MMT Patients Need Physical Activity; Brief Interventions Could Help

Physical activity is so important for patients in methadone maintenance treatment (MMT). They’re already at increased risk of physical and mental health disorders, including chronic pain and sleep problems. Lack of enough physical activity carries additional risks: cardiovascular disease, various psychiatric disorders, high blood pressure, diabetes, osteoporosis, obesity, and colon cancer.

Given the importance of physical activity to their patients, how can MMT programs help?

A study in the Journal of Substance Abuse Treatment (in press) offers some suggestions. The study assessed the levels of physical activity in 305 MMT patients, cited patients’ perceptions of the benefits of and barriers to exercise, and provided recommendations.

Study Group Characteristics

Participants were recruited between December 2008 and May 2011 at nine MMT sites in New England. All were taking part in a smoking cessation intervention trial, and had been enrolled in MMT for at least four weeks.

Additional characteristics of the group:

  • Average age: 40 years
  • 50% men
  • 243 (80%) non-Hispanic white
  • 113 obese; 103 overweight; 18 refused to be weighed
  • Cigarette use: at least 10 per day (inclusion criterion); average, 19.7
  • Average methadone dose: 109 mg/day

Almost 45 percent considered themselves in fair or poor physical health.

Physical Activity Guidelines

The American Heart Association recommends a healthy adult have at least 30 minutes of moderate-intensity aerobic physical activity five days a week, or at least 20 minutes of vigorous activity three days a week.

Study Results

Only 38 percent of participants met or exceeded recommended guidelines, and almost 25 percent reported no physical activity. In contrast, about 49 percent of adults in the U.S. meet guidelines, and almost 14 percent are inactive (less than 10 minutes of activity of moderate intensity per week).

In general, study participants highly endorsed (rated favorably) the benefits of exercise. More than 75 percent credited exercise with giving a sense of accomplishment, improving health, increasing energy level, feeling stronger, improving cardiovascular fitness, becoming physically fit, increasing confidence to stay clean and sober, and maintaining or losing weight in order to look better. Interestingly, those who met activity guidelines were significantly more likely than the others to report relapse prevention and reduced anxiety as benefits.

Motivation: The Key for MMT Patients

The most frequently perceived barrier to exercise was lack of motivation (103 participants). This is consistent with findings from previous studies in substance users. The authors cite an earier study showing that, “encouragingly, motivation to exercise was the best predictor of physical activity.” Among other barriers cited were not having enough energy, having an injury or disability, and health problems.

Noting that brief interventions or counseling sessions have helped increase physical activity in a variety of populations, the authors suggest this approach for MMT patients. Measures could include “brief, counselor administered physical activity or exercise intervention” based on adaptations of the widely used five A’s for smoking cessation intervention—ask, advise, assess, assist, arrange—to provide “a standardized framework for a clinic based brief intervention.” They add that the potential benefits in mental health and relapse prevention, highly endorsed by participants, should be covered during the “advise” part of the exercise.

“Another potentially cost-effective intervention,” according to the authors, “could involve peer led exercise promotion groups run through methadone clinic programs.” Moreover, it would be useful to have a brief discussion of exercise and physical activity during monthly counseling sessions or doctors’ visits, the authors said. “Developing efficacious and low-cost physical activity adjuncts to this population at high risk for lifestyle-induced medical conditions may have important benefits for health and drug treatment outcomes.”

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Caviness CM, Bird JL, Anderson BJ, et al. Minimum recommended physical activity, and perceived barriers and benefits of exercise in methadone maintained persons. J Subst Abuse Treat. 2012. http://dx.doi.org/10.1016/j.jsat.2012.10.002.

Link to the five As of smoking cessation: http://www.ahrq.gov/clinic/tobacco/tobaqrg.pdf

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