The Role of Physical Exercise in Opioid Substitution Therapy: Mechanisms of Sequential Effects

Abstract

It is generally accepted that chronic opioid use is associated with structural and functional changes in the human brain that lead to an enhancement of impulsive behavior for immediate satisfaction. Interestingly, in recent years, physical exercise interventions have been used as an adjunctive treatment for patients with opioid use disorders (OUDs). Indeed, exercise has positive effects on both the biological and psychosocial basis of addiction, modifying neural circuits such as the reward, inhibition, and stress systems, and thus causing behavioral changes. This review focuses on the possible mechanisms that contribute to the beneficial effects of exercise on the treatment of OUDs, with emphasis placed on the description of a sequential consolidation of these mechanisms. Exercise is thought to act initially as a factor of internal activation and self-regulation and eventually as a factor of commitment. This approach suggests a sequential (temporal) consolidation of the functions of exercise in favor of gradual disengagement from addiction. Particularly, the sequence in which the exercise-induced mechanisms are consolidated follows the pattern of internal activation—self-regulation—commitment, eventually resulting in stimulation of the endocannabinoid and endogenous opioid systems. Additionally, this is accompanied by modification of molecular and behavioral aspects of opioid addiction. Overall, the neurobiological actions of exercise in combination with certain psychological mechanisms appear to promote its beneficial effects. Given the positive effects of exercise on both physical and mental health, exercise prescription is recommended as a complement to conventional therapy for patients on opioid maintenance treatment.

Predicting Postoperative Pain and Opioid Use with Machine Learning Applied to Longitudinal Electronic Health Record and Wearable Data

“…The literature shows that access to a preoperatively planned exercise regimen may reduce prolonged opioid use. 40,41,42 Our findings complemented the literature, showing that patients more involved in very active activities (e.g., bicycling) before the surgery were more likely to be on high dose opioid use 6-12 months after surgery, while patients doing more lightly active activities (e.g., walking) before surgery were less likely to be on chronic opioid use 6-12 months after surgery (Figure 6). The type of surgery was also associated with higher chronic opioids (Table 1).…”

Effects of a Two-Month Exercise Training Program on Concurrent Non-Opiate Substance Use in Opioid-Dependent Patients during Substitution Treatment

“…In contrast, in the exercise groups, there was a gradual decrease in the consumption of alcohol, benzodiazepines, cannabis, and cocaine throughout the 8 weeks of the experimental period, with the decrease being greater during the last four weeks of the intervention. These results suggest that the beneficial effects of exercise training occur gradually and support the view of a sequential (temporal) consolidation of exercise functions in favor of gradual disengagement from addiction [95]. Specifically, the sequence in which the mechanisms induced by exercise are unified follows the model of Internal Activation-Self-Regulation-Commitment, with the ultimate result of modifying the molecular and behavioral aspects of addiction [95].…”

“…Specifically, the sequence in which the mechanisms induced by exercise are unified follows the model of Internal Activation-Self-Regulation-Commitment, with the ultimate result of modifying the molecular and behavioral aspects of addiction [95]. Moreover, the impact of exercise on the improvement of opioid-dependent patients is more obvious when aerobic regimens of moderate intensity are applied [95], while these forms of exercise may also promote and strengthen behavioral therapeutic approaches and lead to reduced substance-consumption outcomes [94].…”

Analysis of physical activity and prescription opioid use among US adults: a cross-sectional study

“…Studies have reported a notable lack of enthusiasm towards PA among individuals undergoing methadone maintenance treatment (MMT) [ 26 , 27 ]. Only 38% of individuals in MMT achieved the recommended weekly amount of PA [ 28 ].…”