From withdrawal to motivation: The feasibility, acceptability and early clinical benefits of adapted physical activity during inpatient alcohol withdrawal

Introduction: Physical activity (PA) may improve physical and mental health in alcohol use disorder (AUD), yet poor adherence limits its clinical impact. Inpatient alcohol withdrawal represents a critical window for initiating health behavior change, although patients are often encouraged to rest. Objectives: We evaluated whether supervised adapted physical activity (APA) can be feasibly implemented during inpatient withdrawal care and whether it influences short-term health and exercise engagement and motivation compared with free access to a PA room (FPA). Methods: In this real-world study, 64 participants with severe AUD (26.5% women; mean age = 45.8 ± 11 years) completed pre- and post-assessments during a three-week inpatient withdrawal program. Participants were sequentially allocated to supervised APA or FPA with general advice. Feasibility (attendance and adverse events), session satisfaction, health outcomes (anxiety, depressive symptoms, self-esteem, craving, sleep quality, and physical functional capacity), and PA motivation (amotivation, extrinsic, and intrinsic motivation) were assessed after acute withdrawal at hospital discharge (post-test). Results: APA participants engaged in significantly more PA ( p  < 0.05), with high levels of session satisfaction (median = 8.86 and 8.83/10), and an attendance rate of 83%. Health outcomes and amotivation improved over time in both groups ( p  < 0.001), without group-by-time interaction. Motivation showed a significant group and interaction effect ( p  < 0.05): APA participants scored higher post-test, while FPA participants decreased in extrinsic motivation ( p  = 0.013). Intention-to-treat analyses revealed consistent findings. Conclusions: Implementing supervised APA during early withdrawal treatment is feasible and acceptable. While short-term clinical improvements were similar across groups, APA strengthened motivational processes relevant to PA engagement during recovery.