Comparative effects of different types of exercise interventions on addictive craving, negative affect, and cognitive function in substance use disorder: a substance-subgroup stratified network meta-analysis.

OBJECTIVE: Recovery in patients with substance use disorder (SUD) involves improvement across addictive craving, negative affect, and cognitive function, with differential responses across neuropharmacological subgroups. This study analyzed the effects of different exercise modalities to provide evidence for symptomatic management in SUD patients. METHODS: Seven databases (PubMed, Web of Science, Cochrane Library, EBSCO, Scopus, Google Scholar, and CNKI) were systematically searched. Risk of bias was assessed using the Cochrane RoB 2 tool, and a frequentist consistency model was fitted in Stata 19. The standardized mean difference (SMD) with 95% confidence interval (CI) served as the effect size; the surface under the cumulative ranking curve (SUCRA) quantified relative efficacy. RESULTS: Forty-four RCTs (57 independent comparisons, 3,198 patients) were included. For addictive craving, multicomponent exercise (ME; SUCRA = 0.882) and aerobic exercise (AE; SUCRA = 0.749) ranked highest and were statistically significant versus control (CON). For negative affect, AE (SUCRA = 0.880) and ME (SUCRA = 0.697) ranked highest with statistical significance. For cognitive function, AE ranked highest (SUCRA = 0.770), though no intervention reached significance versus CON. Subgroup analysis showed ME, mind-body exercise (MBE), and AE ranked high and were significant for craving in stimulant use disorder (StUD); AE ranked high and was significant in non-stimulant use disorder (Non-StUD). CONCLUSION: Exercise effects in SUD patients are outcome-specific and substance subtype-dependent. ME and AE showed clear benefits for addictive craving; AE and ME positively affected negative affect; AE demonstrated a stable effect on cognitive function. ME, MBE, and AE may be more effective for craving in StUD, whereas AE and resistance exercise (RSE) may be preferable in Non-StUD. These findings may inform symptom-targeted and stratified exercise-based rehabilitation for SUD patients. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420261388220.