Klamert, Lisa ORCID: 0000-0002-2759-1141 (2024) Efficacy and acceptability of physical activity integrated within substance use treatment for young people. PhD thesis, Victoria University.

Abstract

Physical activity (PA) intervention has potential as an intervention approach for young people with problematic substance use. Currently, physical activity is not routinely integrated into substance use treatment in most countries, including Australia. This thesis aims to investigate the potential integration of physical activity interventions into substance use treatment practice for young Australians. The three phases of the research examined the efficacy of PA interventions, explored young people’s perspectives of PA and made recommendations for research and practice. The Consolidated Framework for Implementation Research (CFIR) and COM-B model of behaviour are used to guide and integrate the research. Phase 1 investigates current research evidence on the effect of physical activity interventions for substance use in young people aged 12-25 years and explores behaviour change techniques that are applied as part of interventions by conducting a rigorous review and meta-analysis. The impact of the underreporting of implementation characteristics as part of the identified interventions is critically discussed. Phase 2 explores correlates of treatment acceptability of PA interventions in young people (n=145) with problematic alcohol, tobacco or illicit substance use and their perspectives (n=4) on integrating PA interventions into treatment practice using a mixedmethods approach, including a quantitative research survey, a qualitative focus group and an integrated discussion. Phase 3 combines findings from Phases 1 and 2 to provide recommendations for research and practice regarding integrating PA interventions into treatment practice for young people with problematic substance use. Quantitative findings demonstrated the potential of different formats of PA interventions to reduce problematic substance use in young people; however, as the existing interventions vary widely in methodology, intervention design and the targeted substances, the evidence could not be synthesised meaningfully. While acceptability of PA interventions was high overall among participating young Australians with problematic substance use (aged 16-25 years), higher reported acceptability was associated with better mental health, lower perception of barriers to PA and higher PA participation. Quantitative findings further indicated that some young people report better mental health and may therefore be more “capable” to participate in PA interventions at this point, while others experience more severe mental health concerns and may thus benefit from focussing on improving their mental health first and potentially only engage in achievable PA tasks (e.g., increasing active transportation). rather participating in a comprehensive intervention. Qualitative exploration of the PA barriers experienced by young people revealed access/availability, logistical, and social barriers. Young people recommended tailored and preference-based PA interventions, engagement aids, clear directions and informative education on PA and substance use. Integrating these findings into a behavioural framework may support clinicians in identifying areas of priority when it comes to PA interventions. To conclude, PA interventions are perceived as acceptable within the treatment of substance use among the young Australians who participated in this program of research. They may offer additive benefits if integrated with existing treatments. However, more research to establish efficacy of PA interventions for substance use treatment is required, including the investigation of different types of substance use. Recommendations for practice are provided, including an assessment of young people’s capability to participate in such interventions and the identification of priority points of intervention, to improve young people’s capability, opportunity and motivation for PA. Factors that might influence the translation of PA interventions into practice and policy are identified based on the preferences of young people involved in this study, highlighting the importance of including young people as critical stakeholders in intervention design and delivery to develop or further refine evidence-based interventions.

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