Bewegungsinterventionen bei Alkoholkonsumstörungen: Internationale Evidenzlage und Effekte einer kontrollierten Längsschnittstudie

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Theoretical Background: Alcohol use disorders are a significant public health problem. According to the Global Burdon of Disease Study 2010, alcohol use is the third major important risk factor for illness and premature death. In Germany 3.4% of the population suffer from alcohol dependence and further 3.1% of the Germans fulfill the criteria for harmful alcohol use. Depending on the severity, numerous somatic, psychic and social sequelae are accompanied by this chronic relapsing disease. Besides the low achievement ratio, high relapse rates are still a major challenge of the treatment. Among all addicts, approximately 10% are chronic multiply impaired dependents (CMD) who are affected particularly severe. In Germany they are treated in sociotherapeutic facilities in which they find a home for a longer time period or even permanent in order to lead them to an abstinent and health orientated lifestyle despite mostly irreversible sequelae. Exercise interventions play an important role in the rehabilitation of many mental illnesses. While the effectiveness of exercise interventions in other psychic diseases has already been proved, the field of alcohol use disorders is not applied so far. Although, first findings from epidemiological, preclinical and clinical studies indicate a possibly effective use of exercise interventions in alcohol use disorders.
The aim of the presented work was initially to summarize the international evidence addressing exercise interventions by conducting a systematic review (publication I) and based on this, to prove an exercise program for CMD patients regarding feasibility and effectiveness (publication II and III).
Methods: The systematic review was conducted by two independent reviewers according to the guidelines of the Centre for Review and Dissemination. In order to evaluate the evidence, the evaluation system of the Oxford Centre for Evidence-Based Medicine was utilized. As a second part of the work a group-based endurance and strength orientated exercise program (2-5x/week à 60min) for CMD patients has been developed as well as implemented in a sociotherapeutic facility and evaluated within a prospective, controlled longitudinal study. The primary outcomes which were examined over 12 months long were adherence, physical activity level (kcal and steps) as well as health-related quality of life. Those outcomes were tested by the means of multisensory activity monitors and with the aid of the Short-Form 36 Health Survey (SF-36). Allocation in either the interventions group or control group (IG and CG, n=44) was conducted according to the personal preference of the patients. Collateral, a healthy age-matched control group (hCG, n=24) was examined. Furthermore, according to the Case Reporting Guidelines the 44 month rehabilitation process of a CMD patient was documented and evaluated.
Results: Publication I: Based on the existing evidence, no definite statement regarding the effectiveness of exercise interventions in alcohol use disorders could be done so far. Despite the inconsistent body of literature and due to the partially methodological insufficient quality, there exists primarily evidence that firstly the conduction of exercise interventions is feasible and safe and secondly that exercise interventions can be effective with regard to somatic, psychic, and psychosocial parameters as well as to addiction specific outcomes. Publication II: Finally 14 patients participated in the IG, 19 patients in the CG and 18 patients in the hCG. Within the IG adherence rate was 64% and on average patients participated in 2.16 ± 0.91 sessions a week. On the physical level a significant enhancement of the kilocalories per week (Δ=3470 ± 2956; f=0.81) and of the steps per week (Δ=14341 ± 16842; f=0.55) was proved. With regards to the health-related quality of life, significant improvements were indicated in physical functioning (Δ=9.3 ± 11.2; f=0.48), vitality (Δ=9.3 ± 14.7; f=0.72), emotional role functioning (Δ=14.3 ± 38.6; f=0.44), and mental health (Δ=13.4 ± 16.6; f=0.45), whereas in the subscales physical role functioning, bodily pain, general health perceptions, and social role functioning no effects (group x time-interactions) were found. Publication III: After 38 months of continuous participation in the exercise program and 44 months of multimodal sociotherapeutic treatment, the CMD patient recovered and could successfully reintegrated occupationally and socially.
Conclusion: results of the presented study show, that by the use of the exercise program one third of the examined CMD patients succeed to be regularly physical active. Beside the enhancement of their physical activity level CMD patients can also profit from exercise and physical activity as to highly relevant aspects of their health-related quality of life. The high clinical relevance of alcohol use disorders and the high demand of effective treatment strategies conflict with the blatant shortcoming of clinical studies addressing exercise interventions. However, the small body of literature which could be generated so far indicates the promising potential of exercise interventions in the treatment of alcohol use disorders. Many aspects are in favor for both, that physical activity is not only beneficial for mental, physical health and health-related quality of life but has also the ability to influence addiction-specific outcomes of affected patients.
In order to exploit the potential of exercise interventions in addiction treatment, further high-quality studies are urgently needed. In the long run, providing exercise interventions as a resource-orientated strategy to addicted patients by the hand could support and stabilize them on their movement towards an autonomous, drug-free and health-orientated way of life.
Original languageGerman
Place of PublicationKöln
PublisherDeutsche Sporthochschule Köln
Number of pages120
Publication statusPublished - 2016

ID: 2908967

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