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Introduction
Alcohol use disorders (AUDs) are among the most common of all psychiatric disorders with an estimated global lifetime prevalence of around 16%. 1 The societal consequences of hazardous drinking are substantial and include accidents, violence and antisocial behaviours. 2 Long-term health consequences can include brain damage, liver cirrhosis and metabolic diseases. 2 The estimated annual cost of excessive alcohol consumption in the USA is around US$223 billion. 3
While the personal and social impact of AUDs can be immense, only a limited number of those affected receive appropriate treatment. 4 5 A survey in the UK found that only 1 out of 18 people who met the criteria for alcohol dependence had received formal treatment. 6 One potential explanation for poor help-seeking is the perceived stigma associated with traditional treatments for AUDs, which are often administered in specialist clinics. 7 8 Current treatment options include pharmacological therapy, cognitive-behavioural interventions (CBT), motivational interviewing and 12-step facilitation treatment (ie, a model of alcohol recovery based on group therapy and support). 9 Despite advancements in these treatment modalities, relapse remains high and pharmacotherapy has unwanted side effects. Among treated individuals, first year remission rates can vary between 60% and 90%, depending on the severity of the disorder and the criteria for remission. 10 11 While effective treatment options are available, there is a need for novel adjunctive interventions that may help in alcohol abstinence and the comorbid health problems commonly associated with the disorder, which include depression/anxiety 12 13 and cardiometabolic risks. 14
Exercise is a potentially efficacious alternative treatment for AUDs that is feasible and appeals to a broad spectrum of patients. 15 16 Meta-analytic reviews have supported the antidepressant effects of exercise among otherwise healthy adults, 17 chronically ill patients 18 and patients with depressive disorders. 19 Evidence supporting the use of exercise in the treatment of substance use disorders is growing. 20 In the field of smoking cessation, where most research exists to date, a review of 17 randomised controlled trials (RCTs) exploring the effects of long-term exercise interventions found that exercise generally improved one or more smoking-related outcomes, and abstinence rates were comparable to CBT and/or nicotine replacement therapy. 21
Evidence supporting exercise interventions for AUDs has expanded in recent years. Two recent...