Exercise as an Adjunct Treatment for Opiate Agonist Treatment: Review of the Current Research and Implementation Strategies

Abstract

Opiate dependence is a significant public health concern linked to poor quality of life, co-morbid psychiatric disorders, and high costs to society. Current opiate agonist treatments are an effective but limited intervention. Adjunctive interventions could improve and augment opiate agonist treatment outcomes, including drug abstinence, quality of life, and physical health. This article reviews exercise as an adjunctive intervention for opiate agonist treatment, especially in regards to improving mood and overall quality of life, while reducing other substance use. Poor adherence and dropout frequently prevent many individuals from garnering the many physical and mental health benefits of exercise. Strategies for implementing an exercise intervention, including safety considerations, are discussed.

Physical activity, psychiatric distress, and interest in exercise group participation among individuals seeking methadone maintenance treatment with and without chronic pain

“…Our findings, combined with those from a prior study in which only a small minority (14%) of MMT patients who attended a mindfulness‐based walking group returned for a second session, underscore the challenge of engaging MMT patients in exercise . Future research should examine different approaches for engaging MMT patients with and without chronic pain in exercise, such as contingency management or using an intervention that is designed to be engaging (eg, exergames, such as the Wii Fit). While findings regarding the efficacy of exercise in attenuating illicit substance use are mixed, the robust evidence supporting the efficacy of exercise in alleviating back pain and depression highlights the potential importance of engaging patients entering MMT in exercise.…”

“…Exercise interventions hold promise in augmenting mental and physical health outcomes among MMT patients who are sedentary or inactive, or older (along with pain outcomes among those with chronic pain). However, the apparent low levels of interest in exercise group participation among individuals seeking MMT suggests that further research: (a) should assess preferences for different types of onsite (eg, Tai Chi) and offsite exercise (eg, home‐based program, gym) and barriers to their participation (eg, transportation, low self‐efficacy) and (b) on the effectiveness of onsite exercise interventions for MMT patients with and without chronic pain may necessitate the targeting of exercise interventions that participants find more engaging than exercise groups (eg, exergames), or adjunctive behavioral or counseling interventions to augment exercise participation (eg, contingency management, motivational interviewing) . Among patients entering MMT with chronic pain, the discrepancy between levels of interest in receiving pain treatment and participating in an exercise group (73% vs. 25%) may highlight the need for providing psychoeducation about chronic pain and its management.…”

“…The promotion of exercise in MMT programs may be particularly timely because a recent study of methadone‐maintained participants found that the majority did not meet recommended weekly levels of physical activity . While exercise has been proposed as an intervention for enhacing the psychological functioning of patients in MMT and for managing pain in those with co‐occurring chronic pain and opioid use disorder, few studies have examined the feasibility, acceptability, or efficacy of these approaches . Among patients with chronic musculoskeletal pain, the avoidance of physical activity is common and may result in deconditioning and pain exacerbation .…”

Effects of Resistance, Endurance, and Concurrent Exercise on Oxidative Stress Markers and the Histological Changes of Intestine After Morphine Withdrawal in Rats

“…Individuals consume different drugs such as methadone for opiate dependence treatment. However, methadone has numerous side-effects and can lead to addiction as well (23). Regular exercise is a useful strategy for opiate addiction programs and has numerous mental and physical health effects (23,24).…”

A Mixed-Method Investigation into Therapeutic Yoga as an Adjunctive Treatment for People Recovering from Substance Use Disorders

“…Each study concluded that the explanatory power of substance and exercise type appeared to be superseded by levels of participant ownership and personal change. These findings are in alignment with PF and MBC values but it is important to note that they were absent from the 12 meta-analyses carried out investigating SUD and exercise (Read and Brown 2003;Greer et al 2012;Weinstock et al 2012;Williams and Strean 2004;Zschucke et al 2012;Lynch et al 2013;Wang et al 2014;Giesen et al 2015; Bardo and Compton 2015;Linke and Ussher 2015;Brellenthin and Koltyn 2016;Stoutenberg et al 2015). This was due to an inclusion criterion favouring the positivist research paradigm, which discredits the SUD sufferers' voice as a source of credible data.…”