Randomized Controlled Trial Comparing Exercise to Health Education for Stimulant Use Disorder

Abstract

Objective To evaluate exercise as a treatment for stimulant use disorders. Method The STimulant Reduction Intervention using Dosed Exercise study was a randomized clinical trial conducted in nine residential addiction treatment programs across the United States from July 2010 to February 2013. Of 497 adults referred to the study, 302 met all eligibility criteria, including DSM-IV criteria for stimulant abuse and/or dependence, and were randomized to either a dosed exercise intervention (Exericse) or a health education intervention (Health Education) control, both augmenting treatment as usual and conducted thrice weekly for 12 weeks. The primary outcome of percent stimulant abstinent days during study weeks 4–12 was estimated using a novel algorithm adjustment incorporating self-reported Timeline Follow Back (TLFB) stimulant use and urine drug screen (UDS) data. Results Percent abstinent days based on TLFB was 90.8% (SD=16.4) for Exercise and 91.6% (SD=14.7) for Health Education participants. Percent abstinent days using the ELCON algorithm was 75.6% (SD=27.4) for Exercise and 77.3% (SD=25.1) for HEI. The primary intent-to-treat analysis, using a mixed model controlling for site and the ELCON algorithm, produced no treatment effect (p=0.60). In post hoc analyses controlling for treatment adherence and baseline stimulant use, Exercise participants had a 4.8% higher abstinence rate (78.7%) compared to HEI participants (73.9%) (p=0.03, number needed to treat=7.2). Conclusions The primary analysis indicated no significant difference between exercise and health education. Adjustment for intervention adherence showed modestly but significantly higher percent abstinent days in the exercise group, suggesting that exercise may improve outcomes for stimulant users with better adherence to an exercise dose.

The Benefits of Physical Exercise on Mental Disorders and Quality of Life in Substance Use Disorders Patients. Systematic Review and Meta-Analysis

“…Of the selected studies, 34 were experimental studies with randomized sampling [4,5,8,9,11,12,15,17,18,21,25,27,29,30,46,48,49,52,54,55,[59][60][61][63][64][65][68][69][70][71][74][75][76][77], while the rest were quasi-experimental [6,7,10,13,14,16,20,22,26,28,47,50,51,53,[56][57][58]62,…”

“…Aerobic exercise was the most used type of program, finding 27 studies that used this type of exercise [4,5,7,8,[10][11][12][13]16,18,22,26,46,49,50,56,57,[59][60][61]67,[74][75][76][77][78][79]. In addition, 14 studies were found that used exercise programs related to body-mind practices, such as yoga, tai chi or qigong [9,15,21,[28][29][30]54,55,[64][65][66]70,71,73], 10 who used combined strength and aerobic exercise [6,17,20,27,32,47,48,52,68,…”

“…We found 25 studies that analyzed the effect of exercise on aspects related to abstinence/ consumption and/or the impulse to consume (craving). Among them, 17 studies showed statistically significant improvements in abstinence [4,7,13,14,50,56,58,62,65,74,75] and in craving [5,7,9,12,28,53], whereas seven studies did not find statistically significant improvements, or these improvements were intra-group but not between groups, both in abstinence [8,16,29,52,59,60,69] and craving [8].…”

A randomized placebo-controlled trial of N-acetylcysteine for cannabis use disorder in adults

“…An intent-to-treat approach including all randomized participants was used. All missing UCTs (missed visit/dropout/lost-to-follow-up) were imputed as positive, a method that does not make the missing-at-random assumption and has been employed in substance use disorder treatment trials (Avants et al, 2000; Bickel et al, 1988; Budney et al, 2006; Johnson et al, 2007; Trivedi et al, 2017; Winhusen et al, 2014). A sensitivity analysis using various single imputation approaches was also performed to evaluate the impact of various deviations from the missing-at-random assumption.…”

Acute Aerobic Exercise Based Cognitive and Motor Priming: Practical Applications and Mechanisms

“…treatment of schizophrenia improved symptoms and functional outcomes compared to cognitive therapy alone (Malchow et al, 2016;Nuechterlein et al, 2016). In addition, stimulant users report more abstinent days when they participate in exercise combined with therapy compared to therapy partnered with health education (Trivedi et al, 2017).…”