New findings have raised concerns regarding the scientific reviews of the effectiveness of exercise-based interventions for addiction.
Exercise-based interventions for substance abuse populations are a subject of research and clinical interest. However, a new scientific review contends that a wide range of methodological concerns and knowledge gaps in the literature are argued to hinder the development of clinical recommendations. The paper has been published in the journal Mental Health and Physical Activity.
The aim of the new scientific review was to summarize the evidence regarding the effectiveness of exercise-based interventions in altering psychological symptoms, substance use outcomes, and quality of life in adults with substance abuse or dependence. Substance abuse and dependence are significant public health concerns, with high prevalence rates and alarming suicide and mortality rates.
These conditions are characterized by compulsions, chronic relapse, and are often accompanied by other disorders such as chronic pain or mental illnesses. Psychological symptoms and substance abuse outcomes pose challenges in management within these populations, resulting in a negative impact on their quality of life, as well as on economic, judicial, and health systems.
Exercise has been suggested as a potential intervention to assist individuals dealing with substance abuse or dependence. Regular physical activity may be recommended to improve their self-discipline and to aid them in coping with their symptoms.
“My primary research interests are associated with the role that psychological (i.e., self-efficacy) and spiritual (i.e., meaning in life) factors play in the self-perception that individuals with chronic pain, cancer, or mental health issues have regarding their well-being, including aspects such as self-perceived happiness and life satisfaction,”
– said study author Javier Martínez-Calderón, an assistant professor at the University of Seville and a co-founder of the Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group.
“In this context, it is strongly believed that exercise-based interventions, such as mind-body exercises or any type of exercise that can be practiced, may be found to be very useful for individuals to gain a better understanding of their physical bodies, which can, in turn, help them become more connected with themselves and improve their mental health. Specifically, great interest is held in the field of addictions, as many individuals with any of these chronic disorders often resort to substance abuse (e.g., opioids) in an attempt to manage the course of their illness.”
Previous systematic reviews have been conducted to examine the effectiveness of exercise-based interventions, with some displaying promising results. Nevertheless, it remains unclear which type of exercise holds the most benefit for specific populations and which psychological symptoms or substance abuse outcomes can be effectively addressed through exercise.
A comprehensive search of multiple databases was carried out by the researchers. The eligibility criteria were formulated based on the PICOs framework (Patient, Intervention, Comparison, Outcome, Study design). Systematic reviews evaluating exercise-based interventions in adults with substance abuse or dependence and co-occurring disorders, utilizing any type of exercise, were included.
A total of 314 titles and abstracts were screened by the researchers, and 18 systematic reviews meeting the eligibility criteria were selected. Within these systematic reviews, a total of 53 meta-analyses and 103 distinct clinical trials were included.
“The potential effectiveness of exercise-based interventions in this population has been evaluated by a significant number of clinical trials. It was surprising and gratifying to observe how clinical research is increasingly demonstrating the potential benefits that physical activity may offer individuals with mental health issues,” shared Martínez-Calderón with PsyPost.
Global terms like “exercise” or “physical activity” were frequently used to represent exercise-based interventions, while terms such as mental health, anxiety, depression, or smoking were used to depict populations and outcomes of interest.
The determination of which type of exercise (e.g., aerobic exercises, yoga-based interventions, strength exercises, or resistance exercises) was most effective for each substance abuse population and which specific exercise interventions yielded the greatest benefits for various psychological symptoms or substance abuse outcomes remained unclear. “In this context, recommending a specific type of exercise to health professionals is practically impossible,” noted the researchers.
Additionally, several methodological concerns and knowledge gaps were identified by the researchers. The systematic reviews were generally found to have critically low methodological quality, with issues such as a lack of transparency in study selection and the necessity for supplementary files listing excluded studies.
“Clinical trials in this domain appear to yield promising results for improving various outcomes, such as psychological symptoms, in individuals exhibiting substance abuse or dependence,” explained Martínez-Calderón. “However, the systematic reviews that have consolidated this primary evidence have revealed numerous methodological flaws, thereby necessitating careful consideration of the conclusions outlined in these systematic reviews.”
The researchers stressed the imperative for future research to concentrate on enhancing the quality of systematic reviews and augmenting the quantity of high-quality clinical trials. They also advocated for the adoption of the GRADE approach in all meta-analyses to offer a more comprehensive understanding of the circumstances governing the formulation of clinical recommendations.
“Primarily, systematic reviews must incorporate an assessment of the certainty of the evidence through the utilization of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach,” conveyed Martínez-Calderón to PsyPost. “This tool is likely the gold standard for assessing the certainty of outcomes scrutinized in systematic reviews, which is indispensable for the application of clinical research in the clinical arena.”
“The synthesis of evidence within the realm of mental health and physical activity needs enhancement,” the researcher appended. “Specifically, the methodological quality of systematic reviews with meta-analysis. We have conducted two additional overviews addressing exercise for schizophrenia and exercise for posttraumatic stress disorders, and we have endeavored to publish these as well, encountering similar methodological issues as those observed in the current overview.”
To summarize evidence on the effectiveness that exercise-based interventions may have to alter psychological symptoms, substance use outcomes, and quality of life in adults with substance abuse/dependence.
An overview of systematic reviews with meta-analysis was conducted. CINAHL, Embase, PubMed, SPORTDiscus, and the Cochrane Library were searched from inception up to December 1st, 2022. Manual searches were developed. AMSTAR 2 was used to evaluate the methodological quality of systematic reviews. Primary study overlap among systematic reviews was calculated using matrices of evidence and the corrected covered area (CCA). Upset and Origami plots were built.
18 systematic reviews including 53 meta-analyses that comprised 103 distinct clinical trials were included. Most of systematic reviews were judged to have critically low quality (89%). Methodological concerns were associated with the reasons to choose a specific research design, the provision of the sources of funding of the included clinical trials, the explanation of the reasons for excluding some potential articles, and the lack of information to discuss the possible role of risk of bias. There was a very high overlap for those systematic reviews that evaluated alcohol (CCA = 20%), tobacco (CCA = 16%), or other drugs (CCA = 27%) populations. Certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was barely judged.
The wide number of methodological concerns that were observed precluded us to make any clinical recommendation. A call-for action is needed to improve the quality of systematic reviews covering this topic.