Exploring the Role of Physical Activity in the Recovery from Alcohol Dependence (PAAD)

Alcohol dependence is a chronic and relapsing disorder. Despite intensive treatment, relapse rates remain high. This highlights the need for new ways to support long-term recovery. Physical activity has potential as an adjunct to treatment. It can offer psychological, physiological, and social benefits, and shows promise as a lifestyle-based intervention that could enhance recovery outcomes and prevent relapse.This thesis explores the role of physical activity in the recovery from alcohol dependence. It also aims to guide the future development of an evidence-based intervention. The research takes a qualitatively driven, mixed-methods approach. It is pragmatic in nature, but interpretivist in its qualitative components. It includes a systematic review and meta-analysis, and two qualitative studies. One involved semi-structured (face-to-face and online) interviews with people in recovery. The other explored the views of healthcare professionals through online interviews and focus groups. These took place in two alcohol recovery services: 1) Alcohol and Drug Services (ADS), Humber Teaching NHS Foundation Trust, East Riding of Yorkshire, and 2) Change Grow Live (CGL) ReNew Alcohol Services, Kingston-upon-Hull.Findings indicate that physical activity can improve psychological wellbeing by reducing stress, anxiety, and depression, and by boosting self-confidence and motivation. Physical benefits include improved sleep, cardiovascular fitness, and energy levels. Socially, it fosters connection and a sense of belonging. However, barriers such as low physical health, poor confidence, limited knowledge, lack of support, and financial strain were common. Healthcare professionals also faced challenges, including time constraints, lack of training, and organisational limitations.This thesis contributes new insights into physical activity as an adjunct to alcohol treatment. It introduces the initial development of the REACTIVE intervention, informed by the Behaviour Change Wheel and UK Medical Research Council guidance. While still in its early stages, REACTIVE shows promise for integration into routine care through person-centred and flexible approaches. The findings highlight the need for improved training for staff and clearer policy recognition of physical activity within alcohol recovery services. This work lays an important foundation for future research focused on refining, co-developing, and testing the intervention. If found feasible and effective, REACTIVE could offer a valuable and scalable addition to existing recovery pathways, particularly for diverse and currently underrepresented groups.