Exercise in Recovery

Because addiction is a chronic illness that changes the structure of the brain and involves compulsive behaviors, it is important for people struggling with this condition to find ways to stay away from drugs or alcohol. The National Institute on Drug Abuse (NIDA) maintains a list of evidence-based principles of effective treatment. They state that the foundation of any approach to addiction treatment starts with detox, then moves into therapy at a rehabilitation program, and finishes with an aftercare plan. However, the methods in each of these steps must be highly individual and flexible because people need access to different approaches to safely detoxing from drugs, forms of social support and therapy, and even complementary treatments that bolster the effectiveness of treatments.

Recently, medical researchers have started to analyze how complementary treatments can support people while they go through addiction treatment. Exercise is becoming increasingly popular as part of addiction treatment during rehabilitation and aftercare. Working out builds physical strength, of course, but it can also regulate brain chemistry, provide a distraction from cravings, improve sleep quality, and aid digestion. There are many benefits to exercising regularly for everyone.

The Centers for Disease Control and Prevention (CDC) recommends around 2–3 hours of moderate aerobic exercise with muscle strengthening per week for the average American adult, but many people who abused drugs or alcohol lose physical strength during the course of their addiction. Exercise helps rebuild lost strength and endurance, reduces the risk of associated chronic diseases like heart disease and diabetes, and can improve mood.

The decision to work out during rehabilitation or as part of an aftercare plan is up to the person overcoming addiction, with input from a counselor or addiction specialist. The type of exercise is also an individual decision, although a combination of aerobic and strength training is usually the best foundation for most people.

The Benefits of Exercise

The Benefits of Exercise in Recovery

Physical activity and exercise are slightly different, and it is important to understand that difference. Any movement of the muscles, like gardening, housework, or climbing stairs, can be classified as physical activity, which works muscles and tendons, and burns calories. Exercise is physical activity that is planned, with the purpose of strengthening muscles, improving physical endurance, and getting other health benefits associated with moving the body.

Exercise is generally classified as light, moderate, and intense. These levels are associated with heart and breathing rate elevations to determine how much the body is working, but the experience of exercise intensity can depend on how healthy and fit the person is when they begin a specific routine. People who are new to an exercise routine may find a beginner’s yoga class to be vigorous for them, while someone who has trained for a marathon may find jogging for an hour a day to be light.

Globally, about 9% of early death has been attributed to not enough exercise. Other studies show that physical activity and substance abuse rates are inversely related. People who exercise are less likely to drink too much or abuse drugs, while people who abuse intoxicating substances are less likely to exercise enough. With this inverse relationship, it makes sense to add some forms of exercise to substance abuse treatment because people who become involved in these programs are less likely to relapse back into substance abuse.

    General benefits from exercise include:

  • Cardio-respiratory endurance that improves heart and lung health
  • Muscular strength
  • Muscular endurance
  • Flexibility

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Types of Exercise That Reduce Withdrawal Symptoms and Relapse Risk

A 2011 study found that any amount of exercise, at all stages of the drug abuse recovery process, for nearly every form of substance abuse, helps to manage withdrawal symptoms and reduce the risk of relapse. While a physician may offer specific guidance about safe exercise routines—for example, someone who suffers a heart arrhythmia from cocaine abuse will need to start with light or moderate aerobic exercise because running could cause further harm—it is mostly up to the individual in treatment to get involved in exercise and discover which forms work best for them.

Here are some exercise approaches that have been studied and found to improve mental health, behavioral health, and reduce the risk of relapse.

  • Aerobic exercise: Walking, especially at a brisk pace, and running are both associated with benefits like heart health, lung health, better sleep quality, reduced stress, and improved mood. A doctor will be able to help with the decision to start with light walking for 30 minutes a day, and if it is safe to train for jogging or running.

  • Weight lifting: Improving muscle tone through lifting weights or going through other forms of strength training was found to reduce depression symptoms in 45 stroke survivors who participated in a program for 10 weeks. Reducing depression can improve mood in people who abused drugs or alcohol, and that can reduce the risk of relapse.

  • Yoga, tai chi, and similar exercises: Yoga is being intently studied as a complementary treatment in mental health and substance abuse programs, because the combination of stretching, strengthening, and meditation is associated with greatly improved mood, the ability to manage stress, reduced negative thoughts, and improved physical health. Tai chi offers similar benefits, as do low-impact martial arts like aikido. Ideally, several options should be available, as someone who enjoys tai chi may not enjoy yoga, and they should be able to customize their recovery to suit their needs.

  • Outdoor activities: Hiking, gardening, and other ways of “playing” outdoors offer the benefits of exercise, and also improve mood by exposing one to sunlight. It is important to protect against skin damage from the sun with sunscreen and appropriate clothing, but sunlight has been found to improve mood by regulating serotonin levels and boosting natural vitamin D production in the body.

A 2014 survey of people in substance abuse treatment asked which types of exercise, when applied during recovery, were preferred. Most in the group reported that they wanted a program they could do on their own, with some specialist supervision and guidance.

    The most popular forms of exercise during or just after rehabilitation were:

  • Walking
  • Yoga or stretching
  • Sports like tennis, soccer, football, or baseball
  • Swimming
  • Resistance or strength training
  • Running or jogging

The least popular forms of exercise included:

  • Aerobic home equipment
  • The gym or YMCA
  • Cycling
  • Exercise videos

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Studies Show Exercise and Addiction Are Inversely Correlated

Fitness in Recovery

Creating and maintaining a regular exercise routine will stimulate the brain’s reward system on a regular basis. This part of the brain reacts to dopamine, serotonin, and norepinephrine. When these neurotransmitters are present or binding to receptor cells, this indicates to the reward system that something positive has happened.

Although the reward system can be falsely triggered through sugary or fatty foods, drugs, alcohol, or risky behaviors, there are ways to safely stimulate this brain region. Exercise and healthy food also stimulate the brain’s reward system, so making these part of one’s rehabilitation and long-term recovery process is crucial.

Exercise during treatment has worked as a complementary treatment approach for many people. One 2014 study on group exercise during treatment for substance use disorders involved 35 patients who were in long-term, residential treatment programs; 24 completed the program, and 11 did not. Those who completed the program reported improved mental and physical health. This demonstrates that exercise can be a valuable component of an overall addiction treatment program.

During the longer recovery process after rehabilitation is complete, regular exercise reduces the risk of relapse.

A 2018 study found that people with alcohol use disorder (AUD) who participated in a running program twice a week for 30–45 minutes reduced their alcohol intake 81% over the course of a month. A previous 2011 study on people struggling with marijuana abuse found that 10 sessions on a treadmill, over two weeks, for 30 minutes per session, reduced marijuana abuse by 50%.

Exercise can be an approach to drug abuse prevention. It improves brain and physical function during rehabilitation.

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Why Does Exercise Help People Overcoming Addiction?

Exercise is beneficial to everyone, but it can be especially useful for people in substance abuse treatment who are struggling with mental health problems and those with co-occurring mental health and substance use disorders. Here are some reasons exercise routines work well for people.

  • Neurotransmitter balance: For most people overcoming addiction, the most important part of exercise during rehabilitation and recovery involves balancing brain chemistry. Drugs and alcohol change brain chemistry, binding to specific receptor cells like endocannabinoids, opioids, or gamma-aminobutyric acid (GABA) receptors to release dopamine, serotonin, and/or norepinephrine, which alters mood, stress, and physical energy.

    Without consistently consuming drugs or alcohol, the brain cannot produce enough neurotransmitters to reach chemical equilibrium, so withdrawal symptoms begin, especially effects like anxiety, depression, insomnia, panic attacks, suicidal thoughts, and cravings. Medical detox, overseen by medical professionals, manages these symptoms as drugs are metabolized out of the body. However, even after detox, mood changes, sleep disorders, and cravings can still come back.

    Regular exercise is known to release endorphins, which can help to moderate brain chemistry, mood, cravings for drugs or alcohol, and even sugars and fats. It can also improve sleep quality. Exercise also appears to release endocannabinoids and galanin, which can reduce stress.

    Some research into recovering smokers who regularly exercise found that stress-related cravings for nicotine diminished as they spent time at the gym.

  • Lessened withdrawal symptoms: Psychological symptoms like anxiety, depression, insomnia, and despair are most intense during detox, and starting a gentle exercise regimen during this time can alleviate that experience. Although other physical symptoms like muscle aches, digestive issues, and joint pain can also be managed with regular exercise, the psychological effects and cravings during detox are more often the cause of relapse during the withdrawal period. Finding a safe, healthy approach to managing these symptoms helps more people end their chemical dependence so they can progress into rehabilitation.

  • Improved brain function: Many people who struggle with drug or alcohol abuse reduce functioning in some areas of their brains, especially the frontal regions. Exercise has been shown, in a study published in 2018 in the Drug and Alcohol Review Journal, to improve mental functioning.

  • Reduced risk of chronic illness: Drug and alcohol abuse damages the heart, lungs, brain, digestive system, and other organs in the body. Exercising regularly improves the function of the body as a whole, especially the brain, heart, and lungs. Muscle atrophy can be reversed, too.

  • A healthy distraction: Mindfulness practices and meditation reduce stress and train the practitioner to ignore cravings. Exercise can also distract from cravings that might otherwise lead to relapse. Taking the mind off life stress, low mood, anxiety, and craving drugs or alcohol stops the person’s hyper-focus on the discomfort of these experiences, which can reduce stress and lessen cravings.

  • A regular schedule: People who struggle with substance abuse are used to compulsively taking doses of drugs or drinking too much when the craving strikes. Cognitive Behavioral Therapy uses daily, weekly, and monthly planning as a way to reduce cravings during certain times of day and reduce the risk of compulsive behaviors leading to relapse. Exercising regularly throughout the week is one way to create a routine that can help the body and brain become healthier, and also help the person manage triggers during certain times of day, in certain places, from boredom, or from stress.

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Exercise Addiction

Some addictions are not to drugs or alcohol. Gambling, shopping, and sex are three of the more infamous activities that can trigger the reward system, leading to compulsive behaviors that are similar to substance addiction. Exercise may also create a similar reaction, so people who have struggled with substance abuse may begin to hyper-focus on their exercise routine to the point of compulsion.

    Signs of exercise addiction include:

  • Obsessing over exercises and behaviors
  • Developing physical problems from exercise but refusing to stop
  • Wanting to stop but being unable to quit
  • Engaging in exercise in secret due to associated problems

A study from the University of Southern California found that 15% of people who became addicted to exercise had been addicted to cigarettes, illicit drugs, or alcohol at one point. Another 25% may have behavioral addictions like gambling or shopping.

It is possible to cause harm to the body by exercising too much, so balance this activity and keep up with medical appointments, mutual support groups, and therapy sessions to recognize if exercise routines turn into problematic behaviors.

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More Rehabilitation Programs and Aftercare Plans Involve Exercise

The Importance of Fitness in Recovery

Since exercise provides numerous benefits for people overcoming addiction to drugs or alcohol, addiction specialists may greatly benefit from training in physical fitness, yoga, tai chi, or other forms of exercise. There are likely to be more specialists in addiction treatment who combine therapeutic treatment like the 12-step model or Cognitive Behavioral Therapy with personal training or group exercise.

Many residential treatment programs offer complementary options like yoga, tai chi, or gentle group exercise. Luxury treatment programs are more likely to have gyms, personal trainers, swimming pools, and exercise equipment available; however, as the physical and psychological benefits to people overcoming addiction become better understood through scientific study, more programs may begin to offer group exercise, physical fitness consultation, and other fitness-related amenities during treatment and aftercare.

Exercise is still a complementary treatment, and it cannot replace the foundation of medically supervised detox and therapy during rehabilitation. Everyone from young children to older adults can benefit from regular exercise, whether they have struggled with addiction or mental illness, or not.

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