research is needed to strengthen the NP and all other providers' awareness of how to safely and effectively treat the SUD patient. [24] Two different substance use disorders were assessed in this review: alcohol and opioid use.…”

“…[11] Over the past few decades, the liberal use of opioids to help relieve chronic pain has led to other undesirable effects such as addiction, morbidity and mortality. [11,12] Individuals who have a history of SUD are met with unique challenges when dealing with chronic pain. First, pain can present more intensely in individuals with SUD.…”