# Effects of different exercise types on craving in substance use disorder patients with drug dependence -network meta-analysis and dose-response relationships based on frequentist and Bayesian models

## TL;DR

Aerobic exercise is most effective for reducing drug cravings in substance use disorder patients, with an optimal dose of 180 METs-min/week.

## Contribution

This study identifies aerobic exercise as the optimal type and quantifies the effective dose for reducing cravings in SUD patients.

## Key findings

- Aerobic exercise significantly reduces drug cravings compared to control groups.
- The optimal exercise dose is 180 METs-min/week, equivalent to three 60-minute sessions per week.
- High-intensity interval and aerobic combined with resistance exercises also show positive effects.

## Abstract

Exercise interventions have been shown to effectively reduce drug craving and improve physical and mental health in patients with substance use disorders (SUDs). However, the optimal type and amount of exercise needed to maximize these benefits for SUDs is not fully understood and warrants further investigation.

A comprehensive search strategy was implemented in four electronic databases (i.e., PubMed, Web of Science, CNKI, and EMBASE) to identify randomized controlled trials examining the impact of exercise on craving in individuals with substance use disorders. Network meta-analysis and dose-response modeling were employed to assess the specific benefits of exercise on craving.

The analysis incorporated a total of 30 randomized controlled trials, encompassing a total of 1,717 subjects. These subjects were comprised of 1,258 male participants (73.26%) and 459 female participants (26.73%). The results of the meta-analysis demonstrated that there was a low grade GRADE evidence suggesting that, in comparison with the control group, aerobic exercise (SMD= -0.73, 95%CI: -1.06 to -0.41), high-intensity interval exercise (SMD= -2.19, 95%CI: -3.90 to -0.49), and aerobic combined with resistance exercise (SMD= -1.96, 95%CI: -2.92 to -1.00) were more effective than the control group. Subgroup analyses revealed positive effects of acute aerobic exercise (SMD= -0.23, 95%CI: -0.41 to -0.04, I²=22%) and long-term aerobic exercise (SMD= -0.46, 95%CI: -0.72 to -0.21, I²=0%) on cravings. Furthermore, the results found that Taijiquan significantly reduced drug craving (SMD= -0.47, 95%CI: -0.70 to -0.24, I²=0%) in the subjects. The dosage analysis revealed that the effective range of total exercise for reducing craving in individuals with substance use disorder was from 20 to 320 METs-min/week (SMD= -0.58, 95%CI: -0.8 to -0.28 to SMD= -0.72, 95%CI: -0.91 to -0.46). The optimal form of exercise was determined to be aerobic exercise, with an optimal exercise dose of 180 METs-min/week, which resulted in an estimated mean difference of -1.46 (95%CI: -2.04 to -0.96). The regression analysis results indicated that the impact of exercise on subjects’ cravings may be influenced by their age level (β= -0.995, 95%CI: -2.002 to -0.011).

Aerobic exercise has been recognized as the most effective form of exercise for alleviating drug cravings in individuals with substance use disorders (SUDs). Research indicates that the exercise dose for SUDs exhibits characteristics of low-dose effectiveness and plateaus in its effects. The optimal total intervention dose is best sustained at 180 METs-min/week, which is equivalent to three 60-minute sessions of moderate-intensity aerobic exercise each week.

Not applicable.

CRD420251004497.

The online version contains supplementary material available at 10.1186/s13722-025-00639-x.

Exercise positively influences drug cravings in individuals with substance use disorders, but this effect is not linear. There exists a non-linear dose-response relationship, which suggests that there may be a “plateau” effect regarding the benefits of exercise on cravings.

Among different types of exercise, aerobic exercise and aerobic combined with resistance exercise have a significant positive effect on craving in people with substance use disorders, and high-intensity interval exercise shows a potentially positive effect.

The best exercise modality for improving craving in people with substance use disorders is aerobic exercise, and the optimal exercise dose is 180 METs-min/week (MD = -1.46, 95% CI: -2.04 to -0.96). The recommended exercise regimen is three 60-minute sessions per week.

The online version contains supplementary material available at 10.1186/s13722-025-00639-x.