While the connection between mind and body is one that often gets discussed it can be easy to misunderstand. Frankly, there are a lot of complex processes that are happening throughout the body all day that drive how we feel and even the things we crave. Improving physical health is an integral part of recovering from substance use disorders (SUDs). But this is not without challenges. There are several questions that often come up such as “What is the best kind of exercise for someone in recovery?”, “How much exercise is too much?”, and “What if I have injuries or pain?”
First, let’s discuss the benefits of regular physical activity for people in recovery. Regular exercise is going to help individuals and improve overall health by increasing bone density, muscular strength, endurance, immune response, resiliency, and by reducing risks for cardiovascular disease, cancer, hypertension, diabetes, and all-cause mortality. It can also improve hormone production and improve sleep quality and quantity, which is crucial to our emotional stability and physical health. Additionally, moderate intensity exercise has been shown to reduce the symptoms of depression, anxiety, trauma, and stress and reduce the frequency and severity of cravings for drugs and alcohol.
However, exercise is not without risk and, when performed incorrectly. there is the possibility for injury, muscle soreness, disturbed sleep, worsened mood, lowered immunity, and, in extremely rare cases, death. What does this mean? Frankly, we cannot crush ourselves with exercise all the time because this could actually increase the risk of relapse in people with substance use disorders and worsen overall mental health. There is a balancing act here that is important to keep in mind, but just like everything else, there is a level of individualization. Someone in early recovery with a very high fitness level may be able to do more without any adverse reactions while someone with a low fitness level may overdo it and then really struggle. It is important to remember that we cannot use a blanket protocol for everyone.
Now let’s answer those questions from earlier. First, “What is the best kind of exercise for someone in recovery?” I have been asked this question and I’m going to give you kind of a mixed message. The best exercise is the kind that the recovering person is willing to do. Physical activity should not feel punitive and should be something that people look forward to doing. Additionally, many people in recovery have trauma and disordered eating and exercise can be very triggering for some of them. So, these are important considerations when working with this population. However, a study by Muller and Clausen (2014) demonstrated that persons with SUDs who engaged in group exercise that included walking, running, group sports, and strength-training reported improvements in four categories of quality of life: psychological, physical, social, and environmental. A meta-analysis by Smith and Lynch (2011) determined that “exercise increases measures of well-being, self-esteem, and self-efficacy” The authors stated that these encouraging emotional conditions are inversely related to substance use which means that the better someone feels about themselves the less likely they are to use drugs or alcohol and that exercise helps people feel better about themselves in most cases. The authors further stated that regular physical activity could even reduce the risk of developing a SUD in the first place. Part of the mechanisms behind these feelings can be attributed to the production of neurotransmitters that make us feel good like dopamine, serotonin, endocannabinoids, and GABA. Additionally, endorphins and acetylcholine are produced that allow heart rate and respiration to come down. Many people have attributed the euphoria associated with exercise to endorphins, but current research demonstrates these neurotransmitters do not cross the blood brain barrier and that post-workout high may actually be coming from endocannabinoids like anandamide (Linden, 2023).
Additionally, it’s important to note that people don’t need to crush themselves with exercise to get mental health benefits. An extremely large study published in the Lancet by Checkroud and colleagues in 2018 demonstrated that moderate intensity exercise was actually the most beneficial to reducing mental distress and associated conditions. In essence, there should be some gas left in the tank at the end of a workout. While many people associate a good or effective workout with being physically crushed this may actually be hindering both physical and emotional progress. In fact, exercise that is very intense may worsen mental health conditions like anxiety and depression. It also temporarily lowers immune function which leaves us more susceptible to communicable illnesses like colds, flus, and COVID-19. For individuals this could be a recipe for disaster, as being physically sick may remind them of going through withdrawals and be a trigger.
This leads us into the next question, “How much exercise is too much?” Again, I’m going to give a bit of a mixed message but in general we do not want to exercise every single day. In fact, it may be best to work out no more than 5 days a week. Many people have tried to argue this point and say things like, “I’m working different body parts so I can train every day!” If only this was how the human body actually worked. The reality is that just separating the body into sections may mean that while we are not sore all over all the time, it doesn’t mean that the whole body has recovered. We are, in many ways, the sum of our parts. And the entire system needs time off in order to heal. People who exercise too often may increase their mental distress and worsen their mental health conditions (Chekroud et al., 2018). This is because exercise is essentially damage to the body and we need to give it time to heal in order to come back stronger. If we do not give ourselves adequate rest time, then the body will break down which will in turn lead to a diminished ability to regulate emotions and cravings. Many people in recovery become obsessed with exercise to a point of it being detrimental, both physically and mentally. Putting the body in a constant state of physical distress will have emotional consequences and for people in recovery this could end up with a relapse. There is a balance to how often and even how long we should work out. When it comes to mental health, a good amount of time per workout is about 45-60 minutes, which ironically is the same amount of time that the body is able to produce growth hormone that counteracts much of the damage (Chekroud et al., 2018; Stokes et al., 2008).
Lastly, many people avoid exercise due to being in physical pain, being injured, or because they feel overwhelmed or embarrassed. In these situations, an individualized approach is necessary, and individuals may need to work with other allied health professionals like physical therapists, chiropractors, and corrective exercise specialists. These professionals have been trained to work with specific injuries and movement imbalances to improve overall functionality. However, many individuals in early recovery have a lowered pain threshold owing to their substance use. This is especially true with opioid users because when a person is using a substance that mimics the body’s natural pain killers the body gets the signal that it no longer has to make these. While it can take some time for this situation to rectify itself, regular physical activity will repair the body’s ability to make these. Additionally, moderate intensity physical activity reduces inflammation that causes pain and emotional distress. So, unless someone is medically prohibited from exercise there is no reason they can’t find some form of exercise that will reduce their pain. What’s amazing about this is that it means that just being physically active (i.e., going for walks, light calisthenics, light resistance training) will reduce the physical issue that may have been a major driving force for their addiction.
The bottom line is that people don’t need to become athletes or do crazy and extreme workouts to reduce their cravings for alcohol or drugs and to improve their mental health conditions. They just need to be physically active in some way. Most people recovering from addiction and mental health conditions who engage in regular moderate intensity physical activity see improvements in health, self-esteem, and the conditions they are recovering from.
This blog was contributed by Joshua Buchbinder, a PhD candidate in Health and Human Performance specifically studying the effects of holistic health practices on the treatment of mental health conditions. He is also the Co-Founder of Legacy Wellness Partners with his wife Elyse Buchbinder, M.S., CNS, LDN. They bring health and wellness programs to mental health and substance use treatment centers throughout the Mid-Atlantic and work directly with patients and providers to improve treatment outcomes. Maryland Addiction Recovery Centers partners with Legacy Wellness Partners to provide health, fitness, and nutritional services for MARC patients. Josh and Elyse can be reached at info@legacywellnesspartners.com or through their website www.legacywellnesspartners.com.
If you or someone you know needs help for addiction or co-occurring disorder issues, please give us a call. Maryland Addiction Recovery Center offers the most comprehensive dual-diagnosis addiction treatment in the Mid-Atlantic area. If we aren’t the best fit for you or your loved one, we will take the necessary time to work with you to find a treatment center or provider that better fits your needs. Please give us a call at (866) 929-4318 or email our team at info@marylandaddictionrecovery.com. For more information on all of our drug addiction, alcohol addiction, and co-occurring disorder services and recovery resources, please visit our website at www.marylandaddictionrecovery.com.
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