Heal, Exercise & Recover (HER): A Qualitative Exploration of Physical Fitness While in Treatment for Substance Use Disorders

Background: There is growing evidence demonstrating the benefits of exercise for physical health and psychological functioning among individuals with substance use disorders (SUDs). Among women, exercise may improve mood, vigor, and general well-being; moreover, exercise has a negative association with symptoms, such as depression, anxiety, and perceived stress. This qualitative study is a first step in the development of a gender-specific physical activity (PA) intervention for women in treatment for SUDs. The purpose of the study is to explore current PA behaviors, attitudes, and beliefs toward PA and physical health among women in treatment for SUDs.

 Methods: The current study represents the qualitative component of a larger study that included the collection of cross-sectional data related to physical and mental health status, physical fitness level, PA behavior, substance use and treatment histories of women currently accessing treatment for SUD. Thirteen women were recruited from a local treatment agency to take part in qualitative interviews. To be eligible for the larger study, women had to be between the ages of 18 and 55, not pregnant, and be able to understand and write the English language. Grounded theory was used to inform qualitative data analysis.

 Results: Preliminary analysis related to participant experiences resulted in five themes. Themes were confounding meanings, exercising as a positive distraction, believing exercise happens as a part of the everyday, replacing substance use with exercise, and exercise motivation through connection. With respect to confounding meanings, participants viewed “exercise” as the same as “physical activity”, “being healthy”, and “not overweight.” Ultimately, participants viewed engaging in exercise as a positive activity and a way to de-stress and distract from life’s responsibilities; at the same time, they viewed “exercise” as a phenomenon that simply happens as part of their day. For example, most of the women viewed “walking to the bus” or “walking my child to daycare” as daily exercise. Most of the women interviewed had histories of methamphetamine abuse and saw their use as a means to control their weight. Invariably, they viewed exercise as a way to get back to where they were when they felt better about themselves physically and discussed it as means to replace meth use. Lastly, women were asked in detail about the ways in which they preferred to engage in exercise. With the exception of one woman, most of the women felt that motivation through exercise would happen best through connection with significant others, friends, and family.

 Implications: Currently, a small body of literature suggests exercise may be a useful component of treatment programs aimed at reducing the negative neural and functional consequences of alcohol and drug use. The current study adds knowledge suggesting that effective strategies are warranted to improve treatment outcomes and maximize physical health outcomes among women in treatment for SUDs.