Characteristics of Patients in Treatment for Alcohol and Drug Addiction Who Succeed in Changing Smoking, Weight, and Physical Activity: A Secondary Analysis of an RCT on Combined Lifestyle Interventions

The BDNF Val66Met polymorphism serves as a potential marker of body weight in patients with psychiatric disorders

Brain-derived neurotrophic factor (BDNF) is a predominant neurotrophic factor in the brain, indispensable for neuronal growth, synaptic development, neuronal repair, and hippocampal neuroplasticity. Among its genetic variants, the BDNF Val66Met polymorphism is widespread in the population and has been associated with the onset and aggravation of diverse pathologies, including metabolic conditions like obesity and diabetes, cardiovascular ailments, cancer, and an array of psychiatric disorders. Psychiatric disorders constitute a broad category of mental health issues that influence mood, cognition, and behavior. Despite advances in research and treatment, challenges persist that hinder our understanding and effective intervention of these multifaceted conditions. Achieving and maintaining stable body weight is pivotal for overall health and well-being, and the relationship between psychiatric conditions and body weight is notably intricate and reciprocal. Both weight gain and loss have been linked to varying mental health challenges, making the disentanglement of this relationship critical for crafting holistic treatment strategies. The BDNF Val66Met polymorphism's connection to weight fluctuation in psychiatric patients has garnered attention. This review investigated the effects and underlying mechanisms by which the BDNF Val66Met polymorphism moderates body weight among individuals with psychiatric disorders. It posits the polymorphism as a potential biomarker, offering prospects for improved monitoring and therapeutic approaches for mental illnesses.

Primary Care at the Intersection of Lifestyle Interventions and Unhealthy Substance Use

Primary care physicians are well-positioned to integrate lifestyle interventions into the management of patients with unhealthy substance use, who may also have mental and physical chronic health comorbidities. However, the COVID-19 pandemic exacerbated the U.S.'s poor state of health, revealing that its current approach to chronic disease management is neither effective nor sustainable. Today's full spectrum comprehensive care model requires an expanded toolkit. Lifestyle interventions broaden current treatment approaches and may enhance Addiction Medicine care. Primary care providers have the potential to have the greatest impact on unhealthy substance use care because they are experts in chronic disease management and their frontline accessibility minimizes healthcare barriers. Individuals with unhealthy substance use are at an increased risk of chronic physical conditions. Incorporating lifestyle interventions with unhealthy substance use care at every level of medicine, from medical school through practice, normalizes both as part of the standard care of medicine and will drive evidence-based best practices to support patients through prevention, treatment, and reversal of chronic diseases.

The Association Between Regular Physical Activity and Depressive Symptoms Among Patients in Treatment of Alcohol and Substance Use Disorders

Background

Alcohol and other substance use disorders and major depression often co-occur. A sedentary lifestyle is related to major depression and even moderate exercise may prevent and contribute to the treatment of depression. Studies have found an effect of physical activity on depression in alcohol and other substance use disorder patients even in clinical settings.

Aim

To investigate the relationship between level of physical activity and depressive symptoms over time in alcohol and substance use disorder inpatients.

Methods

Eighty-nine substance use disorder inpatients were followed for 6 months during treatment. The International Physical Activity Questionnaire was used to categorize 3 groups of low, moderate, or high level of physical activity. In addition to background variables and alcohol and drug use measures, data on biometric measures and on sleep were gathered. Becks Depression Inventory version II (BDI-II) measured depressive symptoms. A multilevel logistic regression was used to analyze the longitudinal relationship between physical activity and depressive symptoms.

Results

Most patients (57%) reported low activity, while 24% reported moderate and 19% high activity. Few changed their activity level during treatment. Moderate physical activity was related to lower score on BDI-II (P = .029). Level of physical activity was closely related to insomnia (P = .024). In the multivariate analysis the relationship between depressive symptoms and physical activity did not withstand the adjustment for insomnia. However, in the multilevel logistic regression higher physical activity was related to lower BDI-II score in a dose dependent manner.

Conclusions

Among these alcohol and other substance use disorders patients in treatment, there was a relationship between depressive symptoms and physical activity. The low level of physical activity identified among these patients was related to a high level of depressive symptoms. The level of depressive symptoms declined over time; but this change was not related to an increase in physical activity.

STRONG for Surgery & Strong for Life - against all odds: intensive prehabilitation including smoking, nutrition, alcohol and physical activity for risk reduction in cancer surgery - a protocol for an RCT with nested interview study (STRONG-Cancer)

Background

There is a large unused potential for risk reduction in the preoperative period via effective lifestyle intervention targeting co-existing risky lifestyles: Smoking, malNutrition, obesity, risky Alcohol intake and insufficient Physical activity (SNAP).

This trial compares the efficacy of the integrated STRONG programme with standard care on preoperative risk reduction and secondly on SNAP factor improvement and frailty, postoperative complications and quality of life. A nested interview study explores the patient preferences and the multi-perspective view of patients, relatives and health professionals.

Methods

In total, 42 surgical patients with ≥1 SNAP factor are allocated to individually tailored STRONG programme or usual care during adjuvant chemotherapy prior to radical bladder cancer surgery. The STRONG programme has ≥6 weekly sessions with patient education, motivational and pharmaceutical support. It is based on intensive smoking and alcohol cessation interventions reporting perioperative quit rates > 50%.

Surgical risk reduction is measured as ≥1 step for 1 or more risky lifestyles on the ASA-score, secondly as having no risky SNAP factors, and as any SNAP improvement. The outcomes are validated by measurements and biomarkers. Postoperative complications are categorised according to the Clavien-Dindo classification. Health-related quality of life is measured by EQ-5D.

The patients are followed up after 6 weeks at surgery and 6 weeks and 6 months postoperatively.

A representative sample of the participants, their relatives and the clinical staff are interviewed until data saturation. Transcription, triangulated analyses and data management are conducted using NVivo computer software.

Discussion

The surgical agenda is characterised by fixed dates for surgery focusing on clear risk reduction within a short time. This requires a clinical useful lifestyle intervention programme with a high effect and coverage as well as containing all SNAP factors and tailored to individual needs.

The STRONG programme seems to meet these requirements. After development in multi-professional collaboration, STRONG is delivered by a specially trained nurse as part of the surgical patient journey.

Overall, this study will bring important new knowledge about risk reduction in a frail patient group undergoing major cancer surgery.

Trial registration

Registration at www.clintrials.gov (NCT04088968)

The manuscript form from https://trialsjournal.biomedcentral.com/bmc/journal and the SPIRIT guidelines are followed.