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

Abstract

Background: Use of physical activity in the treatment and follow-up of people receiving opioid substitution therapy is an understudied area of research. Therefore, the objective of this systematic review was to synthesize the currently available research on the role of physical activity in opioid substitution therapy and proper adaptions for the group. Methods: A systematic search was performed on PsycINFO, EMBASE, MEDLINE, CINAHL, and Web of Science until September 2021 (PROSPERO-reg.no: CRD42020109873). The inclusion criteria were studies involving physical activity interventions for opioid substitution patients. Reference lists of relevant studies were screened to identify additional relevant studies. Data extracted were compiled into tables and descriptively presented. Results: The search yielded 2105 unique records. A total of 10 studies were included, whose methodological quality ranged from satisfactory to very good. Study quality was assessed using a 7-/8-point quality score. The agreement between the reviewers, assessed with Cohen’s kappa, was 0.91. Overall, the results suggest that physical activity increases physical fitness of patients in opioid substitution therapy and decreases substance use. The minority of studies in this field are of high quality with sufficient power. Conclusions: The findings of this systematic review suggest beneficial effects of physical activity on physical fitness, substance use, and mental health for patients in opioid substitution therapy. Although the findings are quite consistent across studies, high-quality studies and sufficiently powered clinical trials are needed to confirm and validate the findings and to conclude on the degree of impact.

A qualitative study of experiences with physical activity among people receiving opioid agonist therapy

“…Physical activity is widely used as adjunctive therapy for people with SUD, both therapeutically and to improve health [ 10 , 31 ]. However, there are still gaps in the literature concerning how to best implement physical activity in OAT clinics, particularly in terms of adapting interventions and ensuring good adherence [ 16 ]. From our findings, most participants had experienced a decline in health and daily function.…”

“…Nevertheless, exercise-related interventions within this population have proven to be challenging with low adherence rates and some individuals having negative experiences to exercise [ 13 – 15 ]. Further, there is limited research on how to best implement exercise interventions among people receiving OAT [ 16 – 18 ]. A recently published systematic review identified only six intervention studies on physical activity and exercise among people in OAT [ 16 ], most of which had methodological shortcomings and were not sufficiently sized to evaluate the effects [ 19 – 24 ].…”

“…Further, there is limited research on how to best implement exercise interventions among people receiving OAT [ 16 – 18 ]. A recently published systematic review identified only six intervention studies on physical activity and exercise among people in OAT [ 16 ], most of which had methodological shortcomings and were not sufficiently sized to evaluate the effects [ 19 – 24 ]. Several of these studies also reported difficulties in adherence, indicating that the interventions were not sufficiently adapted to the participants and did not take into consideration the group’s barriers and facilitators.…”

Liver stiffness and associated risk factors among people with a history of injecting drugs: a prospective cohort study

“…This indicates a need for lifestyle interventions to reduce metabolic risk. A systematic review of physical activity among persons receiving OAT concluded that regular physical activity improved physical fitness, mental health, and substance use [ 48 ]. Robust studies on the efficacy of dietary interventions for persons with SUD are lacking, but a review of five studies indicates that interventions may improve dietary outcomes [ 49 ].…”

“…Robust studies on the efficacy of dietary interventions for persons with SUD are lacking, but a review of five studies indicates that interventions may improve dietary outcomes [ 49 ]. Most included studies reported low adherence, often due to health-related issues, homelessness, lack of transportation and lack of follow-up [ 48 , 49 ]. The frequency of obesity is lower in our sample compared to a cohort recruited from the Norwegian general population in which one-quarter of the participants were obese [ 50 ].…”