Behavior Change Techniques in Physical Activity Interventions for Adults With Substance Use Disorders: A Systematic Review

Public Health Significance Statement This review found promising behavior change techniques that should be incorporated in interventions using physical activity in the context of substance use disorder treatment. The application of these behavior change techniques might reduce the use of substances, promote physical activity, improve secondary psychological outcomes like depression and anxiety, and foster treatment retention among people in treatment for substance use disorders. Objective: Increasing regular physical activity (PA) behavior may be an effective adjunct intervention for substance use disorder (SUD) treatment. This systematic review aims to identify promising behavior change techniques (BCTs), namely, BCTs present in the design of interventions evidencing significant short-term and/or long-term (d >= 0.15 for objective measures and d >= 0.36 for self-report measures) increase in PA and/or reduction of substance use, secondary psychological measures, and retention in the PA intervention. Method: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the search was performed on March 11, 2021 across databases including MEDLINE, PsycINFO, SPORTDiscus, Cochrane Library, CINAHL, ProQuest, Web of Science Core Collection, Google Scholar, Open Grey, and ProQuest Dissertations & Theses. Studies were included if they measured PA, included participants aged >= 18 years, were randomized control trials, and if participants were diagnosed with SUDs. The Cochrane RoB 2.0 Tool was used to assess risk of bias. BCTs from eligible studies were extracted, coded, and ranked according to their proportional presence across studies. Results: The final synthesis included k = 61 studies with N = 12,887 participants. High heterogeneity across outcome measures, interventions, and control conditions was found. In total, 477 applications of BCTs were identified. Instruction on how to perform the behavior, social support (unspecified), behavioral practice/rehearsal, problem-solving, pharmacological support, goal setting (behavior), self-monitoring (behavior), and biofeedback were the eight most frequently used promising BCTs across studies. Conclusions: Incorporating the eight most promising BCTs identified in this review in future PA interventions in SUD populations may improve SUD outcomes.