Exercising alcohol patients don’t lack motivation but struggle with structures, emotions and social context - a qualitative dropout study

Abstract

BackgroundExercise is an important component of a healthy lifestyle, the development of which is a relapse prevention strategy for those with alcohol use disorder. However, it is a challenge to create exercise interventions with a persistent behavioural change. The aim of this qualitative study was to investigate perceived barriers to participation in an exercise intervention among alcohol use disorder patients, who dropped out of the intervention program. Furthermore, this study aims to propose possibilities for a better practice of future intervention studies based on the participants’ experiences and suggestions.MethodsQualitative interviews with 17 patients who dropped out from an exercise intervention in an outpatient treatment centre about their experiences and reasons for dropping out. Social cognitive theory informed the development of the interview guides and systematic text condensation was used for analysis.ResultsAnalysis revealed three central themes: 1) Structural barriers described as the type of exercise and the timing of the intervention, 2) Social barriers described as need for accountability and unsupportive relations, and 3) Emotional barriers described as fear, guilt and shame, and negative affect of the intervention on long term.ConclusionsFuture exercise interventions should include socio-psychological support during the first weeks, begin shortly after treatment initiation instead of concurrently, and focus on garnering social support for participants in both the intervention context and among their existing network in order to best reduce barriers to participation.Trial registrationThis study was retrospectively registered at Current Controlled Trials ISRCTN74889852 on 11 July 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-017-0606-4) contains supplementary material, which is available to authorized users.

Exercise as adjunctive treatment for alcohol use disorder: A randomized controlled trial

“…The reason for this may be that participants’ adherence and motivation to exercise decreases in the months after initiation, e.g. due to the lack of an individually tailored exercise program or social support [ 29 , 30 ], and this may explain why no intervention effect was observed at six months follow-up. Nevertheless, the dropout rate in the present study was 37.1%, which is lower than the 40% reported by Hallgren et al [ 12 ] in their recent meta-analysis.…”

“…Our participants were randomized to either individual or group condition independent of their place of residence, work situation, or any psychosocial considerations. This might have given rise to a wide range of barriers for participation in exercise, as described in a qualitative study of dropouts in the Healthy Lifestyle Study [ 30 ]. Participating, for example, in group exercise with other alcohol patients requires personal strength or at least suitable preparation.…”

“…An important study limitation was the relatively high number of dropouts (37.1%), leaving the study unable to make sufficient measurements across the whole sample at follow-ups [ 30 ]. Furthermore, exercise activity was not recorded in the control group, so we can only assume or guess what happened in this group during treatment.…”

Saying yes or no to physical activity – A comparative cohort analysis of patients seeking treatment for Alcohol Use Disorder

“…This means that all the information given to upcoming participants should be very carefully presented, and future studies, perhaps, should be more careful and spend more time on this part of the studies, especially when they involve physical activities and have some logistics challenges for participants regarding to job, children care e.g. ( Bleidorn, Bucak, Gagyor, Hummers-Pradier, & Dierks, 2015 ; McCann, Campbell, & Entwistle, 2010 ; Sari et al, 2017 ).…”

“…However, it is complicated to investigate the potential benefit of exercise treatment programs for AUD. On a patient level, the difficulties seem to consist of both structural, social and emotional barriers in addition to patient-related factors like somatic problems, psychiatric problems, use of alcohol, education level, and lack of social relations towards engaging in physical exercise ( Sari, Muller, & Roessler, 2017 ). The limited number of controlled studies in the AUD field suffers from patient refusals to participate in the studies, and high drop-out rates during the interventions.…”