Educational Interventions Through Physical Activity for Addiction Prevention in Adolescent Students—A Systematic Review

Reviewer 1’s comments and suggestions for authors and details of the revisions and responses

1. Formatting & Typographical Errors

1.- Lines 4-7: Missing author and correspondence information.

In order to preserve anonymity, the journal editor deletes authorship and affiliation data.

We have made the changes indicated:

Keywords: Substance abuse; physical exercise; sports; drug education; addictive behaviours; health education; secondary education.

3.- Line 22: "biological, genetic and social deterioration and degradation" Redundant, can be simplified.

We have made the right simplification:

This leads to biological, genetic and social deterioration (Parfilova & Velieva, 2016).

2. Issues in the Introduction

1.- Lines 20-24: Lack of specific data on the increase in substance use.

Specific data on the increase in substance abuse have been introduced:

In this regard, between 2010 and 2019 the total number of people in the world who use drugs increased by 22 percent (Arteaga-Zambrano & Mendoza-Alcívar, 2022).

2.- Lines 28-33: Outdated reference (Peñafiel, 2009) for a contemporary issue.

The reference has been updated:

Some studies show that there are various risk and protective factors, which, interacting with each other, favor or decrease the desire to consume these substances (Larsen & Wiers (2016).

3.- Lines 45-49: Redundant explanation of adolescence as a key intervention period.

The text has been modified to avoid the redundancy indicated:

In this way, it is crucial to implement interventions that contain components of physical activity, due to the benefits of physical activity to strengthen regulatory processes in the individual (Weinberg & Gould, 1996), avoiding the desire for harmful reward-seeking behaviors, such as substance abuse (Georgakouli et al., 2017).

3. Issues in the Methodology

1.- Lines 102-113: Missing direct link to PROSPERO registration.

The indicated link has been added:

The review methods were established prior to the start of the present study and the review was registered in the International Prospective Register of Systematic Reviews PROSPERO under the identification number: CRD42023417556 (https://www.crd.york.ac.uk/prospero/export_record_pdf.php).

2.- Lines 114-122: Unclear inclusion criteria (no mention of publication bias control).

An inclusion criterion related to the control of publication bias has been introduced:

h) Meet the quality criteria based on "Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields" (Kmet et al., 2004).

3.- Lines 132-139: Poorly structured database search, needs better use of Boolean operators.

The use of the search phrase used has been clarified:

The next search phrase was formulated and adjusted according to the specific syntax and requirements of each database. ("Addiction Prevention") AND ("Drugs" OR "Alcohol" OR "Cannabis" OR "Marijuana" OR "Tobacco" OR "Substance Use" OR "Legal Drugs" OR "Illegal Drugs" OR "Narcotics") AND ("Physical Activity" OR "Exercise" OR "Sports") AND ("Children" OR "Youths" OR "Adolescents") AND ("Intervention" OR "Experimental" OR "Quasi-experimental" OR "Randomised Controlled Trial")

4. Issues in the Results

1.- Lines 165-186: Inconsistent study selection process, final count of articles is unclear.

The study selection process and the final count of the articles included have been clarified and concretized:

In this way, a total of 7 articles from the different databases were included.  On the other hand, 12 more studies were identified via other methods (after examining the references of the included articles and searching for related articles in the databases analyzed), as follows: Reports extracted through reference lists (n= 5); and (2) Selected studies by searching for articles related to previously selected documents in the databases. (n= 7). Of these 12 studies, after analyzing the title, abstract and screening process, 3 articles were included in the study. Finally, a total of 10 publications were included in the review.

In addition, the flowchart has been modified in order to improve the article selection process.

2.- Lines 190-197: Unjustified quality threshold (65%) for study inclusion.

Due to the scarcity of research related to the subject of study, it was decided to establish a moderate cut-off point in the quality of studies (.65). This issue has been amended in the review.

5. Issues in the Discussion

1.- Lines 482-484: Repetition of information from the introduction.

Repeated information has been removed from the manuscript.

2.- Lines 566-573: Failure to properly analyze negative results, such as increased substance use in some studies.

The error detected in the analysis of the results has been modified.

3.- Lines 585-590: Sentence is too long and unclear, needs rewriting for clarity.

We have made the changes indicated:

On the other hand, it seems that both the number of weekly sessions given in the in-tervention and the duration of each session may influence the significant improvement in the results obtained. In this sense, Collingwood et al. (2000) carry out 3 weekly sessions of between 90 and 180 minutes, being the intervention with the highest number of sessions and duration of sessions, obtained slightly more significant improvements. On the other hand, the study carried out by Melnyk et al. (2013) contemplated 1 session per week of 20 minutes each was carried out, establishing itself as the research with the lowest number of weekly sessions, as well as their duration.

6. Issues in the Conclusion

1.- Lines 126-139: Complex, hard-to-read sentences, should be simplified.

The indicated lines have been simplified.

With regard to the first question, it is possible to indicate a majority predisposition to-wards the study of the variable referring to tobacco use, followed by those variables referring to alcohol use and cannabis, while those referring to the use of other drugs are given to a lesser extent. On the other hand, regarding the second question, the results of the included studies reveal that interventions based on the practice of yoga, physical activity and exercise produce significant improvements in terms of intention and reduction of substance use among the intervened participants. Moreover, it should be noted that these improvements occur with a higher level of significance, the higher the number of weekly sessions, as well as the longer the duration of the sessions.

Thus, this study suggests that active treatment can have a strong potential to reduce substance use. However, these findings should be taken with caution due to the limita-tions presented in the study.

2.- Lines 141-143: Limitations section is underdeveloped, should address:

Limited geographic scope (majority of studies conducted in the U.S.).

Lack of longterm follow-up in interventions.

Differences in effectiveness based on gender and substance type.

Limitations section has been expanded:

However, the results obtained in this systematic review should be treated with caution, as it has some limitations that should be taken into consideration. Firstly, the com-plexity of evaluating the data obtained from the different variables measured in each intervention, as well as specifying these variables, which allude to the concept of "sub-stance", encompassing a multitude of terms corresponding to different drugs and narcotics. Another limitation relates to the differences in effectiveness based on gender and sub-stance type, as well as to the lack of long-term follow-up.

In addition, there is a limited geographical reach, as most of the research included in this review was conducted in the United States, which may raise some doubts about the generalisability of the results to young people and adolescents in other countries. Another limitation to point out is the lack, in some of the studies included in this research, of several interesting data such as the age of the participants (Collingwood et al., 1991; 2000; Schijven et al., 2020), as well as the mean age (and its standard deviation) of the subjects included (Collingwood et al., 1991: 2000; Goldberg et al., 2000; Fishbein et al., 2015), causing some loss of robustness with respect to the extracted findings. All this makes it very difficult to analyse and compare the different research.

Reviewer 2’s comments and suggestions for authors and details of the revisions and responses

1.- The feedback is about the number of sources. Since it is a systematic review it needs to contain more outcomes of study.

The results section has been expanded.

In addition, the flowchart has been modified in order to improve the article selection process.

Added a section on practical implications:

The practical applications of the systematic review relate to, on the one hand, raising awareness among researchers and academics regarding the need to conduct more re-search on the effects of physical activity, exercise or sport on the prevention and reduction of substance use and abuse in adolescents. In addition, the findings of this review could be used to instruct and train educators and trainers involved in the prevention/education of substance use among youth and adolescents on the importance of implementing interventions and programs that consider the systematic and deliberate practice of physical activity, exercise, or sport as an essential focus. In this sense, the considerations found with this research could stimulate educational and social institutions in the adoption of measures that favor the implementation of programs that contemplate the practice of physical activity and sport as a means for the prevention and reduction of the consumption of addictive substances in adolescents.