According to the American Public Health Association (n.d.) [1], substance use disorder is a significant medical and public health concern. The U.S. Department of Health and Human Services (n.d.) [2] notes that substance use disorder can lead to lifelong physical and mental health problems. Traditional psychosocial counseling recovery programs result in limited success. Forty to 60% of those with substance use disorders dropped out from psychosocial treatment programs and were more likely to relapse [3]. While research demonstrates the benefits of exercise programs in helping people address substance use disorders, lack of motivation can a significant issue, raising exercise program attrition and lowering adherence [4]. Typical substance use patients are rarely physically active [5]. Thus, starting and keeping people in exercise programs is vital.

Research demonstrates that those recovering from substance use disorder benefit from physical exercise in addition to traditional therapy because exercise promotes abstinence from illicit substances and aids in stress reduction and the establishment of healthy life habits. Fitness programs improve recovery by reducing cravings and improving well-being [6]. Physical exercise encourages abstinence from illicit substances. According to [7], aerobic exercise, in addition to “body-mind” exercises, is an effective treatment for substance use disorders. With substance use disorders, exercise can fill a psychological gap [8]. Tension, stress reduction, a more positive outlook, and increased self-esteem were all benefits of physical exercise [9]. Those with substance use disorders who were more active reported less severe depression [10]. Further, [8] found that exercise encourages healthy overall habits that promote sustained recovery; those who frequently exercise are less likely to fall into substance abuse patterns and addiction. The benefits of exercise extend to other ailments, according to [11], who found physical exercise and mindfulness are useful in helping people address eating disorders, depression, and schizophrenia.

Exercise programs intended to address addiction or mental disorders should be tailored, community-centric, and held on a regular basis. Client-centered programs that create a positive mindset toward change often succeed in increasing motivation [4]. Programs that foster a supportive social environment provide positive reinforcement for therapy that enhances recovery [11]. Further, tailored programs are more beneficial than general ones [5]. It is paramount that those who begin an exercise routine to help with their recovery are consistently active to ensure maximum treatment success [11].

This qualitative multiple case study of people experiencing a tailored exercise and support program called Move to Heal adds to the research to understand how the combination of physical exercise, coupled with recovery group meetings, helps members sustain their recoveries from substance use disorders and mental health issues. Move to Heal is a 501 (c)(3) non-profit that supports people facing mental health issues, addiction, and other life challenges by offering group exercise, recovery meetings, nutritional coaching, and mental health counseling at gyms across New England. Weekly group workout sessions are open to anyone facing anxiety, depression, PTSD, addiction, postpartum, or other life challenges. Participants participate in a 30-minute workout catered to all fitness levels, followed by a one-hour support meeting. Individual therapy with a licensed therapist is also offered. Those who attend regularly qualify for free gym memberships and free nutritional coaching, as Move to Heal believes that exercise, commitment, and repetition create healthy habits.

We conducted semi-structured qualitative interviews with a cohort of four participants who are actively engaged with the Move to Heal program. The participants were selected through convenience sampling from recommendations by the leaders of Move to Heal. The interviews were conducted via remote video conference over a period of 5 months in 2022. To protect identities, we have used pseudonyms for each participant. All participants signed consent forms prior to their participation.

Allison was academically successful and a fully functional alcoholic in her teenage years. She was surrounded by alcohol users in her youth, which led to her experimentation with alcohol at a young age. She joined an addiction recovery group after realizing that she needed help, but soon began using again. Her addiction became more severe with time. She tried different treatment centers with varying levels of success before eventually trying Move to Heal.

Benjamin was introduced to drinking at an early age, and an extreme addiction was present by the time he began college. He sought out parties for alcohol and drugs, which strengthened his dependence. After school, Benjamin found himself in the public eye while his addiction continued. He functioned for many years before becoming addicted to more extreme substances. He was arrested and later went into counseling before finally admitting himself to a hospital for a detox. After serving jail time, he became involved with fitness-related programs, which improved his physical health. An essential program in his recovery was Move to Heal.

Carl grew up in a rough area, experimenting with alcohol and drugs at a young age. During high school, he went to treatment before getting sober. However, Carl relapsed years later, becoming involved with more severe substances and eventually overdosing. After these traumatic experiences, he found the motivation to get sober and went to AA. Despite the help that AA offered, he was still suffering physically until he was introduced to Move to Heal.

Dana experienced a severe injury at a young age, which affected her mental health. She experimented with substances during high school. Hard family life and uncertainty about the future caused depression and continued substance abuse, as well as eating disorders. Substance abuse continued in college, and eventually, Dana dropped out. She began working at a restaurant, where access to alcohol worsened her addiction. After going to rehab and detoxing, she relapsed again before eventually discovering Move to Heal and rebuilding her life.

Findings

Our investigation unearthed three salient themes that encapsulate the dynamics of the participants’ experiences. First, those who entered traditional recovery programs struggled to maintain sobriety and often relapsed. Second, Move to Heal cultivated a tight-knit community that nurtures physical health and emotional well-being. It created a sense of belonging among participants. Finally, the program catalyzed participants to achieve sustained recovery and a better quality of life.

Theme 1: Participants initially sought help but relapsed. Throughout the course of the interviews, a common theme emerged when interviewees were asked about their previous struggles: frequent relapse. For Allison, it was normal to be a high-functioning addict who realized she needed help but did not prioritize it. Only after joining Alcoholics Anonymous but later falling back into addiction did she recognize the need for a different type of recovery program. For Benjamin, sobriety was a constant battle, and he struggled with an array of substances for many years. Even programs such as AA and an attempted family intervention weren’t successful in his achievement of sustaining sobriety. This was also the case for Carl, who was sober for several years before relapsing and overdosing and then finally discovering Move to Heal. Carl said, “When I relapsed, I was in disarray and not happy with my life. When I drank, everything felt better. The effect made everything go away. It just kept getting worse and worse. I was lying to my parents, lying to my family, lying to myself.” Dana was hooked on drugs and going to rehab but relapsing. Dana said, “I was scared, so substances helped me cope with that and deal with that fear that I had. I really struggled, and I felt alone.” According to Dana, “I liked the way [drugs] made me feel. It made the anxiety go away and kind of just made things melt, and I felt better. I got some relief, and it kind of made me want to try more things. I smoked a lot, and whenever I could get my hands on those pills, I wanted them.” After being around people who enabled her addiction and relapses to continue, she decided to rebuild her life from nothing, no longer letting dependence control her life.

Theme 2: Move to Heal establishes a tight-knit community. For all four participants, Move to heal proved to have a positive impact by creating an environment that encouraged physical and emotional health. Participants found that the unique aspect of including physical activity before group sessions proved helpful to their experience. Allison states, “Physical movement component is a way to bring people together. Most other recovery programs do not incorporate that at all.” When physical and emotional help are combined, many participants feel that they are bettering themselves in both ways, which is an essential aspect of Move to Heal. According to Benjamin, Move to Heal helped him develop a passion for exercise for the first time. Benjamin said, “[Move to Heal] is a blessing.” Carl noted, “Move to Heal shows me what I can do and what I am capable of.” He said, “I realized that the more I go, the more I gain from it. Slowly but surely, everything was getting better. The exercise component is invaluable. I directly correlate my positivity with Move to Heal. The more I went, the more positive I got and the more people I met. The biggest thing is that it’s not just alcoholics and addicts; it’s people dealing with a magnitude of things, and getting that perspective is also invaluable to me.”

For the four participants, participation in Move to Heal was the first time they were able to stay sober and thrive without being dependent on substances. Working out before meetings allowed them to feel that they could be more open during group meetings. They noted that forming a positive relationship between working out and physical activity can benefit group therapy. According to Dana, “For me, it helps me open up more after the workout. It’s a little different at Move to Heal; everyone is giving each other high fives during their workout and rooting each other on and it’s just so supportive. people get more vulnerable. I’ve been to a lot of meetings in my years of sobriety, and not all of them get into the meat so quickly. At Move to Heal, you can relate to what people are saying and talking about what they are going through with such honesty.”

Theme 3: Move to Heal is vital to success. Not only has Move to Heal encouraged physical and emotional health, but it has also proven crucial to improving participants’ well-being. For Allison, Move to Heal has been the primary part of her sustained recovery. She commented, “If you were to ask him (my husband) what the most important piece of my recovery has been, he would, without hesitation, say Move to Heal.”

In addition to achieving sustained recovery, Benjamin underwent a complete body transformation. After an unhealthy relationship with his body, fitness helped him change his lifestyle, habits, and mood positively. Similarly, Carl commented, “I’m happy. [Move to Heal] improves not just my physical health, it improves my willingness to go to the gym. I want to get better physically because, internally, I realize that this is benefitting me. What that does for my mental health is that I feel happier after a workout good about myself. It makes me feel like I’m not by myself all the time. Having that support mentally. I know I need it. [Move to Heal] can only benefit you.” Dana noted that her body image shifted as well. She commented, “I am in the best shape of my life. I feel so much healthier in my body. Working out has always been a tricky thing for me. I just never had a healthy relationship with it. [The nutritionists] helps me figure out what is healthy and what is good to do the things I want to be able to do with my body.”

Three prevalent themes emerged from the research. First, the participants, when first placed in conventional recovery programs, relapsed and struggled to maintain sobriety in the long-term. Second, programs offered by Move to Heal, tailored to physical and mental improvement, encouraged well-being and built a sense of community. Third, participants found that Move to Heal fostered sustained recovery and improved quality of life. Our findings support the literature demonstrating how traditional therapy and a tailored exercise program enabled sustained recovery [5,4]. For all study participants, the services offered at Move to Heal went beyond exercise and group therapy; they created solid and consistent habits that fostered physical and mental health, reduced stress, and improved confidence. Further, the sense of community established by physical exercise and group therapy in Move to heal facilitated participants’ ability to feel open and engaged in a supportive environment.

This work has implications for programs that attempt to support recovery for patients struggling with addiction or other life challenges by informing them that successful programs include a physical component in addition to traditional group therapy. This research demonstrates that exercise is valuable to recovery programs because it establishes healthy habits, creates community, and offers significant health benefits.

Limitations and Future Research: One limitation of this research was that, due to the sensitivities of participation, access to Move to Heal clients limited the research to those who were recommended by the leadership of Move to Heal and who felt comfortable discussing their addiction. A delimitation of this research was that it involved those who regularly participate in Move to heal programs, and for those who have established healthy exercise habits, success at staying sober is more likely. Therefore, the research may not fully account for the range of experiences Move to Heal clients had.

Further research is needed to explore other substance abuse programs that involve exercise and mental health support. Exploring such programs would further validate Move to Heal’s model if they prove successful. Additionally, studies exploring the longevity of sobriety after such programs would demonstrate ongoing efficacy.