Exercises like jogging or weight training may help addiction recovery

Adding simple workouts to treatment improved recovery from a variety of substance-use disorders, including to cocaine, opioids, cannabis and alcohol

At a moment when substance-use disorders and overdoses are on the rise, new research offers hope for the addicted: People who exercised as part of their addiction treatment programs were substantially more likely to reduce their substance use than those who didn’t.

The study, published Wednesday in PLOS One, found that incorporating simple workouts such as jogging or weight training into treatment improved the likelihood of recovery from a variety of substance-use disorders, including to cocaine, opioids, cannabis and alcohol.

“Exercise is fantastic medicine for those struggling to recover from their addiction,” said Jeremiah Weinstock, a psychology professor at St. Louis University, who studies addiction but was not involved with the new review.

The findings build on other research, some with animals, showing that exercise changes our brains and thinking in ways that can reduce drug cravings and relapse and might even stave off addictions in the first place.

The idea for the new study took root when Florence Piché, its lead author and a kinesiology doctoral student at the University of Montreal, began outside work as a therapist at a Canadian substance-use disorder clinic. A student of exercise, she suspected physical activity would aid in patients’ recovery but wished for scientific backing.

She didn’t find as much as she’d hoped. Many previous scientific studies and reviews focused on exercise and tobacco, but not other drugs.

So she and her colleagues decided to write their own, gathering past experiments comparing substance-use disorder treatments that included exercise to those that didn’t. They wound up with 43 studies involving 3,135 men and women who’d sought treatment for dependence to many different addictive substances (except tobacco, which they thought had been reviewed enough).

The programs’ exercise routines varied but most commonly involved easy jogging about three times a week, or comparable amounts of weight training, walking, yoga or cycling.

The scientists then compared results, finding a decided advantage to exercise. In studies that quantified participants’ drug usage from start to end, people who exercised generally quit or reduced their use. Those who didn’t exercise typically didn’t reduce their drug usage as much.

“In the same treatment programs, people did better if there was physical activity,” Piché said.

The review didn’t explore the question of how exercise — which involves mostly physical, not mental, exertion — might influence people’s willpower and drug cravings. But it did find that, in many of the included studies, people who exercised were more fit and less depressed by the study’s end.

But other recent research, looking more directly into what exercise does during recovery, has settled on a number of contributing effects.

“Exercise has so many benefits for those overcoming an addiction,” Weinstock said. “There is the immediate bump in mood after one’s workout, and, over time, exercise reduces depression and anxiety, which often co-occur with addiction. Exercise also helps the brain heal from the many damaging effects substance use has on our brains.”

In animal studies, for instance, heavy usage of drugs such as cocaine, methamphetamine or alcohol weakens or kills brain cells and reduces neurogenesis, the process by which brains create new neurons. Exercise, on the other hand, increases neurogenesis, and bolsters the health of existing neurons.

The effects can be especially striking in alcohol-use disorders and recovery. In a 2019 review, the authors concluded that “exercise is associated with brain health, alcohol is not, and the mechanisms by which exercise benefits the brain directly counteract the mechanisms by which alcohol damages it.”

“There have been multiple recent studies suggesting exercise is helpful for treating alcohol use disorder,” said J. Leigh Leasure, a neuroscience professor at the University of Houston and the review’s senior author.

But perhaps the most intriguing and consequential effects of exercise involve how it may change the brain’s reward system, which directs what we enjoy, want and seek out. Most substances of abuse wildly light up the reward system, and especially the production and uptake of dopamine, a neurotransmitter involved in reward processing. In effect, drugs make us — and lab animals — feel great and desire more.

But exercise can alter dopamine processing, potentially making exercise feel more pleasurable than drugs. In a telling 2018 rat study, when animals started running, they remodeled their dopamine system in ways that “could mediate exercise-induced attenuation of drug-seeking behavior,” the authors wrote.

“Our research shows that exercise can manipulate the brain’s dopamine signaling, which we know is involved and is dysfunctional in people who are addicted,” said Panayotis Thanos, a senior research scientist at the University of Buffalo and senior author of the rat study.

Exercise likewise seems to lessen relapses after animals have habituated to and then weaned from addictive drugs such as cocaine.

But the ideal types and amounts of exercise to bolster addiction treatment remain uncertain, Thanos and other scientists said, although his lab is in the middle of experiments designed to start answering those questions.

A more intractable concern is that people with substance-use disorders, even those seeking treatment, understandably may feel little motivation to exercise, Weinstock said. They might be feeling exhausted, defeated or overwhelmed. They also may have physical limitations.

He and his colleagues have been experimenting with monetary payments during treatment if people exercise, he said, which may help people start and then stay with an exercise routine, but, even then, programs probably need to be tailored to each individual’s fitness and interests.

Also, the physical activities studied in the new review and the related research involved were part of residential or well-supervised outpatient programs.

Whether people who just want to cut back on, for instance, alcohol or cannabis, should likewise deploy exercise to help them remains an open question, especially in terms of alcohol.

In some studies by Leasure’s group and others, healthy people who exercised tended also to be people who drank quite a bit. “Alcohol is different” from many other addictive substances, Leasure said, “and shows a positive relationship with physical activity.”

But the exercising drinkers in her and others’ studies were not seeking help for their drinking, she pointed out, suggesting that people who are trying to recover from alcohol-use disorders may respond differently to exercise.

For them, as for many others joining substance-use disorder programs, threading easy exercise into the program seems to amplify the benefits and up the chances the program meaningfully will help.

Article by Washingtonpost