Physical Activity Interventions Within Occupational Therapy for Persons With Substance Use Disorder: A Systematic Review

Abstract

Substance use disorders (SUDs) may significantly impact occupational performance and participation. Physical activity interventions are beneficial for individuals with SUD and can be delivered by occupational therapy practitioners (OTPs). We aimed to evaluate the current evidence for physical activity interventions within the scope of occupational therapy (OT) for treating SUDs. This systematic review followed PRISMA guidelines for data abstraction and assessment, including 28 articles in this review. Searches were conducted in Medline, APA PsycInfo, Embase, CINAHL, and OTSeeker from September 2021 to August 2023. Physical activity interventions included yoga, tai chi, comprehensive integrated approaches (CIA), high-intensity/circuit training, and music/dance interventions. Yoga, tai chi, CIA, and high-intensity exercise significantly reduced substance use and cravings. Tai chi, CIA, and dance/music interventions decreased stress and improved mental health and sleep outcomes. This review provides a foundation for advancing OTP-directed physical activity interventions in SUD-related rehabilitation and recovery.

Plain Language Summary

How Occupational Therapy Practitioners Can Help People With Substance Use Disorder Incorporate Physical Activity Into Their Daily Lives

Existing evidence was reviewed to better understand physical activity options for individuals with substance use disorder and how occupational therapy practitioners can incorporate these activities into their client sessions. Previous research supports that aerobic exercise, physical activity, and group-based exercises can help reduce substance cravings, lower the risk of relapse, and improve mood and motivation. In this review, physical activities examined included yoga, tai chi, comprehensive integrated approaches (CIA), high-intensity or circuit training, and music and dance activities. There is strong evidence that physical activity enhances outcomes for individuals with substance use disorders. Occupational therapy practitioners can implement physical activity into their treatment sessions to support individuals in substance use rehabilitation and recovery through integrating walking, jogging, cardiovascular training, strength training, yoga, tai chi, and dance.

Keywords

exercise physical activity intervention occupational therapy substance use disorder

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References

Abdullah

Huang

Lin

Yang

Y. K.

(2022). Dopaminergic and glutamatergic biomarker disruption in addiction and regulation by exercise: A mini review. Biomarkers, 27(4), 206–218. https://doi.org/10.1080/1354750X.2022.2049367

Abrantes

A. M.

Blevins

C. E.

(2019). Exercise in the context of substance use treatment: Key issues and future directions. Current Opinion in Psychology, 30, 103–108. https://doi.org/10.1016/j.copsyc.2019.04.001

*Agarwal

R. P.

Kumar

Lewis

J. E.

(2015). A pilot feasibility and acceptability study of yoga/meditation on the quality of life and markers of stress in persons living with HIV who also use crack cocaine. The Journal of Alternative and Complementary Medicine, 21(3), 152–158. https://doi.org/10.1089/acm.2014.0112

Agency for Healthcare Research and Quality U.S. Preventive Services Task Force. (2012). The guide to clinical preventive services 2012. https://www.ncbi.nlm.nih.gov/books/NBK115122/

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process, fourth edition. American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010p1–7412410010p87. https://doi.org/10.5014/ajot.2020.74S2001

American Occupational Therapy Association. (2021). Occupational therapy scope of practice. American Journal of Occupational Therapy, 75(Suppl. 3), 7513410030. https://doi.org/10.5014/ajot.2021.75S3005

Amorelli

(2016). Psychosocial occupational therapy interventions for substance-use disorders: A narrative review. Occupational Therapy in Mental Health, 32(2), 167–184. https://doi.org/10.1080/0164212x.2015.1134293

Berg

C. J.

Thomas

J. L.

L. C.

Guo

Collins

Okuyemi

K. S.

Ahluwalia

J. S.

(2012). Change in smoking, diet, and walking for exercise in Blacks. Health Education & Behavior, 39(2), 191–197. https://doi.org/10.1177/1090198111432252

*Bichler

Niedermeier

Fruehauf

Laengle

Fleischhacker

W. W.

Mechtcheriakov

Kopp

(2017). Acute effects of exercise on affective responses, cravings and heart rate variability in inpatients with alcohol use disorder–a randomized cross-over trial. Mental Health and Physical Activity, 13, 68–76. https://doi.org/10.1016/j.mhpa.2017.10.002

10.

Bradshaw

(2017). Occupational therapy and complementary health approaches and integrative health. American Journal of Occupational Therapy, 71(Suppl. 2), 7112410020. https://doi.org/10.5014/ajot.2017.716S08

11.

Brown

R. A.

Abrantes

A. M.

Read

J. P.

Marcus

B. H.

Jakicic

Strong

D. R.

. . .Gordon

A. A.

(2010). A pilot study of aerobic exercise as an adjunctive treatment for drug dependence. Mental Health and Physical Activity, 3(1), 27–34. https://doi.org/10.1016/j.mhpa.2010.03.001

12.

Centers for Disease Control and Prevention. (2023). A blog of the National Center for Health Statistics. National Center for Health Statistics. https://blogs.cdc.gov/nchs/

13.

*Cevasco

A. M.

Kennedy

Generally

N. R.

(2005). Comparison of movement-to-music, rhythm activities, and competitive games on depression, stress, anxiety, and anger of females in substance abuse rehabilitation. Journal of Music Therapy, 42(1), 64–80. https://doi.org/10.1093/jmt/42.1.64

14.

Chandler

Clarke

McKenzie

Boutron

Welch

(2016). A revised tool for assessing risk of bias in randomized trials. Cochrane Database of Systematic Reviews, Issue, 10(1), 29–31. https://doi.org//10.1002/14651858.CD201601

15.

Crooks

Toolsiedas

McDougall

Nowrouzi-Kia

(2024). Systematic review protocol of yoga therapy as modality in occupational therapy practice for adults experiencing mood disorders. British Medical Journal (BMJ) Open, 14(1). https://doi.org/10.1136/bmjopen-2023-077740

16.

Cunningham

Uyeshiro Simon

Preissner

(2022). Practice guidelines—occupational therapy practice guidelines for adults with multiple sclerosis. American Journal of Occupational Therapy, 76, 7605397010. https://doi.org/10.5014/ajot.2022.050088

17.

*Dempsey

(2009). Dance/movement therapy as an effective clinical intervention to decrease anxiety and support the recovery process. In Brooke

(Eds.), The use of creative therapies with chemical dependency issues (pp. 162–173). Charles C Thomas Pub Ltd.

18.

Epley

Wolske

Lee

Mirza

Fisher

(2021). Habits and health promotion in occupational therapy: A scoping review. Annals of International Occupational Therapy, 4(4), 269–286. https://doi.org/10.3928/24761222-20210921-04

19.

Fields

Kinney

Condon

Villavicencio

(2022). Physical activity interventions that address motor and balance impairments and skills for adults with traumatic brain injury (2012-2021). The American Journal of Occupational Therapy, 76(2), 7613393190. https://doi.org/10.5014/ajot.2022/76S2019

20.

*Gaihre

Rajesh

S. K.

(2018a). Effect of add-on yoga on cognitive functions among substance abusers in a residential therapeutic center: Randomized comparative study. Annals of Neurosciences, 25(1), 38–45. https://doi.org/10.1159/000484165

21.

*Gaihre

Rajesh

S. K.

(2018b). Effect of yoga and physical exercise on motor functions among substance abusers: A randomised comparative study. Journal of Clinical & Diagnostic Research, 12(10). https://doi.org/10.7860/JCDR/2018/35341.12156

22.

Gold

M. S.

Kobeissy

F. H.

Wang

K. K.

Merlo

L. J.

Bruijnzeel

A. W.

Krasnova

I. N.

Cadet

J. L

. (2009). Methamphetamine-and trauma-induced brain injuries: Comparative cellular and molecular neurobiological substrates. Biological Psychiatry, 66(2), 118–127. https://doi.org/10.1016/j.biopsych.2009.02.021

23.

Gutman

S. A.

(2006). Why addiction has a chronic, relapsing course. The neurobiology of addiction: Implications for occupational therapy practice. Occupational Therapy in Mental Health, 22(2), 1–29. https://doi.org/10.1300/J004v22n02_01

24.

Haglund

Ang

Mooney

Gonzales

Chudzynski

Cooper

C. B.

. . .Rawson

R. A.

(2015). Predictors of depression outcomes among abstinent methamphetamine-dependent individuals exposed to an exercise intervention. American Journal of Addiction, 24, 246–251. https://doi.org/10.1111/ajad.12175

25.

*Hallgren

Romberg

Bakshi

A. S.

Andréasson

(2014). Yoga as an adjunct treatment for alcohol dependence: A pilot study. Complementary Therapies in Medicine, 22(3), 441–445. https://doi.org/10.1016/j.ctim.2014.03.003

26.

*He

Yang

Miao

Zhang

Zhu

(2021). Four-week Tai Chi intervention decreases attention bias to drug cues in individuals with methamphetamine use disorder. The American Journal of Drug and Alcohol Abuse, 47(5), 638–648. https://doi.org/10.1080/00952990.2021.1950745

27.

Hildebrand

M. W.

Geller

Proffitt

(2023). Practice guidelines—Occupational therapy practice guidelines for adults with stroke. American Journal of Occupational Therapy, 77, 7705397010. https://doi.org/10.5014/ajot.2023.077501

28.

Hill

Vogler

Gullo

(2023). Occupational therapists’ understanding of supporting physical activity participation when working with children and adolescents: A national survey. Australian Occupational Therapy Journal, 70(3), 303–313. https://doi.10.1111/1440-1630.12854

29.

Horn

Dino

Branstetter

S. A.

Zhang

Noerachmanto

Jarrett

Taylor

(2011). Effects of physical activity on teen smoking cessation. Pediatrics, 128(4), e801–e811. https://doi.org/10.1542/peds.2010-2599

30.

Kitzinger

R. H.

Gardner

J. A.

Moran

Celkos

Fasano

Linares

. . .Royzner

(2023). Habits and routines of adults in early recovery from substance use disorder: Clinical and research implications from a mixed methodology exploratory study. Substance Abuse: Research and Treatment, 17, 11782218231153843. https://doi.org/10.1177/11782218231153843

31.

*Kumar

Kumar

K. J.

Benegal

Roopesh

B. N.

Ravi

G. S.

(2020). Integrated intervention program for alcoholism improves impulsiveness and disadvantageous reward processing/risk-taking. Indian Journal of Psychiatry, 62(4), 384. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_103_20

32.

*Kumar

Kumar

K. J.

Benegal

Roopesh

B. N.

Ravi

G. S.

(2021). Effectiveness of an integrated intervention program for alcoholism: Electrophysiological findings. Indian Journal of Psychological Medicine, 43(3), 223–233. https://doi.org/10.1177/0253717620927870

33.

*Lander

Chiasson-Downs

Andrew

Rader

Dohar

Waibogha

(2018). Yoga as an adjunctive intervention to medication-assisted treatment with buprenorphine+ naloxone. Journal of Addiction Research & Therapy, 9(1). https://doi.org/10.4172/2155-6105.1000354

34.

*Li

D. X.

Zhuang

X. Y.

Zhang

Y. P.

Guo

Wang

Zhang

Yao

Y. G.

(2013). Effects of tai chi on the protracted abstinence syndrome: A time trial analysis. The American Journal of Chinese Medicine, 41(01), 43–57. https://doi.org/10.1142/S0192415X1350004

35.

Lovell

G. P.

Gordon

J. A.

Mueller

M. B.

Mulgrew

Sharman

(2016). Satisfaction of basic psychological needs, self-determined exercise motivation, and psychological well-being in mothers exercising in group-based versus individual-based contexts. Health Care for Women International, 37(5), 568–582. https://doi.org/10.1080/07399332.2015.1078333

36.

Zhao

Chen

Lui

. . .Zhou

(2021). Effects of exercise programs on neuroelectric dynamics in drug addiction. Cognitive Neurodynamics, 15(1), 27–42. https://doi.org/10.1007/s11571-020-09647-w

37.

Lynch

W. J.

Peterson

A. B.

Sanchez

Abel

Smith

M. A.

(2013). Exercise as a novel treatment for drug addiction: A neurobiological and stage-dependent hypothesis. Neuroscience & Biobehavioral Reviews, 37(8), 1622–1644. https://doi.org/10.1016/j.neubiorev.2013.06.011

38.

*Menglu

Ruiwen

Suyong

Dong

(2021). Effects of tai chi on the executive function and physical fitness of female methamphetamine dependents: A randomized controlled trial. Frontiers in Psychiatry, 12, Article 653229. https://doi.org/10.3389/fpsyt.2021.653229

39.

Mooney

L. J.

Cooper

London

E. D.

Chudzynski

Dolezal

Dickerson

. . .Rawson

R. A.

(2014). Exercise for methamphetamine dependence: Rationale, design, and methodology. Contemporary Clinical Trials, 37(1), 139–147. https://doi.org/10.1016/j.cct.2013.11.010

40.

Moore

S. C.

Patel

A. V.

Matthews

C. E.

Berrington

Gonzalez

Park

Katki

H. A.

. . .Lee

I. M.

(2012). Leisure time physical activity of moderate to vigorous intensity and mortality: A large pooled cohort analysis. PLOS Medicine, 9(11), Article e1001335. https://doi.org/10.1371/journal.pmed.1001335

41.

National Heart Lung and Blood Institute. (2014). Quality assessment tool for before–after (pre–post) studies with no control group. National Institute of Health. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools

42.

Nesbitt

A. E.

Collins

K. J.

Nalder

Sabiston

C. M.

(2021). Occupational outcomes of a physical activity intervention for post-secondary student mental health. Canadian Journal of Occupational Therapy, 88(3), 254–265. https://doi.org/10.1177/00084174211021708

43.

Newman

R. M.

Polo

K. M.

Amanat

Campbell

Fleischer

Morikawa

(2024). Practice guidelines—Occupational therapy practice guidelines for adults living with and beyond cancer. American Journal of Occupational Therapy, 78, 7805397010. https://doi.org/10/5014/ajot.2024.078501

44.

OCEBM Levels of Evidence Working Group. (2009). The Oxford levels of evidence. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653

45.

*Oh

C. U.

Kim

N. C.

(2016). Effects of tai chi on serotonin, nicotine dependency, depression, and anger in hospitalized alcohol-dependent patients. The Journal of Alternative and Complementary Medicine, 22(12), 957–963. https://doi.org/10.1089/acm.2016.0246

46.

Open Science Framework. (2021, June 16). A scoping review of occupational therapy for clients with substance use disorders. https://osf.io/sjd45/

47.

Page

M. J.

McKenzie

J. E.

Bossuyt

P. M.

Boutron

Hoffmann

T. C.

Mulrow

C. D.

. . .Moher

(2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ (Clinical Research Ed.), 372, Article n71. https://doi.org/10.1136/bmj.n71

48.

Patterson

M. S.

Spadine

M. N.

Boswell

T. G.

Prochnow

Amo

Francis

A. N.

. . .Heinrich

K. M.

(2022). Exercise in the treatment of addiction: A systematic literature review. Health Education Behavior, 49(5), 801–819. https://doi.org/10.1177/10901981221090155

49.

*Petker

Yanke

Rahman

Whalen

Demaline

Whitelaw

. . .MacKillop

(2021). Naturalistic evaluation of an adjunctive yoga program for women with substance use disorders in inpatient treatment: Within-treatment effects on cravings, self-efficacy, psychiatric symptoms, impulsivity, and mindfulness. Substance Abuse: Research and Treatment, 15, 11782218211026651. https://doi.org/10.1177/11782218211026651

50.

*Przekop

Przekop

Haviland

M. G.

Oda

(2018). Comprehensive treatment for patients with chronic pain in a 12-step based substance use disorder program. Journal of Bodywork and Movement Therapies, 22(3), 685–692. https://doi.org/10.1016/j.jbmt.2017.08.009

51.

Rawson

R. A.

Chudzynski

Gonzales

Mooney

Dickerson

Ang

. . .Cooper

C. B.

(2015). The impact of exercise on depression and anxiety symptoms among abstinent methamphetamine-dependent individuals in a residential treatment setting. Journal of Substance Abuse Treatment, 57, 36–40. https://doi.org/10.1016/j.jsat.2015.04.007

52.

Rawson

R. A.

Chudzynski

Mooney

Gonzales

Ang

Dickerson

. . .Cooper

C. B.

(2015). Impact of an exercise intervention on methamphetamine use outcomes post-residential treatment care. Drug and Alcohol Dependence, 156, 21–28. https://doi.org/10.1016/j.drugalcdep.2015.08.029

53.

Rosa

H. Z.

Barcelos

R. C. S.

Segat

H. J.

Roversi

Dias

V. T.

Milanesi

L. H.

Burger Me

. (2020). Physical exercise modifies behavioral and molecular parameters related to opioid addiction regardless of training. European Neuropsychopharmacology, 32, 25–35. https://doi.org/10.1016/j.euroneuro.2019.12.111

54.

*Ross

Cidambi

Dermatis

Weinstein

Ziedonis

Roth

Galanter

(2008). Music therapy: A novel motivational approach for dually diagnosed patients. Journal of Addictive Diseases, 27(1), 41–53. https://doi.org/10.1300/J069v27n01_05

55.

Ryan

D. A.

Boland

(2021). A scoping review of occupational therapy interventions in the treatment of people with substance use disorders. Irish Journal of Occupational Therapy, 49(2), 104–114. https://doi.org/10.1108/IJOT-11-2020-0017

56.

Ryan

D. A.

Naughton

de Faoite

Dowd

Morrissey

(2023). An occupation-based lifestyle lecture intervention as part of inpatient addiction recovery treatment: Exploring occupational performance, balance and personal recovery. Substance Abuse: Research and Treatment, 17, 1–10. https://doi.org/10.1177/11782218231165123

57.

Schmid

A. A.

Van Puymbroeck

Portz

J. D.

(2019). Yoga improves occupational performance, depression, and daily activities for people with chronic pain. WORK: A Journal of Prevention, Assessment & Rehabilitation, 63(2). https://doi.org/10.3233/WOR-192919

58.

Segat

H. J.

Martini

Roversi

Rosa

S. G.

Muller

S. G.

Rossato

D. R.

. . .Burger

M. E.

(2022). Impact of two types of exercise training on AMPH addiction: Role of hippocampal neurotrophins. Physiology & Behavior, 251, 113804. https://doi.org/10.1016/j.physbeh.2022.113804

59.

Shaheen

Ramadan

Hefnawy

Ibrahim

I. A.

Hassanein

M. E.

. . .Flouty

(2023). Appraising systematic reviews: A comprehensive guide to ensuring validity and reliability. Frontiers in Research Metrics and Analytics, 8. https://doi.org/10.3389/frma.2023.1268045

60.

*Sharma

Singh

(2017). Recreational activity and yoga: An avenue to prevent criminal propensity among drug addicts. International Journal of Economic Research, 14, 617–623. https://doi.org/10.3233/BPL-150007

61.

Shea

B. J.

Reeves

B. C.

Wells

Thuku

Hamel

Moran

. . .Henry

D. A.

(2017). AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 358, Article j4008. https://doi.org/10.1136/bmj.j4008

62.

Somkuwar

Staples

M. C.

McKenzie

Atoosa

Chitra

(2015). Evaluating exercise as a therapeutic intervention for methamphetamine addiction-like behavior. Brain Plasticity, 1(1), 63–81. https://doi.org/10.3233/BPL-150007

63.

Stimpson

N. J.

Davison

Javadi

A. H.

(2018). Joggin’ the noggin: Towards a physiological understanding of exercise-induced cognitive benefits. Neuroscience & Biobehavioral Reviews, 88, 177–186. https://doi.org/10.1016/j.neubiorev.2018.03.018

64.

Stoffel

V. C.

Moyers

P. A.

(2004). An evidence-based and occupational perspective of interventions for persons with substance-use disorders. The American Journal of Occupational Therapy, 58, 570–586.

65.

*Sureka

Govil

Dash

Kumar

Singhal

(2014). Sudarshan kriya for male patients with psycho active substance dependence: A randomized control trial. ASEAN Journal of Psychiatry, 16(1), 28–37. https://doi.org/10.1016/j.ajp.2014.06.010

66.

*Tamhankar

Barnes

Pereira

(2005). Personality predisposition and prognosis of alcoholics after therapeutic intervention. Psychological Studies University of Calicut, 50(2–3), 277–280.

67.

Taylor

L. G.

Primucci

Irwin

J. D.

Teachman

Tucker

(2024). The uses and effectiveness of occupational therapy physical activity interventions in young children with developmental disabilities: A systematic review. Physical & Occupational Therapy in Pediatrics, 44(2), 56–77. https://doi.org/10.1080/01942638.2023.2199836

68.

Ussher

McCusker

Morrow

Donaghy

(2000). A physical activity intervention in a community alcohol service. British Journal of Occupational Therapy, 63(12), 598–604.

69.

Wang

Zhou

(2014). Impact of physical exercise on substance use disorders: A meta-analysis. PLOS ONE, 9(10), Article e110728. https://doi.org/10.1371/journal.pone.0110728

70.

Wang

Zhou

Chang

Y. K.

(2015). Acute exercise ameliorates craving and inhibitory deficits in methamphetamine: An ERP study. Physiology & Behavior, 147, 38–46. https://doi.org/10.1016/j.physbeh.2015.04.008

71.

Wasmuth

S. L.

Crabtree

J. L.

Scott

P. J.

(2014). Exploring addiction-as-occupation. British Journal of Occupational Therapy, 77(12). https://doi.org/10.4276/03082214X14176260335264

72.

Wasmuth

S. L.

Outcalt

Lysaker

P. H.

(2015). Metacognition in persons with substance abuse: Findings and implications for occupational therapists. Canadian Journal of Occupational Therapy, 82(3). https://doi.org/10.1177/0008417414564865

73.

Wasmuth

S. L.

Pritchard

Kaneshiro

(2016). Occupation-based intervention for addictive disorders: A systematic review. Journal of Substance Use and Addiction Treatment, 62, 1–9. https://doi.org/10.1016/j.jsat.2015.11.011

74.

Weinstock

Barry

Petry

N. M

. (2008). Exercise-related activities are associated with positive outcome in contingency management treatment for substance use disorders. Addictive Behaviors, 33(8), 1072–1075. https://doi.org/10.1016/j.addbeh.2008.03.011

75.

Wheeler

Acord-Vira

(2023). Occupational therapy practice guidelines for adults with traumatic brain injury. The American Journal of Occupational Therapy, 77(4), 7704397010. https://doi.org/10.5014/ajot.2023.077401

76.

White

W. L.

(2012). Recovery/remission from substance use disorders: An analysis of reported outcomes in 415 scientific reports, 1868–2011. Philadelphia Department of Behavioral Health and Intellectual Disability, Services and the Great Lakes Addiction Technology Transfer Center. https://www.drugsandalcohol.ie/39251/1/whitewl2012_recoveryremission_from_substance_abuse_disorders.pdf

77.

*Willy-Gravley

Beauchemin

Pirie

Gomes

Klein

(2021). A randomized controlled trial of yoga with incarcerated females: Impacts on emotion regulation, body dissociation, and warnings of substance relapse. Social Work Research, 45(1), 20–29. https://doi.org/10.1093/swr/svaa023

78.

*Wimberly

A. S.

Engstrom

Layde

McKay

J. R.

(2018). A randomized trial of yoga for stress and substance use among people living with HIV in reentry. Journal of Substance Abuse Treatment, 94, 97–104. https://doi.org/10.1016/j.jsat.2018.08.001

79.

Wood

Henderson

Foster

E. R.

(2022). Practice guidelines—Occupational therapy practice guidelines for people with Parkinson’s disease. American Journal of Occupational Therapy, 76, 7603397010. https://doi.org/10.5014/ajot.2022.7630001

80.

*Yan-Guang

Jing-Yi

Xiao-Wu

Meng-Lu

Su-Yong

Ding

. . .Dong

(2021). Comparison of physical effect between two training methods for individuals with substance use disorder. BMC Sports Science, Medicine & Rehabilitation, 13(1), Article 6. https://doi.org/10.1186/s13102-021-00234-y

81.

Yorks

D. M.

Frothingham

C. A.

Schuenke

M. D.

(2017). Effects of group fitness classes on stress and quality of life of medical students. Journal of the American Osteopathic Association, 117(11), e17–e25. https://doi.org/10.7556/jaoa.2017.140

82.

*Yuvarani

Priya

V. V.

Kamatchi

Tharani

Vaishnavi

(2019). Study to analyse the effect of exercise in individuals with alcohol withdrawal syndrome (Aws). Indian Journal of Public Health Research & Development, 10(12).

83.

*Zhang

Zhu

(2020). Effect of Taijiquan exercise on rehabilitation of male amphetamine-type addicts. Evidence-based Complementary and Alternative Medicine, 2020, 8886562. https://doi.org/10.1155/2020/8886562

84.

*Zhu

Dai

Geng

Zhu

. . .Theeboom

(2018). Long-term effects of Tai Chi intervention on sleep and mental health of female individuals with dependence on amphetamine-type stimulants. Frontiers in Psychology, 9, Article 1476. https://doi.org/10.3389/fpsyg.2018.01476

85.

*Zhu

Jiang

Schöllhorn

W. I.

(2020). Long-term effects of mind-body exercises on the physical fitness and quality of life of individuals with substance use disorder—A randomized trial. Frontiers in Psychiatry, 11, Article 528373. https://doi.org/10.3389/fpsyt.2020.528373

86.

*Zhu

Dai

Wang

Zhou

(2016). Beneficial effects of Tai Chi for amphetamine-type stimulant dependence: A pilot study. The American Journal of Drug and Alcohol Abuse, 42(4), 469–478. https://doi.org/10.3109/00952990.2016.1153646