Thompson et al. Systematic Reviews (2018) 7:9
DOI 10.1186/s13643-018-0674-0
PROTOCOL Open Access
Physical activity and the prevention,
reduction, and treatment of alcohol and/or
substance use across the lifespan (The
PHASE review): protocol for a systematic
review
Tom P. Thompson1* , Adrian H. Taylor1, Amanda Wanner1, Kerryn Husk1, Yinghui Wei2, Siobhan Creanor1,
Rebecca Kandiyali3, Jo Neale4, Julia Sinclair5, Mona Nasser1 and Gary Wallace6
Abstract
Background: Alcohol and substance use results in significant human and economic cost globally and is associated
with economic costs of £21 billion and £15billion within the UK, respectively, and trends for use are not improving.
Pharmacological interventions are well researched, but relapse rates across interventions for substance and alcohol use
disorders are as high as 60–90%. Physical activity may offer an alternative or adjunct approach to reducing rates of
alcohol and substance use that is associated with few adverse side effects, is easily accessible, and is potentially
cost-effective. Through psychological, behavioural, and physiological mechanisms, physical activity may offer benefits in
the prevention, reduction, and treatment of alcohol and substance use across the lifespan. Whilst physical activity is
widely advocated as offering benefit, no systematic review exists of physical activity (in all forms) and its effects on all
levels of alcohol and substance use across all ages to help inform policymakers, service providers, and commissioners.
Methods: The objectives of this mixed methods systematic review are to describe and evaluate the quantitative and
qualitative research obtained by a diverse search strategy on the impact of physical activity and its potential to:
1. Reduce the risk of progression to alcohol and/or substance use (PREVENTION)
2. Support individuals to reduce alcohol and/or substance use for harm reduction (REDUCTION), and
3. Promote abstinence and relapse prevention during and after treatment for an alcohol and/or substance use
disorder (TREATMENT).
With the input of key stakeholders, we aim to assess how what we know can be translated into policy and practice.
Quantitative, qualitative, service evaluations, and economic analyses will be brought together in a final narrative
synthesis that will describe the potential benefits of physical activity for whom, in what conditions, and in what form.
Discussion: This review will provide details of what is known about physical activity and the prevention, reduction,
and treatment of alcohol and/or substance use. The synthesised findings will be disseminated to policymakers, service
providers, and commissioners in the UK.
(Continued on next page)
* Correspondence: tom.thompson@plymouth.ac.uk
1
Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth
Science Park, Derriford, Plymouth PL6 8BX, UK
Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
, Thompson et al. Systematic Reviews (2018) 7:9 Page 2 of 15
(Continued from previous page)
Systematic review registration: PROSPERO number: CRD42017079322.
Keywords: Physical activity, Exercise, Alcohol use, Substance use, Addiction, Prevention, Harm reduction, Treatment,
Mixed method
Background flexible, accessible, acceptable across the range of levels
Rationale of use and have a lower risk of adverse events compared
Alcohol and substance use is common: globally, 5.9% to pharmacological treatment [22]. In 2001 (with up-
and 1% of deaths are attributable to alcohol and illicit dates in 2005 and 2008), AT (with co-researchers)
drug use, respectively [1]. In the UK, alcohol use is at- reviewed and reported the effects of exercise on smoking
tributed to more than one in five deaths of men aged from eight randomised controlled trials (RCTs) as part
16–54 years old [2], and alcohol harms are associated of a Cochrane Review [23]. This evidence contributed to
with an economic annual cost of around £21 billion a 2008 report to the US Surgeon General on smoking
(£3.5billion in healthcare [3]). Illicit drug use in the UK cessation which highlighted the value of exercise as an
has an economic cost of around £15 billion [4] (£488 option to support smoking cessation [24], and in the
million through healthcare [5]), with nearly one in ten UK, many NHS Stop Smoking Services now advocate
adults aged 16–59 in England and Wales having used exercise [25]. In 2014, an update to the Cochrane Review
illicit drugs in the past year [6]. Worldwide, alcohol- revealed there were 20 RCTs of exercise and smoking
attributable deaths increased from 3.8% in 2004 [1] to cessation, suggesting a rapid growth of interest in the
5.9% in 2012 [7], and illicit drug use levels have failed to topic [23]. A first systematic review is now needed of
decline between 2005 and 2010 [8], with a slight increase physical activity interventions for the prevention, reduc-
in the UK in recent years [6]. tion, and treatment of alcohol and/or substance use that
also includes a comprehensive search of grey literature
Scope for identifying new interventions
and service evaluations to generate practical implications
Pharmacological interventions for alcohol and substance for practice and policy.
use disorders have been well researched and reported on
for the management of withdrawal, dependence, and re- Evidence for the role of PA for preventing alcohol and/or
lapse prevention. The Cochrane Drug and Alcohol substance use
Group has published 11 and 30 reviews of pharmaco- Prospective studies indicate that sports participation in
logical interventions for alcohol and substance use, re- adolescents and young people is associated with an in-
spectively, whilst psychosocial interventions (e.g. brief crease in alcohol use but decrease in illicit drug use [26].
interventions and motivational interviewing) are less However, such studies may fail to eliminate confounding
well reported, with six and eight published reviews, re- factors (e.g., specific sports may attract those more pre-
spectively. Preventive interventions only have five re- disposed to engaging in ‘risky’ behaviours).
views for alcohol use, and three reviews for substance In contrast, a rigorous study in Finland tracked 1870
use [9]. Due to the heterogeneity of the types of drugs twin pairs from 16 to 27 years of age and concluded that
used and style of intervention, it is hard to summarise low levels of physical activity increased the risk of both
meaningfully the available data of existing interventions. alcohol and illicit drug use [27]. This further demon-
However, with relapse rates as high as 60% 1 year after strates the need for a robust, systematic review assessing
treatment for substance use disorders (SUD) [10–12] the role of physical activity (not just participation in
and 60–90% for alcohol use disorders (AUD) [13–16] sports) on progression to alcohol and/or substance use
and drug substitution therapies being associated with in- disorders.
nate complications [17–20], there is a need for evidence
for new treatments and preventive interventions to help Evidence for the effects of PA interventions for harm
address the growing burden of alcohol and/or substance reduction and treatment of alcohol and/or substance use
use. There is increasing interest in the role of physical activ-
Physical activity (PA; defined as any bodily movement ity as a treatment and reduction strategy for alcohol
produced by skeletal muscles that requires energy ex- and/or substance use. In 2011, the US National Institute
penditure, inclusive of organised sport [21]) and health- on Drug Abuse (NIDA) invested $4.3 million [28] on a
oriented exercise interventions could impact on the pre- programme of work including high-quality RCTs such as
vention, reduction, and treatment of alcohol and/or sub- STRIDE [29] which is investigating stimulant use reduc-
stance use and have the potential to be cost-effective, tion using exercise. A recent systematic review by Wang
