BACKGROUND: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSION: 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.