Short summary

Physical exercise in treatment of alcohol use disorders is suggested to have an effect on alcohol intake, cardiorespiratory fitness and socio-psychological outcomes. Healthy Lifestyle Study tests this effect in a randomized controlled trial with three arms:

1. Standard treatment alone
2. Standard treatment and physical exercise in groups
3. Standard treatment and physical exercise on an individual basis.

Baseline information on patients' alcohol behavior, cardiorespiratory fitness and psychological factors are collected. Follow up data are collected after 6 and 12 months.

Rationale

Alcohol use disorder is a widespread problem in Denmark and has severe impacts on health and quality of life of each individual. The clinical treatment of alcohol use disorder involves evidence-based knowledge on medical treatment, physical training, and psychological management. The aim of this study is to investigate the effect of physical exercise on alcohol intake, cardio-respiratory fitness and socio-psychological outcomes.

The outcome of current alcohol treatment is modest, as relapse rates are high. Interventions that can increase the effectiveness of treatment are strongly needed. Relapse prevention strategies in alcohol treatment fall into two broad categories: 1) Specific intervention techniques, often designed to help the patient cope with high-risk situations and 2) Global self-control approaches, intended to reduce relapse risk by promoting positive lifestyle change. With reference to these strategies, physical exercise can be used both as early prevention, and as part of a continuous treatment process.

Despite the potential benefits of exercise interventions, only few studies have tested the impact of exercise as an adjunct to alcohol treatment. Findings from the studies support a positive relationship between physical exercise and drinking outcome. However, most of the studies suffer from methodological limitations such as small sample sizes or high dropout.

The overall purpose of the Healthy Lifestyle study is to evaluate the effect of adding exercise to treatment of outpatients with alcohol use disorder.

Description of the cohort

180 consecutive patients entering the alcohol outpatient clinics in Odense and Svendborg, and suffering from alcohol use disorder, abuse or dependence according to DSM-IV-TR, are enrolled in the study if they meet the following inclusion criteria: Age between 18 and 60 years, Native Danish speaking, have no severe psychosis or cognitive impairment, have no severe physical disabilities or medical problems and accept participating in the study.

Data and biological material

• Data on areas in patients' life are collected using the Addiction Severity Index (ASI): medicine, employment, alcohol, drug, legal status, family/social network and psychiatric health. Baseline data are collected by employees in the alcohol outpatient clinics, while 6 and 12 month follow up data are collected by members of the research group.
• The time-line-follow-back method (TLFB) is used to describe alcohol-free days as well as number of drinks per day. By use of TLFB patients describe the daily number of standard drinks 30 days before the basic interview and 30 days before the 6 and 12-month follow-up interview.
• The Bruce Treadmill Protocol is used to measure participants' cardio-respiratory fitness where maximum oxygen uptake values are recorded (VO2max).
• Blood lactate concentration is measured 2 min after the completion of the fitness test by a Lactate Pro (LP, Arkrey KDK, Japan) and a Borg scale (1-20) to express the subjective exhaustion.
• The International Physical Activity Questionnaire (IPAQ), a 27-item self-completion questionnaire is used to assess the level of physical activity of participants prior to treatment.
• EuroQuol-5D (EQ-5D) is used to assess self-reported well-being of participants.
• Common Mental Disorders - Screening Questionnaire (CMD-SQ) is used to assess depression and anxiety.
• The IIP (Inventory of Interpersonal Problems) is used to assess interpersonal problems of participants.
• Qualitative interviews with dropout patients are carried out to understand reasons for leaving the project and to understand which role physical activity plays in their lives.

Collaborating researchers and departments

Department of Psychology, University of Southern Denmark

• Professor and Principal Investigator Kirsten K. Roessler
• PhD-student Sengü"l Sari
• Student Co-worker Ajla Dervisevic
• Student Co-worker Martin Mau
• Student Co-worker Sine østergaard
• Student Co-worker Ann Jessen
• Student Co-worker Josefine Pilegaard
• Student Co-worker Karoline Mathiasen
• Student Co-worker Charlotte Nielsen

Unit of Clinical Alcohol Research, University of Southern Denmark

• Assistant professor Randi Bilberg
• Project Director Anette Søgaard Nielsen

Department of Sports Science and Clinical Biomechanics, University of Southern Denmark

• Associate Professor Kurt Jensen

Department of Psychiatry, Odense University Hospital

• Research Professor Bent Nielsen

Department of Biostatistics, University of Copenhagen

• Professor Claus Ekstrøm

The Alcohol Outpatient Clinic, Odense

• Head of Department Elisabeth Jessen

The Alcohol Outpatient Clinic, Svendborg

• Head of Department Lise Janning

Publications associated with the project

Exercise as outpatient treatment of alcohol dependence. A pilot study. / Roessler, K.K. Bilberg, R., Jensen, K., Kjærgaard, A.-S., Dervisevic, A. & Nielsen, B. (2013). Sports Science Review 22,3-4:205-216.

Physical exercise as a supplement to outpatient treatment of alcohol use disorders - a randomized controlled trial. / Sari, S.  Bilberg, R., Jensen, K., Søgaard-Nielsen, A., Nielsen, B. & Roessler, K.K. (2013). BMC Psychology 2013 1:23.