Peer-Facilitated Physical Activity Intervention Delivered During Methadone Maintenance

Project: Research project

Description

There are 2.5 million Americans who abuse or are dependent on opioids, including heroin and prescription painkillers. This number has increased by 50% in the last decade, creating a significant public health concern. Methadone maintenance treatment (MMT), involving daily distribution of methadone at clinics, is the most common treatment for opioid dependence. While MMT has been effective in helping opioid dependent patients improve their quality of life, the overwhelming majority of these patients continue to engage in unhealthy lifestyles (e.g., physical inactivity and cigarette smoking) that lead to significant mental and physical health morbidities. For example, patients in MMT have much higher rates of cardiovascular disease, diabetes, hypertension, obesity, depression, sleep difficulties, and cognitive impairments than age-matched controls, which lead to premature death. Given the mental health, physical health, and drug treatment benefits of physical activity (PA), interventions targeting increases in PA in patients receiving MMT could have a significant impact on reducing the overall morbidity and mortality.

To date, few PA studies have been conducted with substance abusing populations and, only one small pilot study with MMT patients. Our goal is to develop a feasible, acceptable and effective multilevel PA intervention that addresses both individual and interpersonal factors delivered in the context of a health care setting (i.e., methadone clinics). To do so, we are proposing to train MMT patients who are already engaging in PA at public health recommended levels to deliver a group-based PA intervention to physically inactive MMT patients at a large community-based methadone clinic. Peer-facilitated interventions for self-management skills are common in the care of patients with chronic medical conditions and an increasing number of studies have also examined peer-facilitated PA interventions across various populations though, none with substance abusing patients. Consistently peer-facilitated PA interventions have been found to effectively increase and sustain physical activity levels, compared to controls or professionally-led interventions. Peers share salient characteristics of the population of interest (e.g., in MMT) who are successfully engaging in a desired behavior (e.g. physically active) such that they can share information, help in problem solving barriers, act as role models, and offer support and encouragement. Peers may play a particularly important role in increasing physical activity in MMT, as this population faces unique and significant barriers to PA (e.g., depression, smoking, triggers for drug use in environment). Through the development of interpersonal relationships and social support, we expect that MMT peers who have successfully navigated these challenges will help inactive MMT patients increase self-efficacy and motivation for initiating and sustaining PA.

The design of this study takes place in 2 phases -- the R21 phase will be focused on the development of a peer-facilitated PA+Fitbit intervention (Peer-PA+Fitbit), while the R33 phase will be devoted to evaluating the preliminary efficacy of Peer-PA+Fitbit in a small RCT. The R21 phase (Years 1 & 2) will consist of 4 stages: 1) focus groups with potential peers and physically inactive MMT patients; 2) development of a PA manual that integrates use of the Fitbit; 3) developing a training protocol for peers; and 4) a 12-week open pilot trial (n=20) to test the feasibility and acceptability of the Peer-PA+Fitbit intervention. The R33 Phase (Years 3-5) will involve randomizing 110 patients currently receiving MMT to either: 1) Peer-PA+Fitibit OR 2) minimal PA intervention (brief advice plus Fitbit; BA+Fitbit). Follow-up assessments will be conducted at 3, 6, & 12-months to determine both the short- and long-term adherence to physical activity. We expect that this project will lead to the development of a novel, multilevel peer-facilitated PA intervention tailored to patients in MMT. If preliminary efficacy of the Peer-PA intervention can be established, patients in MMT would have a valuable adjunct to existing opioid treatment that can be delivered in a setting that they access every day for methadone dosing, thereby improving the overall health and well-being of this at-risk population.
StatusFinished
Effective start/end date9/30/168/31/19

Funding

  • HHS-NIH: National Institute on Drug Abuse (NIDA): $35,862.00

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Methadone
Exercise
Therapeutics
Opioid Analgesics
Mental Health
Public Health
Smoking
Depression
Population
Morbidity
Premature Mortality
Heroin
Health