Impaired Aerobic Endurance and Muscular Strength in Substance Use Disorder Patients

Abstract

Although substance use disorder (SUD) patients are documented to have an inactive lifestyle, which is associated with cardiovascular disease, other lifestyle-related diseases and premature death, evidence regarding their aerobic endurance and muscular strength is limited. Therefore, the authors aimed to evaluate directly assessed maximal oxygen consumption, walking efficiency, as well as maximal strength in a group of SUD patients.A total of 44 SUD patients in residential treatment, 31 men (31 ± 8 years) and 13 women (34 ± 10 years), were included and completed the physical testing. The patients were compared with an age- and sex-matched reference group.Male and female SUD patients exhibited a maximal oxygen consumption of 44.6 ± 6.2 and 33.8 ± 6.6 mL· min−1 kg−1, respectively. This was significantly lower than the reference group, 15% (P = 0.03) for men and 25% (P = 0.001) for women. In addition, the SUD patients had a 13% significantly reduced walking efficiency (P = 0.02), compared with healthy controls. The impairments in aerobic endurance were accompanied by significant reductions in maximal strength of 30% (P = 0.001) and 33% (P = 0.01) for men and women, respectively. In combination, these results imply that SUD patients have impaired endurance and muscular strength compared with what is typically observed in the population, and consequently suffer a higher risk of developing cardiovascular and other lifestyle-related diseases and early death. Effective physical exercise should be advocated as an essential part of the clinical practice of SUD treatment to improve the patient's health and consequently reduce the costs because of the high use of emergency departments, hospital, and medical care.

Patients with schizophrenia have impaired muscle force‐generating capacity and functional performance

“…Additionally, healthy women have a mathematically somewhat worse efficiency contrasted to healthy men, contributing to the difficulty of reaching statistically difference in women. Interestingly, the reduction seen in men is similar to what is observed in substance use disorder patients, 35 but somewhat higher compared to previous reports from in-and outpatients with schizophrenia suggesting an efficiency between 17% and 20%. 11,44 The lower walking efficiency implies that patients with schizophrenia overconsume energy during certain physical activities or basic activities that involve walking.…”

“…This likely puts them at a significantly higher risk of premature death as low muscle strength previously has been associated with higher risk of death from all‐cause, cancer, and cardiovascular disease . Although data on muscle strength are limited from schizophrenia patients, the impairment is similar to what has been observed in another psychiatric patient population, substance use disorder patients, a population with similar life expectancy, and levels of inactivity . Thus, reductions in maximal muscle strength could be a general pattern within psychiatry.…”

Cardiorespiratory fitness and body composition of stimulant users: A baseline analysis of the STRIDE cohort

“…Given the high correlation observed between time on treadmill and VO 2peak values in our subset of participants who completed their maximal exercise test using indirect calorimetry, we believe that the use of time on treadmill provides a valid representation of CRF levels for our entire sample. While the VO 2peak values for the men (38.4 ± 7.4 mL•kg -1 •min -1 ) and women (30.8 ± 6.3 mL•kg -1 •min -1 ) in our subset of 30 individuals are higher than those (men = 30.6 mL•kg -1 •min -1 ; women = 23.2 mL•kg -1 •min -1 ) from a younger sample of methamphetamine users (Dolezal et al, 2013), they are lower than substance using European adults (Flemmen & Wang, 2015). According to established reference values ( ACSM Guidelines for Exercise Testing and Prescription, 2010), the CRF levels observed in this study equate to the 40 th and 35 th percentiles for men and women, respectively, presenting a potentially significant health risk.…”

“…CRF has also been associated with depression (Dishman et al, 2012), schizophrenia (Scheewe, Takken, Kahn, Cahn, & Backx, 2012), and sleep (King, Oman, Brassington, Bliwise, & Haskell, 1997), which can all be impacted by stimulant use (Morgan et al, 2006). Two previous studies in substance using populations, one in methamphetamine users, reported CRF levels well below the population average (Dolezal et al, 2013; Flemmen & Wang, 2015), which may be related to the poor health conditions often observed in these individuals. However, both of these studies had relatively small sample sizes (39 and 44 individuals, respectively) creating a need for verification across a larger population of stimulant users.…”

“…However, individuals in our study had their body composition assessed immediately after intake to the RTP, indicating that their BMI levels had not yet been impacted by their recovery period. Elevated BMIs increase the risk of morbidity and mortality (Guh et al, 2009) and may prove to be particularly detrimental when combined with a decrease in walking efficiency (Flemmen & Wang, 2015) and functional ability (Henry, Minassian, & Perry, 2010) in individuals with substance use disorders. The average WCs observed for our sample would be considered a risk factor for women (93.1cm), but not for men (93.7cm) (NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and Treatment of Obesity in Adults (US), 1998).…”