Meena Gella, OMS IV

Medical professionals everywhere are fully supporting the benefits of exercise. The American College of Sports Medicine and American Diabetes Association state aerobic exercise and resistance training together can efficiently lower body weight, decrease cardiovascular risk factors, reduce disease progression, improve mood and so much more.

It is a cornerstone of patient self-treatment for many acute and chronic disease processes across the spectrum. However, a new and up-and-coming theorem is that exercise can decrease addiction, substance abuse, and therefore prevent imminent bad outcomes. A study published in 

 looked at the effects of acute exercise on drug cravings, mood, and self-esteem, and presented preliminary findings. The study concluded that football, circuit training, and walking are feasible therapeutic activities for inpatients with poly-substance dependence.

One big limitation of this study was that it was performed in a select group of patients, and further randomized controlled studies would have to be performed to determine long-term effects.

In addition to risk reduction, aerobic exercises such as running and weight lifting have shown to improve psychological imbalances.

Increased intensity aerobic exercises decrease down-regulation of activity in the prefrontal cortex. This area is often up-regulated in anxiety and depression. Many nicotine users state they use tobacco products to curb the effects of their anxiety. Exercise has been shown to decreased nicotine withdrawal and cravings with increased levels of exercise. When comparing steady-state running and anaerobic sprint training, the latter has been found to increase levels of dopamine and brain-derived neurotropic factor (BDNF).

Findings from preclinical studies have hypothesized that BDNF is increased by exercise and serves as a substitute reward for drug intake by increasing dopaminergic activity.

Evidence shows aerobic exercise can change the mesolimbic pathway, altering seeking and addiction behaviors in substance users.

This alteration is theorized to be mediated by decreased binding of the dopamine type 1-like and dopamine type 2-like receptors.

The evidence regarding use of forms of exercise and impact on drug cravings and substance use disorders is limited. Given the limited evidence available, further exploration in this theory may impact the lives of many in a multifactorial way. Exercise improves psychological, behavioral, neurobiological, and overall health of patients. The overall safety profile of this treatment does more benefits than harm in most cases.

This provides pharmacist and other health care professionals another opportunity to provide counseling regarding this possibility as this approach may have a multifactorial impact.

Ellingsen MM, Johannesen SL, Martinsen EW et al. Effects of acute exercise on drug craving, self-esteem, mood and affect in adults with poly‐substance dependence: Feasibility and preliminary findings. 

. Volume 37, Issue 6. 04 June 2018. doi.org/10.1111/dar.12818

Colledge F, Gerber M, Ludyga S et al. Anaerobic Exercise Training in the Therapy of Substance Use Disorders: A Systematic Review. 

. 04 December 2018. doi.org/10.3389/fpsyt.2018.00644

Robison LS, Swenson S, Hamilton J et al. Exercise Reduces Dopamine D1R and Increases D2R in Rats: Implications for Addiction. 

Medicine and Science in Sports and Exercise

Linke SE, Ussher M. Exercise-based treatments for substance use disorders: evidence, theory, and practicality. 

The American Journal of Drug and Alcohol Abuse

Articles

Exercise improves psychological, behavioral, neurobiological, and overall health of patients.

Exercise: Another Potential Option for Substance Abuse Disorder

Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of death in the United States today. According to the American College of Cardiology (ACC) and American Heart Association (AHA) Task Force, managing elevated cholesterol is one of the the key elements to decreasing negative outcomes in this multifactorial disease state.

The ASCVD Risk algorithm is used to calculate a 10-year risk of heart disease or stroke and for recommendations of statin therapy. This algorithm calculates this risk by evaluating the following factors: history of ASCVD, low-density lipoprotein (LDL) cholesterol levels, age, current diagnosis of diabetes, sex, race, total cholesterol, high-density lipoprotein (HDL) cholesterol levels, medication controlled hypertension, and smoking history. Any history of the following conditions is considered a known history of ASCVD: acute coronary syndrome, myocardial infarction, stable angina, coronary revascularization, stroke, transient ischemic attack, peripheral arterial disease, or patients with very high LDL levels (>190).

Risk factors for ASCVD include smoking, dyslipidemia, diabetes, and hypertension. The cornerstone to preventing bad outcomes is focusing on a heart healthy lifestyle. According to the CDC, a heart healthy lifestyle revolves around maintaining a healthy weight, eating a well-rounded diet, exercising 3 to 5 times per week for 30-minute increments, avoiding tobacco products, and limiting alcohol use. 

Assessment of ASCVD risk is crucial for primary prevention of cardiovascular disease. For those aged 20 to 39 years, traditional risk factors such as tobacco use, hypertension, or others, can be measured to identify whether lifestyle optimization or treatment is needed.

 For adults aged 20 to 39 years and 40 to 59 years, who are not at an elevated (

 7.5%) 10-year risk, an estimation of a lifetime or 30-year risk for ASCVD can be made.

Estimating ASCVD 10-year risk can be performed using an online risk calculator provided by ACC. The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease guidelines suggest the race and sex specific Pooled Cohort Equation to estimate 10- year ASCVD risk of asymptomatic adults ages 40 to 79 years. 

 Adults are categorized into low (<5%), borderline (5% to 7.5%), intermediate (

With the 2019 ACC/AHA guidelines for primary prevention of cardiovascular disease, statin treatment recommendations vary from previous guidelines. Patients’ aged 20 to 75 years and LDL 

 190 mg/dl use high-intensity statin without risk assessment. 

 Moderate-intensity statin can be used in patients aged 40 to 75 years and with type 2 diabetes mellitus. High intensity statin in this patient population may be considered based on risk estimation. For patients aged 40 to 75 years and with LDL 

70 mg/dl and <190 mg/dl without diabetes, use risk estimator to identify intensity of statin.

Patients on statin therapy should be assessed for compliance, therapy effectiveness, and adverse effects. Fasting lipid levels should be checked to assess effectiveness. These should be compared to values prior to statin initiation. Adverse effects are usually experiences in the first 4 to 12 weeks of starting treatment. Common adverse effects include myalgia. Certain drug-drug interactions can increase risk of patients experiencing myalgia with statins. Patients should also be screened for type 2 diabetes mellitus.

Statins and a heart healthy lifestyle are able to manage the risks of ASCVD effectively; however, there are times when additional treatments are needed. Specifically, other agents should be considered in patients with a heavy history of ASCVD events or with multiple high-risk factors. Ezetimibe is often the second-line agent added to maximized statin therapy. Additional therapy can be considered if ezetimibe and statin combination therapy do not lower the LDL-C level below 70 mg/dL. The next agent considered is a proprotein convertase subtilisin/kexin type 9 inhibitor. 

Updated 2019 guidelines by ACC/AHA for primary prevention of cardiovascular disease shows different categories of patients and respective statin intensity treatment compared with previous guidelines. Identifying appropriate risk factors and category will help with selecting the appropriate intensity statin. 

Grundy SM, Stone NJ, Bailey AL et al. 2018 Guideline on the Management of Blood Cholesterol. 

. Nov 2018. DOI: 10.1016/j.jacc.2018.11.003.

Preventing Heart Disease: Healthy Living Habits. Center for Disease Control and Prevention. 

https://www.cdc.gov/heartdisease/healthy_living.htm

 Reviewed August 10, 2015. Accessed October 17, 2019.

2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 

Managing elevated cholesterol is one of the the key elements to decreasing negative outcomes in atherosclerotic cardiovascular disease.