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Fitness therapy and addiction recovery: A proven combination of success

Fitness therapy and addiction recovery

On the surface, a gym on the campus of a drug and alcohol treatment facility might seem an odd addition. With a little prodding, however, most people reach that a-ha moment fairly quickly: Of course fitness therapy for addiction recovery is an ideal tool for struggling patients.

After all, addiction and exercise affect the same areas of the brain. Both produce chemicals that change the way individuals feel. But while addicts may start out using drugs to feel “good,” the pleasure soon turns to pain — physical, mental, emotional and spiritual. The repetitive cycle of constant drug and alcohol use rings the brain dry of natural endorphins and other neurotransmitters, each use producing less and less until the addict and alcoholic struggles to imbibe enough just to feel normal.

Regular, moderate exercise, on the other hand, provides a natural “high” for those who engage in it regularly. Not only that, but the benefits can be enormous, and not just on an individual’s physical health.

It makes common sense, then, that fitness therapy for addiction recovery can be integrated into an effective treatment plan for those struggling to find a new way to live without the use of drugs and alcohol.

Fitness: From necessity to luxury

fitness therapy and addiction recoveryExercise is a relatively contemporary pastime, given that man’s early existence necessitated strenuous activity just to survive in primitive times. As Dr. Lance C. Dalleck and Dr. Len Kravitz, writing for the University of New Mexico [1], point out, “Tribes commonly went on one- or two- day hunting journeys for food and water. Regular physical activity apart from that necessary for hunting and gathering was also a principal component of life. Following successful hunting and gathering excursions, celebration events included trips of six to 20 miles to neighboring tribes to visit friends and family, where dancing and cultural games could often last several hours. This Paleolithic pattern of subsistence pursuit and celebration, demanding a high level of fitness and consisting of various forms of physical activity, defined human life.”

The introduction of agriculture, however, changed the diet, the health and the physicality of early humans. As tribes began to coalesce into larger communities and cities, “specialization of occupations reduced the amount and intensity of work-related physical activities, various healers and philosophers began to stress that long life and health depended on preventing illnesses through proper diet, nutrition, and physical activity,” according to a Surgeon General report for the Centers for Disease Control and Prevention [2].

As humans congregated, however, they also came into conflict with one another. According to a piece detailing the history of fitness on the website The Art of Manliness [3], “Between 4,000 BC and the fall of the Roman Empire in 476 AD, civilizations rose and fell through war and conquest. Assyrians, Babylonians, Egyptians, Persians, and later on, the Greeks and Romans all imposed physical training on boys and young men. The purpose? Preparing for battle.”

While Greco-Roman feats of physicality would later give rise to a number of modern exercise regimens, those cultures didn’t hold a monopoly on the emphasis of fitness as a path to betterment. As the aforementioned Surgeon General report notes, other cultures around the world have records of fitness therapy as a form of self-improvement [2]:

  • In ancient China, “Tai chi chuan, an exercise system that teaches graceful movements, began as early as 200 B.C. with Hua T’o.”
  • In India, “The Ajur Veda, a collection of health and medical concepts verbally transmitted as early as 3000 B.C., developed into Yoga, a philosophy that included a comprehensively elaborated series of stretching and flexibility postures.”
  • In Africa, “systems of flexibility, agility, and endurance training … served as an integral component of religious ritual and daily life. The Samburu and the Masai of Kenya still feature running as a virtue of the greatest prowess, linked to manhood and social stature.”
  • In North America, before the arrival of Europeans, running was a vital part of Native American culture. Across many tribes, members “ran to communicate, to fight, and to hunt. Running was also a means for diverse American Indian cultures to enact their myths and thereby construct a tangible link between themselves and both the physical and metaphysical worlds.”

Fitness therapy and addiction recovery: The evolution

fitness therapy and addiction recoveryBy the time of the fall of the Roman Empire, lavish and ostentatious lifestyles with an emphasis on hedonism meant a decline in the physical health of many Romans. With ways of life more closely resembling primitive man, the tribes that brought about Rome’s collapse were physically superior, and the Dark Ages ushered in afterward saw a turn toward two distinct classes: Rulers, who underwent rigorous physical training as soldiers, knights and combatants; and vassals, who toiled in the fields and exercised through labor.

As the Renaissance dawned, however, Europeans began to look back fondly at Greco-Roman traditions. A renewed interest in art and philosophy led to a revival of ancient ideas, and as thinkers of the day focused on improvement of the mind, the body soon followed. One of the aspects of ancient civilization revived in this period is that of the gymnasium. According to Eric Chaline, author of “The Temple of Perfection: A History of the Gym” [4], “The gymnasium was one of the most important social institutions in the ancient Greek world, a place where Athenian men of all ages mixed, and where younger men were trained to become the citizen rulers of the world's first democracy.” Two of the most important were The Lyceum, run by Aristotle; and The Academy, oversaw by Plato.

During medieval times, ancient manuscripts described these institutions, and physicians of the day began to understand and recommend exercise for its health benefits, according to Chaline: “However, it's unlikely that the people they were writing for, the aristocracy, ever did practise ancient athletics. The revival of interest in physical training at the gymnasium during the Renaissance was purely academic.”

By the 1700s, however, pride revived the practice of physical fitness. French forces, commanded by Napoleon and consisting mostly of commoners, delivered a crushing defeat to the Prussians by 1806, and German humiliation was felt on a deeply personal level. Enter Friedrich Ludwig Jahn in 1809, who “moved to Berlin to become a gymnastics teacher, and he conceived that regular physical exercise could be the catalyst of revival for his countrymen's moral spirit and physical ability.  Excellence of mind and body intertwined could become a cultural identity that no one could remove or corrupt.” [5]

While considered a pioneer of gymnastics — he invented the pommel horse, the horizontal and parallel bars and promoted the use of gymnastic rings — “the physical culture festivals he sponsored attracted as many as 30,000 enthusiasts, but the essence and end goal of his gymnastics and calisthenics methods were above all practical and functional, not artistic. He advocated the practice of the traditional natural movements like running, balancing, jumping, climbing, and so on.” [3]

By the mid-1800s, fitness as a form of exercise and a path to physical beauty had spread to Sweden, Spain and France; on the other side of the Atlantic, it began to develop as a regimen in America as well.

Fitness in America

According to papers from the University of Toledo [6], “The physical fitness movement in the United States followed the influx of a large number of German immigrants who fled their country due to the 1848 revolution.” A student of Jahn, Charles Follen, opened the Round Hill School at Harvard, “which stressed rigorous mental and physical exercise,” and the German gymnastic institution Turnverein opened in Cincinnati in 1848.

Twenty years prior, however, Catharine Beecher — the half-sister of “Uncle Tom’s Cabin” writer Harriet Beecher Stowe — implemented physical fitness as part of the curriculum at the Hartford Female Seminary, which she established with her sister, Mary: “In an attempt to ‘remedy physical defects’ at her school, an English woman visited and demonstrated some exercises, which ‘then had no name,’ but what Beecher would develop into her own organized system of ‘Calisthenics,’” writes Catherine Mas [7] for an undergraduate thesis at the Columbia University Department of history. “Borrowing the term from Greco-Roman fitness practice, Beecher was the first to develop the system of free body exercises in the United States and advocate for its establishment in schools’ physical education curriculum.”

By the turn of the century, a number of individuals had made significant contributions to physical fitness as an integral part of a healthy lifestyle, but a handful bear mentioning:

  • Dudley Allen Sargent, the director of Hemenway Gymnasium at Harvard from 1879 to 1919, was considered “America’s pre-eminent leader in the field of physical education,” according to The New York Times upon his death in 1924 [8]. The Dictionary of American Biography goes on to add, “during the 40 years in which he held the position [at Harvard], he exerted a greater influence on the development of physical training in American colleges and schools than any other man.”
  • William G. Anderson, who took over management of the Yale gymnasium in the 1890s and became what the New York Herald Tribune described at the time as an enthusiastic proponent of fitness [9]. Influenced by Beecher, he introduced dance into the Yale fitness program in 1903; over the course of his career, he wrote a number of books on physical education and “conducted statistical studies to prove that athletes live longer,” according to the Yale alumni magazine [9]. “He invented several devices for testing strength and development, including the ergometer. His influence was felt around the country through the physical education summer schools he directed in New York, Utah and California.”
  • President Theodore Roosevelt, whose propensity for physicality was legendary. According to the news website Timeline [9], “Roosevelt kicked off his presidency in 1901 with a rigorous exercise regimen, launching an unofficial fitness mandate that persists to the present day Oval Office. Probably the most continuously active president in US history, Roosevelt rode horses, wrestled, and went on ‘rough, cross-country walks’ where he rock-climbed and swam frozen rivers to reach his destination.”
  • Bernarr Macfadden, a quirky, self-made millionaire who turned an adolescent interest in fitness into riches. According to CNN [10], “by his early twenties, he was wrestling professionally, advertising himself as a personal trainer, and publishing pamphlets on exercise and fitness. That led to the launch of a magazine, Physical Culture, in 1899.” While the snake oil approach to health and fitness eventually led the American Medical Association to accuse the magazine of doing “incalculable harm,” the glamorization of fitness can be traced to Macfadden.

Fitness therapy and addiction recovery: The modern age

fitness therapy and addiction recoveryBy the mid 20th century, one figure led the way toward the modern fitness craze: Jack LaLanne, who first opened a combination gym, health food store and juice bar in 1936 in Oakland. According to his New York Times obituary [11], “‘The Jack LaLanne Show’ made its debut in 1951 as a local program in the San Francisco area, then went nationwide on daytime television in 1959. His short-sleeved jumpsuit showing off his impressive biceps, his props often limited to a broomstick, a chair and a rubber cord, Mr. LaLanne pranced through his exercise routines, most notably his fingertip push-ups.”

It continued through the mid-1980s, by which point fitness has exploded in popularity. Actress Jane Fonda released “‘Jane Fonda's Workout’ (in 1982) … widely credited with markedly increasing sales of the new-fangled VCR and starting the at-home fitness craze. Other programs like Jazzercise … built on the same theory; emphasizing aerobics, especially choreographed cardio routines, and ‘toning’ exercises with light weights as the best way for women to get in shape.” [12]

By the 1990s, at-home devices like Bowflex and ab rollers, alongside group fitness regimens built around step exercises and an explosion of interest in extreme sports, cemented physical activity as part of the American mainstream. According to Statista [13], the global fitness and health club industry generates $80 billion in revenue annually, and a study detailed by the news agency Reuters [14] indicates that physical inactivity costs the global economy $67.5 billion per year in productivity and health care costs. People who exercise are healthier, more productive individuals, which is why modern health care has taken a keen interest in linking physical fitness to physical health through incentive programs, Fitbit challenges and more.

And advances in science have illuminated more clearly the benefits of exercise that aren’t defined by sculpted muscles and healthy heart rates. “Endorphins are only one of many neurotransmitters released when you exercise,” according to an article on the website Healthline [15]. “Physical activity also stimulates the release of dopamine, norepinephrine, and serotonin. These brain chemicals play an important part in regulating your mood. For example, regular exercise can positively impact serotonin levels in your brain. Raising your levels of serotonin boosts your mood and overall sense of well-being. It can also help improve your appetite and sleep cycles, which are often negatively affected by depression.”

And that brings us back to addiction and the role fitness therapy for addiction recovery can play: “Our brains are wired to increase the odds that we will repeat pleasurable activities,” according to the National Institute on Drug Abuse [16]. “The neurotransmitter dopamine is central to this. Whenever the reward circuit is activated by a healthy, pleasurable experience, a burst of dopamine signals that something important is happening that needs to be remembered. This dopamine signal causes changes in neural connectivity that make it easier to repeat the activity again and again without thinking about it, leading to the formation of habits.

“Just as drugs produce intense euphoria, they also produce much larger surges of dopamine, powerfully reinforcing the connection between consumption of the drug, the resulting pleasure, and all the external cues linked to the experience. Large surges of dopamine ‘teach’ the brain to seek drugs at the expense of other, healthier goals and activities.”

Fitness therapy and addiction recovery: An ideal match

Drugs, the NIDA points out, “interfere with the way neurons send, receive, and process signals via neurotransmitters.” Some drugs activate neurons because their chemical makeup resembles that of a natural neurotransmitter, but they do so abnormally; others can cause neurons to release unusually large doses of natural neurotransmitters, resulting in a flood of “feel-good” chemicals immediately but depleting stores that are necessary for long-term mood maintenance.

“Addictive drugs, for example, can release two to 10 times the amount of dopamine that natural rewards do, and they do it more quickly and more reliably,” according to a piece in the Harvard Mental Health Letter [17]. “In a person who becomes addicted, brain receptors become overwhelmed. The brain responds by producing less dopamine or eliminating dopamine receptors — an adaptation similar to turning the volume down on a loudspeaker when noise becomes too loud.”

The parts of the brain affected include, according to the NIDA [16]:

  • The basal ganglia, “which play an important role in positive forms of motivation, including the pleasurable effects of healthy activities like eating, socializing, and sex, and are also involved in the formation of habits and routines.”
  • The extended amygdala, which “plays a role in stressful feelings like anxiety, irritability, and unease, which characterize withdrawal after the drug high fades and thus motivates the person to seek the drug again.”
  • The prefrontal cortex, which “powers the ability to think, plan, solve problems, make decisions, and exert self-control over impulses.”

The brain on drugs, needless to say, is a scrambled mess, and even after a period of safe, medically supervised detox, it takes months and sometimes years for the chemistry of an addicted brain to level off. However, fitness therapy for addiction recovery can play a helpful role. How? Consider the parts of the brain activated by physical exercise:

  • The basal ganglia: “Physical activity, especially motor fitness level training, might be a promising tool that leads to structural changes in the basal ganglia. This might have the potential to diminish the cognitive decline in older adults and to support the academic success in children and young adults,” according to a 2016 study published in the Journal of Neurology and Neuromedicine [18].
  • The amydala: According to the website Forever Fit Science [19], “Rodent research … demonstrated that daily wheel running effectively prevents hippocampal and amygdalar memory deficits and strengthens neural circuitry for these brain areas.”
  • The prefrontal cortex: “The findings from this study indicate that acute aerobic exercise improves executive functioning, a grouping of higher-order cognitive processes that depend on the prefrontal cortex,” writes a group of researchers for Journal of the International Neuropsychological Society [20].

Fitness therapy for addiction recovery: Evidence-based

Is fitness therapy for addiction recovery the only solution for those who struggle with drugs and alcohol? Absolutely not. But given its history as a way humans have improved their health throughout recorded history, and its role in regulating areas of the brain also affected by addiction, it’s a crucial component.

Writing for the Harvard Health Blog of Harvard Medical School, Dr. Claire Twark writes [21] that “exercise shows promise … a small study in humans investigated an exercise program offered to 38 men and women who misused a variety of substances, including opioids, cannabis, amphetamines, and cocaine. Participants agreed to take part in group exercise three times a week for two to six months. Twenty people completed the intervention. When reassessed a year later, five reported abstinence and 10 reported that they had decreased their substance use.”

In addition, Twark continues, patients working toward recovery find that exercise “helps to distract them from cravings. Workouts add structure to the day. They help with forming positive social connections, and help treat depression and anxiety in combination with other therapies.” Writing for the magazine Self, Louise Green shares [22] her similar, intimately personal experience: “A year into my sobriety, I started running. I found a positive, healthy community where I began to feel accepted and confident. With every run, I left behind pieces of shame and believed in myself just a little bit more. I had found my new high. It started with 5K races, then 10K, then half-marathons, and then I eventually left my full-time career to become a personal trainer because I had become so captivated by this new way of living … fitness became my life, and it helped me bridge the gap from early recovery to long-term sobriety.”

Writing for U.S. News and World Report [23], Anna Ciulla details other positive links between fitness therapy and addiction recovery:

  • “Researchers at Vanderbilt found that after 10 30-minute sessions on a treadmill over a two-week period, heavy marijuana users were able to cut their cravings and cannabis use by more than 50 percent.”
  • “Similar results cited by the National Institute on Drug Abuse occurred in two earlier independent experiments … with cocaine-seeking lab rats. When the rats were made to run on an exercise wheel, they exhibited less cocaine-seeking behavior.”
  • “Exercise decreased drug use among methamphetamine, amphetamine and cocaine users in a 2011 study in the journal Frontiers in Psychiatry.”

Clearly, there is a mountain of evidence to back up the notion that fitness therapy is a positive step for any individual looking to improve his or her overall health. It makes sense that offering fitness therapy in an addiction treatment setting would be a natural complement to traditional psychotherapy — but with the understanding that it can have real effects as a therapeutic modality for addiction treatment all on its own, it seems to be a no-brainer.

SOURCES

[1]: https://www.unm.edu/~lkravitz/Article%20folder/history.html

[2]: https://www.cdc.gov/nccdphp/sgr/intro2.htm

[3]: https://www.artofmanliness.com/articles/the-history-of-physical-fitness/

[4]: https://www.abc.net.au/radionational/programs/archived/bodysphere/the-history-of-the-gym/6361190

[5]: https://www.landmarks-stl.org/news/the_glories_of_germanhood_a_history_of_the_turnverein_in_st._louis._chapter/

[6]: https://www.utoledo.edu/library/canaday/exhibits/quackery/quack6.html

[7]: https://asit-prod-web1.cc.columbia.edu/historydept/wp-content/uploads/sites/20/2017/07/Catherine-Mas.pdf

[8]: https://www.tandfonline.com/doi/abs/10.1080/10671188.1948.10620979?journalCode=urqe17

[9]: https://yalealumnimagazine.com/articles/4213-building-a-better-student-body

[10]: http://money.com/money/4074103/wackiest-millionaire-ever-run-president/

[11]: https://www.nytimes.com/2011/01/24/sports/24lalanne.html

[12]: https://www.shape.com/fitness/fitness-industry-through-years

[13]: https://www.statista.com/topics/1141/health-and-fitness-clubs/

[14]: https://www.reuters.com/article/us-health-activity-idUSKCN1072S1

[15]: https://www.healthline.com/health/depression/exercise#1

[16]: https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain

[17]: https://www.health.harvard.edu/newsletter_article/how-addiction-hijacks-the-brain

[18]: https://www.jneurology.com/articles/exerciseinduced-changes-in-basal-ganglia-volume-and-their-relation-to-cognitive-performance.html

[19]: https://foreverfitscience.com/brain-health/4-areas-brain-exercise/

[20]: https://static1.squarespace.com/static/5651cdc8e4b03de1aca6c145/t/56b90d42d51cd446dcd8b01b/1454968131173/Basso_etal++2015.pdf

[21]: https://www.health.harvard.edu/blog/can-exercise-help-conquer-addiction-2018122615641

[22]: https://www.self.com/story/how-fitness-helped-me-recover-from-addiction

[23]: https://health.usnews.com/health-care/for-better/articles/2018-11-05/the-benefits-of-regular-exercise-in-recovery