Supervised exercise as adjunctive treatment for substance use disorder: Systematic review and meta-analysis

Substance use disorder (SUD) comprises a spectrum of cognitive, behavioral, and physiological symptoms, indicating that individuals continue to use substances despite significant substance-related problems. Recent evidence suggests multiple types of exercise as adjunctive or main intervention options for SUD. The study aimed to evaluate the effectiveness of supervised exercise in improving quality of life, mental health outcomes, and substance use in individuals with SUD.

Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials. gov were systematically searched for relevant randomized controlled trials. We assessed depression, anxiety, urine drug screen (UDS) and quality of life (QoL) of participants in the included studies. The revised Cochrane risk-of-bias tool assessed the quality of the studies. Regarding meta-analysis, effect sizes reported using standardized mean difference (SMD) and risk ratio (RR), the random-effects model, and the inverse variance (IV) technique. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria were used to evaluate the certainty of the evidence.

Eight studies were included in the qualitative review, whereas 4 were included in the quantitative synthesis. Exercise interventions demonstrated superior effects compared with standard treatment in improving outcomes for individuals with SUD in terms of QoL in the subdomains of physiology (SMD = 0.94, 95% confidence interval [CI]: 0.67-1.22, P < .00001, I2 = 0%), psychology (SMD = 0.89, 95% CI: 0.62-1.16, P < .00001, I2 = 0%), and social (SMD = 0.73, 95% CI: 0.31-1.14, P < .0006, I2 = 58%). However, exercise showed a similar effect to the control in the number of patients with positive urine drug screen (risk ratio = 0.79, 95% CI: 0.56-1.12, P = .18, I2 = 0%).

Adjunctive exercise effectively improved the QoL of patients with SUD. However, it showed no effect on decreasing use. More evidence is needed to establish this as an adjunct to the initial lines of SUD interventions.