UPLIFT: Progressive Resistance Training (PRT) as Adjunctive Treatment for Alcohol Use Disorder (AUD)

Interventional Description of intervention(s) / exposure 1.Brief Name: High intensity progressive resistance training (PRT) in addition to usual care (please see description of usual care received by the control group). 2.Rationale: PRT or strength training has been reported as the preferred modality of exercise by individuals undergoing substance abuse treatment (Abrantes et al, 2011). To date, only one study of high intensity PRT has been published, and it was found to be superior to aerobic exercise and moderate intensity resistance training (circuit training) in reducing depressive symptoms during rehabilitation for alcohol and substance abuse (Palmer et al, 1995). This is in agreement with the known anti-depressant effects of PRT (Gordon et al, 2018; Cooney et al, 2013; Herring et al, 2012; Singh et al, 2005). However, the effect of PRT on alcohol dependency itself are currently unknown, and so PRT presents a novel and innovative therapy that warrants testing in appropriately designed studies. 3. Materials: Free-weights and Digital K400 Keiser pneumatic resistance machines (Keiser Sports health Equipments, Inc. Fresno, CA) 4. PRT Protocol: The intervention period is 12 weeks in duration and training will be 3 times per week for approximately 45-60 minutes. Week 1 of the intervention will include familiarisation and gradual increase in target intensity from 50%, 60%, 70% 1RM in each successive session. From the first session of week 2, training intensity will be set at 80% 1RM and progressed by a projected gain in strength of 3% 1RM each session, used in conjunction with the Borg Rating of Perceived Exertion Scale. At the start of every 7th session, 1RM will be re-tested and target weight at 80% 1RM will be recalculated based on the new 1RM. Total training volume is 24 repetitions per exercise, set initially at 3 sets of 8 repetitions. However, as intensity is most important, sets and repetitions may be manipulated such that prescribed intensity is adhered to and the total volume remains 24 repetitions per exercise. In addition, assessor observation of pain, accessory muscle use or violations of form will be used to titrate the load. Eight resistance machines will be used and exercises will be completed in the following order; leg press, seated row, knee extension, chest press, knee flexion, tricep pushdown, lateral raises and plantar flexion initially. There will be 2-3 minutes rest between sets to allow sufficient recovery of anaerobic metabolism. 5. Supervision: Subjects will be trained by an exercise physiologist accredited by Exercise and Sport Science Australia in a supervised setting at a ratio of 1 trainer for 4-5 subjects 6. Mode of delivery: Every training session will be supervised face to face. 7. Location: Once patients are discharged into the outpatient program, participants randomly assigned to the intervention group will commence their training at the Faculty of Health Science, Cumberland Campus of the University of Sydney in Lidcombe NSW Australia. 8. Frequency: Participants will train 3 days of the week on non-consecutive days over the 12-week intervention period. 9. Adherence: Session adherence and compliance to the exercise prescription will also be monitored and recorded. Participants will be contacted following any missed sessions, to discuss reasons for absence and to encourage their attendance at subsequent training sessions. Abrantes, A.M., Battle, C.L., Strong, D.R., Ing, E., Dubreuil, M.E., Gordon, A., & Brown, R.A.(2011). Exercise preferences of patients in substance abuse treatment. Mental Health and Physical Activity, 4(2), 79-87. Cooney, GM., Dwan, K., Greig, CA., Lawlor, DA., Rimer, J., Waugh, FR., & McMurdo, M. (2013). Exercise for depression. Cochrane Database of Systematic Reviews, (9) Cd004366. Gordon, BR., McDowell, CP., Hallgren, M., Meyer, JD., Lyons, M., & Herring, MP. (2018). Association of Efficacy of Resistance Exercise Training With Depressive Symptoms: Meta-analysis and Meta-regression Analysis of Randomized Clinical Trials. JAMA Psychiatry, 75(6), 566-576 Herring, MP., Puetz, TW., O’Connor, PJ., & Dishman, RK. (2012). Effect of exercise training on depressive symptoms among patients with a chronic illness: a systematic review and meta-analysis of randomized controlled trials. JAMA Internal Medicine, 172(2), 101-111 Palmer, J.A., Palmer, L.K., Michiels, K., & Thigpen, B. (1995). Effects of type of exercise on depression in recovering substance abusers. Perceptual and Motor Skills, 80, 523-530. Singh, N.A., Stavrinos, T.M., Scarbek, Y., Galambos, G., Liber, C., & Fiatarone Singh, MA. (2005). A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 60(6):768-776.