A complier average causal effect analysis of the Stimulant Reduction Intervention using dosed exercise study
Objective: Exercise is a promising treatment for substance use disorders, yet an intention-to-treat analysis of a large, multi-site study found no reduction in stimulant use for exercise versus health education. Exercise adherence was sub-optimal; therefore, secondary post-hoc complier average causa...
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doaj-fff922225e294eaf88847b6ee6c3bb092020-11-25T01:39:15ZengElsevierContemporary Clinical Trials Communications2451-86542018-06-011018A complier average causal effect analysis of the Stimulant Reduction Intervention using dosed exercise studyThomas Carmody0Tracy L. Greer1Robrina Walker2Chad D. Rethorst3Madhukar H. Trivedi4University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USAUniversity of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USAUniversity of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USAUniversity of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USACorresponding author. Julie K. Hersh Chair for Depression Research and Clinical Care, Betty Jo Hay Distinguished Chair in Mental Health, Director, Center for Depression Research and Clinical Care, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA.; University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USAObjective: Exercise is a promising treatment for substance use disorders, yet an intention-to-treat analysis of a large, multi-site study found no reduction in stimulant use for exercise versus health education. Exercise adherence was sub-optimal; therefore, secondary post-hoc complier average causal effects (CACE) analysis was conducted to determine the potential effectiveness of adequately dosed exercise. Method: The STimulant use Reduction Intervention using Dosed Exercise study was a randomized controlled trial comparing a 12 kcal/kg/week (KKW) exercise dose versus a health education control conducted at nine residential substance use treatment settings across the U.S. that are affiliated with the National Drug Abuse Treatment Clinical Trials Network. Participants were sedentary but medically approved for exercise, used stimulants within 30 days prior to study entry, and received a DSM-IV stimulant abuse or dependence diagnosis within the past year. A CACE analysis adjusted to include only participants with a minimum threshold of adherence (at least 8.3 KKW) and using a negative-binomial hurdle model focused on 218 participants who were 36.2% female, mean age 39.4 years (SD = 11.1), and averaged 13.0 (SD = 9.2) stimulant use days in the 30 days before residential treatment. The outcome was days of stimulant use as assessed by the self-reported TimeLine Follow Back and urine drug screen results. Results: The CACE-adjusted analysis found a significantly lower probability of relapse to stimulant use in the exercise group versus the health education group (41.0% vs. 55.7%, p < .01) and significantly lower days of stimulant use among those who relapsed (5.0 days vs. 9.9 days, p < .01). Conclusions: The CACE adjustment revealed significant, positive effects for exercise. Further research is warranted to develop strategies for exercise adherence that can ensure achievement of an exercise dose sufficient to produce a significant treatment effect. Keywords: Complier average causal effects, Exercise intervention, Health education, Stimulant abuse or dependence, Clinical trials networkhttp://www.sciencedirect.com/science/article/pii/S2451865417300996 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Thomas Carmody Tracy L. Greer Robrina Walker Chad D. Rethorst Madhukar H. Trivedi |
spellingShingle |
Thomas Carmody Tracy L. Greer Robrina Walker Chad D. Rethorst Madhukar H. Trivedi A complier average causal effect analysis of the Stimulant Reduction Intervention using dosed exercise study Contemporary Clinical Trials Communications |
author_facet |
Thomas Carmody Tracy L. Greer Robrina Walker Chad D. Rethorst Madhukar H. Trivedi |
author_sort |
Thomas Carmody |
title |
A complier average causal effect analysis of the Stimulant Reduction Intervention using dosed exercise study |
title_short |
A complier average causal effect analysis of the Stimulant Reduction Intervention using dosed exercise study |
title_full |
A complier average causal effect analysis of the Stimulant Reduction Intervention using dosed exercise study |
title_fullStr |
A complier average causal effect analysis of the Stimulant Reduction Intervention using dosed exercise study |
title_full_unstemmed |
A complier average causal effect analysis of the Stimulant Reduction Intervention using dosed exercise study |
title_sort |
complier average causal effect analysis of the stimulant reduction intervention using dosed exercise study |
publisher |
Elsevier |
series |
Contemporary Clinical Trials Communications |
issn |
2451-8654 |
publishDate |
2018-06-01 |
description |
Objective: Exercise is a promising treatment for substance use disorders, yet an intention-to-treat analysis of a large, multi-site study found no reduction in stimulant use for exercise versus health education. Exercise adherence was sub-optimal; therefore, secondary post-hoc complier average causal effects (CACE) analysis was conducted to determine the potential effectiveness of adequately dosed exercise. Method: The STimulant use Reduction Intervention using Dosed Exercise study was a randomized controlled trial comparing a 12 kcal/kg/week (KKW) exercise dose versus a health education control conducted at nine residential substance use treatment settings across the U.S. that are affiliated with the National Drug Abuse Treatment Clinical Trials Network. Participants were sedentary but medically approved for exercise, used stimulants within 30 days prior to study entry, and received a DSM-IV stimulant abuse or dependence diagnosis within the past year. A CACE analysis adjusted to include only participants with a minimum threshold of adherence (at least 8.3 KKW) and using a negative-binomial hurdle model focused on 218 participants who were 36.2% female, mean age 39.4 years (SD = 11.1), and averaged 13.0 (SD = 9.2) stimulant use days in the 30 days before residential treatment. The outcome was days of stimulant use as assessed by the self-reported TimeLine Follow Back and urine drug screen results. Results: The CACE-adjusted analysis found a significantly lower probability of relapse to stimulant use in the exercise group versus the health education group (41.0% vs. 55.7%, p < .01) and significantly lower days of stimulant use among those who relapsed (5.0 days vs. 9.9 days, p < .01). Conclusions: The CACE adjustment revealed significant, positive effects for exercise. Further research is warranted to develop strategies for exercise adherence that can ensure achievement of an exercise dose sufficient to produce a significant treatment effect. Keywords: Complier average causal effects, Exercise intervention, Health education, Stimulant abuse or dependence, Clinical trials network |
url |
http://www.sciencedirect.com/science/article/pii/S2451865417300996 |
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